Trends and Disparities in Poststroke Depression Within 1 Year of Ischemic Stroke

One of the most frequent neuropsychiatric complications after a stroke is poststroke depression (PSD). However, it is unclear whether disparities exist in PSD diagnosis. The authors examined a 10-year trend in PSD by socioeconomic and clinical characteristics.

A retrospective cohort study of acute ischemic stroke (AIS) patients admitted to a stroke network in 2014-2023 was performed. PSD was defined as newly diagnosed major depression or initiation of antidepressant medication up to 1 year poststroke. Trend, bivariate, and multivariable logistic regression analyses of patient sociodemographic and clinical characteristics and discharge stroke outcomes were conducted.

Of 23,514 AIS patients, 15.0% (N=3,534) met the criteria for PSD. Women and non-Hispanic Whites were diagnosed as having PSD at a higher proportion than were men and non-White patients, respectively. Higher odds of PSD were associated with female sex (OR=1.32, 95% CI=1.22-1.43), ages 18-49 years (OR=1.30, 95% CI=1.08-1.56) and 50-79 years (OR=1.26, 95% CI=1.15-1.38), National Institutes of Health Stroke Scale score of 6-15 at hospital admission (OR=1.23, 95% CI=1.10-1.37), and modified Rankin Scale score of 2-3 at hospital discharge (OR=1.32, 95% CI=1.19-1.46) and 4-5 (OR=1.38, 95% CI=1.24-1.53).

Women, non-Hispanic White patients, and middle-aged patients and patients with moderate stroke severity on initial examination and poor functional outcomes at discharge were more likely to have a PSD diagnosis. Long-term depression screening is a pressing need among stroke patients, especially among racial-ethnic minority populations that may be underdiagnosed or undertreated for PSD.