PT  - JOURNAL ARTICLE
AU  - Holly Elser
AU  - Michelle Caunca
AU  - David H Rehkopf
AU  - Wells Andres
AU  - Rebecca F Gottesman
AU  - Scott E Kasner
AU  - Kristine Yaffe
AU  - Andrea L C Schneider
TI  - Trends and inequities in the diagnosis and treatment of poststroke depression: a retrospective cohort study of privately insured patients in the USA, 2003–2020
AID  - 10.1136/jnnp-2022-330179
DP  - 2022 Nov 17
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - jnnp-2022-330179
4099  - http://jnnp.bmj.com/content/early/2022/11/17/jnnp-2022-330179.short
4100  - http://jnnp.bmj.com/content/early/2022/11/17/jnnp-2022-330179.full
AB  - Background Depression is a common neuropsychiatric consequence of stroke, but there is little empiric evidence regarding clinical diagnosis and management of poststroke depression.Methods Retrospective cohort study among 831 471 privately insured patients with first stroke in the USA from 2003 to 2020. We identified diagnoses of poststroke depression using codes from the International Classification of Diseases. We identified treatment based on prescriptions for antidepressants. We used Cox proportional hazards regression analysis to examine rates of poststroke depression diagnosis by gender, age and race/ethnicity. Among individuals who received a diagnosis of poststroke depression, we estimated treatment rates by gender, race/ethnicity and age using negative binomial regression analysis.Results Annual diagnosis and treatment rates for poststroke depression increased from 2003 to 2020 (both p for trend<0.001). Diagnosis rates were higher in women than men (HR 1.53, 95% CI 1.51 to 1.55), lower among members of racial/ethnic minorities (vs white patients: Asian HR 0.63, 95% CI 0.60 to 0.66; Black HR 0.76, 95% CI 0.74 to 0.78; Hispanic HR 0.88, 95% CI 0.86 to 0.90) and varied by age. Among individuals diagnosed with poststroke depression, 69.8% were prescribed an antidepressant. Rates of treatment were higher in women vs men (rate ratio, RR=1.19, 95% CI: 1.17 to 1.21), lower among members of racial/ethnic minorities (vs white patients: Asian RR 0.85, 95% CI 0.80 to 0.90; Black RR 0.92, 95% CI 0.89 to 0.94; Hispanic RR 0.96, 95% CI 0.93 to 0.99) and higher among older patients.Conclusions In this insured population, we identify potential inequities in clinical management of poststroke depression by gender, race/ethnicity and age that may reflect barriers other than access to healthcare.Data may be obtained from a third party and are not publicly available.