Nearly half of patients with poststroke mood disorders did not receive mental health treatment. These are the findings of a study published in the journal Stroke.
Depression and anxiety affect around a third and a quarter of patients who are recovering from stroke, respectively. These symptoms can have negative impacts on recovery outcomes. As such, addressing mental health concerns can be an important component of poststroke care among many patients.
For the study, a substudy of the PRECISE project — an observational cohort study derived from a national-wide register, the Australian Stroke Clinical Registry (AuSCR) —, researchers evaluated mental health treatment in a poststroke setting. Adults (N=7214) who were admitted to 45 hospitals in Australia between 2012 and 2016 with stroke or transient ischemic attack (TIA) were evaluated for mental health care receipt in the 18 months following stroke. Self-reported anxiety or depression was based on EuroQOL, 5–dimensions, 3-level (EQ-5D-3L) responses.
These were the characteristics of patients who did (n=2675) and did not (n=4539) receive mental health treatment were:
- median age, 69.6 (IQR, 59.4-78.3) and 72.4 (IQR, 62.6-79.8) years (P <.001);
- 50% and 38% were women (P <.001);
- 65% and 66% had an ischemic stroke (P <.001);
- 51% and 55% were able to walk independently on admission (P <.001); and
- 57% and 28% had self-reported anxiety or depression (P <.001), respectively.
Among those who self-reported symptoms of anxiety or depression, 54% received any mental health treatment and 50% received pharmaceuticals poststroke. In the entire cohort, 37% received any mental health treatment poststroke compared with 28% prestroke; and 34% and 26% received pharmaceuticals, respectively.
Receipt of mental health treatment was explained by clinical factors (28%), demographic characteristics (2%), and structural factors (2%). In the full model, 23 predictors explained 32% of the variance (c2, 130.73; P <.001).
The strongest predictors for receiving mental health treatment poststroke were:
- receipt of mental health medication prestroke (adjusted odds ratio [aOR], 17.58; 95% CI, 15.05-20.55),
- self-reported anxiety or depression (aOR, 2.55; 95% CI, 2.24-2.90),
- prestroke Medicare mental health uptake (aOR, 1.80; 95% CI, 1.37-2.38), and
- female gender (aOR, 1.30; 95% CI, 1.13-1.48).
Meanwhile, patients with TIA (aOR, 0.64; 95% CI, 0.49-0.83), ischemic stroke (aOR, 0.71; 95% CI, 0.56-0.89), and the ability to walk at admission (aOR, 0.85; 95% CI, 0.74-0.97) were less likely to receive mental health care.
In a sensitivity analysis that excluded patients who had a history of mental health treatment, patients who had continuity of primary care were less likely to receive mental health treatment poststroke (OR, 0.81; 95% CI, 0.67-0.97).
Overall, receipt of mental health services did not associate with survival or health care utilization outcomes. However, patients who self-reported anxiety or depression were associated with increased hospital utilization (hazard ratio [HR], 1.06; 95% CI, 1.01-1.11).
The major limitation of this study was the use of self-reported symptoms of anxiety and depression.
The researchers concluded, “[A]pproximately 1 in 2 people living with stroke with self-reported anxiety/depression are not receiving mental health treatment, and those who do are mostly receiving medication only. Health professionals should screen for mental health problems and introduce treatment options, with particular attention to individuals who are at risk of not receiving treatment.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
This article originally appeared on Neurology Advisor
Tjokrowijoto P, Stolwyk RJ, Ung D, et al. Receipt of mental health treatment in people living with stroke: associated factors and long-term outcomes. Stroke. Published online March 23, 2023. doi:10.1161/STROKEAHA.122.041355