Post-stroke depression management in the Israeli primary care setting: a retrospective cohort study

Area of Science:

• Neurology
• Psychiatry
• Primary Care Medicine

Background:

• Post-stroke depression (PSD) is a common complication following stroke.
• Effective diagnostic and treatment strategies are crucial for patient outcomes.

Purpose of the Study:

• To characterize post-stroke depression (PSD) diagnostic and treatment patterns in an outpatient primary care setting.
• To investigate the timing, screening methods, therapeutic interventions, and associations with mortality for PSD.

Main Methods:

• Retrospective cohort study of over 11,000 patients diagnosed with new stroke between 2016-2022.
• Analysis of diagnostic criteria, time to diagnosis and treatment, screening tool utilization, and all-cause mortality.
• Inclusion of patients with subsequent depression diagnosis or antidepressant initiation post-stroke, excluding pre-existing depression.

Main Results:

• PSD occurred in 40.2% of patients, with most diagnoses (53.1%) made by primary care physicians using clinical assessment.
• Only 4.5% of patients underwent screening; 65.1% initiated antidepressants within 30 days.
• PSD patients showed higher rehabilitation participation (69.5% vs. 48.5%) and paradoxically lower mortality rates (22.1% vs. 27.9%).

Conclusions:

• Primary care physicians diagnose most PSD cases, primarily via clinical judgment, highlighting a gap in screening tool utilization.
• The majority of PSD diagnoses occur within the first year post-stroke, suggesting the need for repeated evaluations.
• Early antidepressant treatment and increased rehabilitation engagement are associated with improved mortality outcomes in PSD patients, indicating areas for management improvement.