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May 31, 2022; 98 (22) Research Article

Trends in Outpatient Treatment for Depression in Survivors of Stroke in the United States, 2004–2017

Liming Dong, Briana Mezuk, Linda S. Williams, Lynda D. Lisabeth
First published April 4, 2022, DOI: https://doi.org/10.1212/WNL.0000000000200286
Liming Dong
From the Department of Epidemiology (L.D., B.M., L.D.L.), University of Michigan School of Public Health, Ann Arbor; School of Population Medicine and Public Health (L.D.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Health Services Research and Development Center for Health Information and Communication (L.S.W.), Roudebush VA Medical Center; Department of Neurology (L.S.W.), Indiana University School of Medicine; and Regenstrief Institute, Inc. (L.S.W.), Indianapolis, IN.
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Briana Mezuk
From the Department of Epidemiology (L.D., B.M., L.D.L.), University of Michigan School of Public Health, Ann Arbor; School of Population Medicine and Public Health (L.D.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Health Services Research and Development Center for Health Information and Communication (L.S.W.), Roudebush VA Medical Center; Department of Neurology (L.S.W.), Indiana University School of Medicine; and Regenstrief Institute, Inc. (L.S.W.), Indianapolis, IN.
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Linda S. Williams
From the Department of Epidemiology (L.D., B.M., L.D.L.), University of Michigan School of Public Health, Ann Arbor; School of Population Medicine and Public Health (L.D.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Health Services Research and Development Center for Health Information and Communication (L.S.W.), Roudebush VA Medical Center; Department of Neurology (L.S.W.), Indiana University School of Medicine; and Regenstrief Institute, Inc. (L.S.W.), Indianapolis, IN.
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Lynda D. Lisabeth
From the Department of Epidemiology (L.D., B.M., L.D.L.), University of Michigan School of Public Health, Ann Arbor; School of Population Medicine and Public Health (L.D.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Health Services Research and Development Center for Health Information and Communication (L.S.W.), Roudebush VA Medical Center; Department of Neurology (L.S.W.), Indiana University School of Medicine; and Regenstrief Institute, Inc. (L.S.W.), Indianapolis, IN.
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Trends in Outpatient Treatment for Depression in Survivors of Stroke in the United States, 2004–2017
Liming Dong, Briana Mezuk, Linda S. Williams, Lynda D. Lisabeth
Neurology May 2022, 98 (22) e2258-e2267; DOI: 10.1212/WNL.0000000000200286

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Abstract

Background and Objectives Depression is highly prevalent and persistent among survivors of stroke. It is unknown how treatment for depression among survivors of stroke has changed in the evolving context of stroke care and mental health care in the general US population, especially among vulnerable sociodemographic subgroups who bear higher risks for stroke and unfavorable poststroke outcomes and experience disparities in access to and quality of stroke and mental health care. The study examined temporal trends in outpatient treatment for depression among survivors of stroke in the United States between 2004 and 2017.

Methods The study sample consisted of 10,243 adult survivors of stroke and 264,645 adults without stroke drawn from the Medical Expenditure Panel Survey, a nationally representative survey in the United States. Trends in outpatient treatment for depression and potential unmet needs in the stroke population, including variations across sociodemographic subgroups, were examined and compared with the nonstroke population.

Results The rate of receipt of outpatient treatment for depression among survivors of stroke was 17.7% in 2004–2005 and 16.0% in 2016–2017 (adjusted odds ratio for period change [aOR] 0.90, 95% CI 0.71–1.15). Older, male, non-Hispanic Black, and Hispanic survivors of stroke were less likely to receive treatment for depression. Approximately two-thirds of survivors of stroke who screened positive for depression received no outpatient treatment during a calendar year. The sociodemographic disparities and treatment gap persisted during the study period, which differed from the nonstroke population. Among survivors of stroke who received any treatment for depression, there was a remarkable increase in use of psychotherapy (aOR 2.26, 95% CI 1.28–4.01), despite its less frequent use compared with pharmacotherapy.

Discussion Although depression is common after stroke, the majority of survivors of stroke receive no treatment for depression. This gap has remained largely unchanged over past decades, with substantial sociodemographic differences. Efforts are needed to improve depression care for survivors of stroke and reduce disparities.

Glossary

aIRR=
adjusted incidence rate ratio;
aOR=
adjusted odds ratio;
ICD=
International Classification of Diseases;
MEPS=
Medical Expenditure Panel Survey;
MEPS-HC=
Medical Expenditure Panel Survey–household component;
OR=
odds ratio;
PHQ-2=
2-item Patient Health Questionnaire;
SAQ=
Self-Administered Questionnaires

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Submitted and externally peer reviewed. The handling editor was José Merino, MD, MPhil.

  • Received August 11, 2021.
  • Accepted in final form February 10, 2022.
  • © 2022 American Academy of Neurology
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