Receipt of Mental Health Treatment in People Living With Stroke: Associated Factors and Long-Term Outcomes

It is your doctor's responsibility to prevent depression and anxiety post stroke by having 100% recovery protocols.  If your doctors are having to treat depression and anxiety post stroke,  they are COMPLETE FUCKING FAILURES!

Receipt of Mental Health Treatment in People Living With Stroke: Associated Factors and Long-Term Outcomes

Priscilla Tjokrowijoto,

Renerus J. Stolwyk,

David Ung,

Ian Kneebone,

Monique F. Kilkenny,

Joosup Kim,

Muideen T. Olaiya,

Lachlan L. Dalli,

Dominique A. Cadilhac,

Mark R. Nelson,

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Originally published23 Mar 2023https://doi.org/10.1161/STROKEAHA.122.041355Stroke. 2023;54:1519–1527

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Abstract

Background:

Untreated poststroke mood problems may influence long-term outcomes. We aimed to investigate factors associated with receiving mental health treatment following stroke and impacts on long-term outcomes.

Methods:

Observational cohort study derived from the Australian Stroke Clinical Registry (AuSCR; Queensland and Victorian registrants: 2012–2016) linked with hospital, primary care billing and pharmaceutical dispensing claims data. Data from registrants who completed the AuSCR 3 to 6 month follow-up survey containing a question on anxiety/depression were analyzed. We assessed exposures at 6 to 18 months and outcomes at 18 to 30 months. Factors associated with receiving treatment were determined using staged multivariable multilevel logistic regression models. Cox proportional hazards regression models were used to assess the impact of treatment on outcomes.

Results:

Among 7214 eligible individuals, 39% reported anxiety/depression at 3 to 6 months following stroke. Of these, 54% received treatment (88% antidepressant medication). Notable factors associated with any mental health treatment receipt included prestroke psychological support (odds ratio [OR], 1.80 [95% CI, 1.37–2.38]) or medication (OR, 17.58 [95% CI, 15.05–20.55]), self-reported anxiety/depression (OR, 2.55 [95% CI, 2.24–2.90]), younger age (OR, 0.98 [95% CI, 0.97–0.98]), and being female (OR, 1.30 [95% CI, 1.13–1.48]). Those who required interpreter services (OR, 0.49 [95% CI, 0.25–0.95]) used a health benefits card (OR, 0.73 [95% CI, 0.59–0.92]) or had continuity of primary care visits (ie, with a consistent physician; OR, 0.78 [95% CI, 0.62–0.99]) were less likely to access mental health services. Among those who reported anxiety/depression, those who received mental health treatment had an increased risk of presenting to hospital (hazard ratio, 1.06 [95% CI, 1.01–1.11]) but no difference in survival (hazard ratio, 0.86 [95% CI, 0.58–1.27]).

Conclusions:

Nearly half of the people living with mood problems following stroke did not receive mental health treatment. We have highlighted subgroups who may benefit from targeted mood screening and factors that may improve treatment access.

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Approximately one-third of people living with stroke experience depression at some point in their recovery, while an estimated 18% to 24% experience anxiety.^1,2 The 2 conditions are comorbid and associated with caregiver burden.^3,4 Unresolved depression or anxiety may affect a range of poststroke outcomes, including recovery in activities of daily living and long-term survival.^5–7 Individuals who experience poststroke depression have been shown to have increased hospitalizations and outpatient visits relative to those without a mental health diagnosis, even after accounting for prestroke medical utilization, stroke severity, and mental health-related visits.⁸

See related article, p 1528

Pharmacotherapy is often the first-line treatment for depression after stroke but may be associated with side effects and risks especially in those with multiple comorbidities and polypharmacy.^9–11 Psychological treatment has been used to alleviate symptoms of poststroke depression or anxiety without adverse impacts.¹⁰ For depression, psychological interventions delivered in conjunction with medication seem to be more effective than either treatment alone.^12,13 Clinical guidelines for the treatment and prevention of poststroke mood problems include antidepressant medications, exercise programs, and psychological therapies.¹⁴ Despite evidence of treatment effectiveness, more than two-thirds of people living with stroke reported that their psychological needs were not fully met.^15–17 Most Australians with a neurological disorder reported at least 1 barrier to receiving mental health treatment,¹⁸ and treatment access may be complicated by physical, cognitive, and communication limitations.¹⁹ Our earlier research, one of the first to investigate this in people with stroke, identified older age, not feeling socially isolated, having no previous mental health treatment, no medical diagnosis of anxiety/depression, and no multidisciplinary team care arrangement plan as barriers.²⁰ Although this study provided novel insights, the restriction of the cohort to registry participants who completed a project-specific survey may not have been reflective of the broader population. Further investigation was warranted to confirm these results at a population level and to clarify whether receipt of mental health treatment influences long-term outcomes.

The objectives of this study were to (1) identify demographic, clinical and structural factors associated with receipt of mental health treatment following stroke or transient ischemic attack in a population cohort and (2) investigate the association between receipt of mental health treatment in the 6 to 18 months following stroke and long-term outcomes, including survival and hospital utilization.

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