Abstract
Background: Prestroke depression status and post–acute rehabilitation care (PARC) are determinants of poststroke depression and function. However, little is known on how prestroke depression status affects PARC placement, a possible pathway for upstream intervention. We examined how prestroke depression status affects PARC in a population-based study. Methods and Results: Incident ischemic stroke cases were from the BASIC (Brain Attack Surveillance in Corpus Christi) Project from 2008 to 2012. Prestroke depression status was self-reported and categorized as (1) never depressed, (2) history of depression without antidepressant use before stroke onset, or (3) antidepressant use before stroke onset. PARC included home, a skilled nursing facility, or an inpatient rehabilitation facility. Confounder-adjusted multinomial regression models were used to examine the association between prestroke depression status and PARC. Adjustment for stroke severity was deferred in the main analyses because it may lie on the causal pathway. There were 548 stroke survivors (mean age 65.3 years, 48.3% female, 62.6% Mexican-American). The adjusted odds ratios comparing home discharge to a skilled nursing facility were 1.88 (95% CI: 0.86-4.11) for those with a history of depression and 2.55 (95% CI: 1.11-5.83) for those using an antidepressant at stroke onset, relative to those never depressed. The adjusted odds ratios comparing an inpatient rehabilitation facility to a skilled nursing facility were 1.17 (95% CI 0.40-3.42) and 3.28 (95% CI 1.24-8.67) for those with a history of depression and those using an antidepressant at stroke onset, respectively, relative to those never depressed. Conclusions: Antidepressant use before stroke onset may increase odds of home and inpatient rehabilitation facility discharge compared with skilled nursing facility discharge.
| Original language | English (US) |
|---|---|
| Article number | e013382 |
| Journal | Journal of the American Heart Association |
| Volume | 8 |
| Issue number | 16 |
| DOIs | |
| State | Published - Aug 20 2019 |
Funding
This study was funded by National Institutes of Health Grants R01 HL098065 and R01 NS38916. This study was funded by National Institutes of Health Grants R01 HL098065 and R01 NS38916. Our analytic sample was composed of 548 stroke patients: 366 (66.8%) patients were never depressed, 87 (15.9%) had a history of depression, and 95 (17.3%) were taking antidepressants at the time of stroke. Descriptive statistics are presented in Table. Those using an antidepressant before stroke onset were more likely to be female, insured, more disabled, to have dementia, and to have more comorbidities. On average, those with a history of depression were less likely to use alcohol excessively. Those who were never depressed were more likely to be male, have normal cognition, less likely to have dementia, and more likely to be married or living with a partner. With respect to PARC, 345 patients (63.0%) went home, 77 (14.1%) went to a SNF, and 96 (17.50%) went to an IRF. On average, those with a history of depression and those taking antidepressants before their stroke had similar depression symptom severity, with mean PHQ-9 scores of 9.41 and 10.09, respectively, compared with 3.91 for those with no history of depression. Table presents the sequentially adjusted associations of prestroke depression status with the odds of discharge to home compared with SNF, relative to those never depressed.
Keywords
- antidepressant
- depression
- epidemiology
- rehabilitation
- stroke
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
