Most stroke survivors receive no treatment for depression

A majority of stroke survivors received no treatment for depression, with sociodemographic differences driving the persistent treatment gap, according to a study published in Neurology.

“As a leading cause of disability, depression negatively interferes with stroke treatment, impedes stroke recovery and increases mortality risk,” Liming Dong, PhD, of the department of epidemiology at the University of Michigan School of Public Health, and colleagues wrote. “However, depression is largely undertreated in the stroke population.”

Dong and colleagues sought to examine temporal trends in outpatient treatment for depression among survivors of stroke in the United States between 2004 and 2017, particularly for underrepresented sociodemographic groups who may experience treatment gaps and disparities in quality of life.

The study included 10,243 adult survivors of stroke and 264,645 adults without stroke drawn from the Medical Expenditure Panel Survey, a nationally representative survey conducted in the U.S. Symptoms of depression were measured with the Patient Health Questionnaire-2, while sociodemographic characteristics included age (those younger than 60 years, those between 60 and 74 years old and those 75 years old and over), sex, race and ethnicity, family income, health insurance status and marital status. Researchers then examined trends in outpatient treatment for depression and potential unmet needs in the stroke population, including variations across sociodemographic subgroups, then compared them with individuals who had not had a stroke.

Results showed the rate of receipt of outpatient treatment for depression among survivors of stroke was 17.7% in 2004 to 2005 and 16% in 2016 to 2017 (adjusted OR 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.

Data additionally revealed that sociodemographic disparities and treatment gap persisted during the study period, which differed from the population without strokes. Among survivors of stroke who received any treatment for depression, there was a significant increase in use of psychotherapy (aOR 2.26, 95% CI, 1.28–4.01), despite its less frequent use compared with pharmacotherapy.

“This study shows a significant number of survivors are not getting the help and support they need after a stroke,” Linda S. Williams, MD, research scientist with Regenstrief and professor of neurology at Indiana University School of Medicine, said in a release that accompanied the study. “This rate has remained low over more than a decade, despite societal changes in attitudes toward mental health treatment.”

Reference: