Prescription and predictors of post-stroke antidepressant treatment: A population-based study

Mortensen, Jens Tølbøll; Andersen, Grethe

doi:10.1111/ane.12947

Cited by 15 publications

(16 citation statements)

References 21 publications

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“…Similarly, in a recent study on 5070 consecutive first-ever ischemic stroke patients with a mean age of over 70 years [20], almost half of the previously untreated patients started antidepressant medication shortly after IS, the cumulative incidence of antidepressant treatment over 6 months post-stroke was 35%, and the most commonly prescribed antidepressants were SSRIs. Furthermore, in that study [20], increasing stroke severity was associated with a higher likelihood of newly prescribed antidepressant after stroke. Association between stroke severity and initiating PSAD was also found in young individuals in our study.…”

Section: Discussionmentioning

confidence: 86%

Initiation of antidepressants in young adults after ischemic stroke: a registry-based follow-up study

et al. 2021

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Objective Data on post-stroke use of antidepressants in young individuals are scarce. We examined pattern and factors associated with initiating post-stroke antidepressants (PSAD) after ischemic stroke (IS) in young adults. Methods Helsinki Young Stroke Registry includes patients aged 15–49 years with first-ever IS, 1994–2007. Data on prescriptions, hospitalizations and death came from nationwide registers. We defined time of initiating PSAD as time of the first filled prescription for antidepressants within 1 year from IS. We assessed factors associated with initiating PSAD with multivariable Cox regression models, allowing for time-varying effects when appropriate. Results We followed 888 patients, of which 206 (23.2%) initiated PSAD. Higher hazard of starting PSAD within the first 100 days appeared among patients with mild versus no limb paresis 2.53 (95% confidence interval 1.48–4.31) and during later follow-up among those with silent infarcts (2.04; 1.27–3.28), prior use of antidepressants (2.09; 1.26–3.46) and moderate versus mild stroke (2.06; 1.18–3.58). The relative difference in the hazard rate for moderate–severe limb paresis persisted both within the first 100 days (3.84, 2.12–6.97) and during later follow-up (4.54; 2.51–8.23). The hazard rate was higher throughout the follow-up among smokers (1.48; 1.11–1.97) as well as lower (1.78; 1.25–2.54) and upper white-collar workers (2.00; 1.24–3.23) compared to blue-collar workers. Conclusion One-fourth of young adults started PSADs within 1 year from IS. We identified several specific clinical characteristics associated with PSAD initiation, highlighting their utility in assessing the risk of post-stroke depression during follow-up.

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Section: Discussionmentioning

confidence: 86%

Initiation of antidepressants in young adults after ischemic stroke: a registry-based follow-up study

et al. 2021

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“…While this finding seems self-evident, no other study investigating the determinants of ADM use after stroke considered information about depression. 13,[36][37][38][39] Only 1 study explored if the application of a depression screening determined ADM use and found no association, with the restriction of only 6 out of 123 people with stroke being screened. 40 Furthermore, history of depression and previous use of ADM were predictors of current use, reflecting the "feedback loop" of past health status and health service use on future use, as formulated by Andersen's model.…”

Section: Antidepressant Medication (Adm)mentioning

confidence: 99%

“…These factors and outcomes have been rarely considered in previous studies, presumably because they are not easily accessible in register-based research. 8,13,36,38,45 Future studies should consider the indication and adequacy of treatment, the dynamic nature of unmet need, the differentiation between health status and need as well as self-perceived and professionally evaluated need. 14,49 The replication of these findings is necessary to elaborate on the time-dependency of age and self-efficacy in predicting service use and in order to inform public health strategies adequately.…”

Section: Study Limitationsmentioning

confidence: 99%

Determinants of Antidepressant Treatment and Outpatient Rehabilitation Within the First Year After Stroke

Ladwig

Werheid

2020

J Geriatr Psychiatry Neurol

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This study aims to identify individual determinants of antidepressant treatment and outpatient rehabilitation after stroke. People with ischemic stroke ( N = 303) recruited at 2 inpatient rehabilitation clinics were included into a prospective longitudinal study with follow-up telephone interviews 6 and 12 months later. Participants reported on their use of antidepressant medication and psychotherapy as well as physical, occupational, speech, and neuropsychological therapy. The use of antidepressants at discharge ( n = 65, 23.8%) was predicted by the severity of depressive symptoms, severity of stroke, history of depression, and use of antidepressants at admission (all p < .05, R 2= .55). The number of outpatient rehabilitation services used at follow-ups was predicted by higher functional and cognitive impairment, higher education, younger age, severity of depressive symptoms, and lower self-efficacy (all p < .05; R 2 6M = .24, R 2 12M = .49). The relevance of identified determinants for the improvement of treatment rates after stroke is discussed.

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“…Administrative registries that routinely collect data at a population level can be useful resources for studies of temporal trends in cerebrovascular disorders, [1][2][3][4][5] and in observational research focusing on the cause, treatment, and course of stroke. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Large clinical databases or medical registers anchored in well-defined populations can furthermore be a particularly attractive solution to the challenge of acquiring valid data over extended time-periods for relatively rare disorders such as intracerebral hemorrhage (ICH). 10,[21][22][23][24][25][26][27][28][29] However, to be useful data sources for epidemiologic research, registers must first provide data of sufficiently high quality.…”

Section: Introductionmentioning

confidence: 99%

<p>The Validity of Intracerebral Hemorrhage Diagnoses in the Danish Patient Registry and the Danish Stroke Registry</p>

Hald¹,

Sloth²,

Agger³

et al. 2020

CLEP

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Purpose: To establish the validity of intracerebral hemorrhage (ICH) diagnoses in the Danish Stroke Registry (DSR) and the Danish National Patient Registry (DNPR). Patients and Methods: Based on discharge summaries and brain imaging reports, we estimated the positive predictive value (PPV) of a first-ever diagnosis code for ICH (ICD-10, code I61) for all patients in the Region of Southern Denmark (1.2 million) during 2009-2017 according to either DNPR or DSR. We estimated PPVs for any non-traumatic ICH (a-ICH) and spontaneous ICH (s-ICH) alone (ie, without underlying structural cause). We also calculated the sensitivity of these diagnoses in each of the registers. Finally, we classified the location of verified s-ICH. Results: A total of 3,956 patients with ICH diagnosis codes were studied (DSR only: 87; DNPR only: 1,513; both registries: 2,356). In the DSR, the PPVs were 86.5% (95% CI=85.1-87.8) for a-ICH and 81.8% (95% CI=80.2-83.3) for s-ICH. The PPVs in DNPR (discharge code, primary diagnostic position) were 76.2% (95% CI=74.7-77.6) for a-ICH and 70.2% (95% CI=68.6-71.8) for s-ICH. Sensitivity for a-ICH and s-ICH was 76.4% (95% CI=74.8-78.0) and 78.7% (95% CI=77.1-80.2) in DSR, and 87.3% (95% CI=86.0-88.5) and 87.7% (95% CI=86.3-88.9) in DNPR. The location of verified s-ICH was lobar (39%), deep (33.6%), infratentorial (13.2%), large unclassifiable (11%), isolated intraventricular (1.9%), or unclassifiable due to insufficient information (1.3%). Conclusion: The validity of a-ICH diagnoses is high in both registries. For s-ICH, PPV was higher in DSR, while sensitivity was higher in DNPR. The location of s-ICH was similar to distributions seen in other populations.

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Prescription and predictors of post-stroke antidepressant treatment: A population-based study

Abstract: Antidepressant treatment in this real-life clinical setting was common and initiated early, in almost half the treated patients within 14 days. Our results suggest that special focus should be given to the severe strokes as they may have a greater risk of requiring treatment.

Cited by 15 publications

References 21 publications

Initiation of antidepressants in young adults after ischemic stroke: a registry-based follow-up study

Initiation of antidepressants in young adults after ischemic stroke: a registry-based follow-up study

Determinants of Antidepressant Treatment and Outpatient Rehabilitation Within the First Year After Stroke

<p>The Validity of Intracerebral Hemorrhage Diagnoses in the Danish Patient Registry and the Danish Stroke Registry</p>

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