Prevalence, patterns and predictors of depression treatment among community-dwelling older adults with stroke in the United States: a cross sectional study

Abstract

BackgroundDepression is one of the most common psychiatric conditions among stroke survivors and is associated with several negative health outcomes. However, little is known about the depression treatment patterns among stroke survivors. The objective of this study was to examine national-level prevalence, patterns and predictors of depression treatment among community-dwelling stroke survivors.MethodsThis study adopted a retrospective, cross-sectional study design using multiple years of Medical Expenditure Panel Survey (MEPS) (2002–2012) data. The study population consisted of older adults (age ≥ 50 years) who (i) were stroke survivors (ICD-9-CM codes of 430–438), (ii) did not die during the calendar year, and (iii) had co-occurring depression (ICD-9-CM code of 296.xx, or 311.xx). Depression treatment, identified by antidepressant medication and/or psychotherapy use, was the dependent variable of this study. Multinomial logistic regression analysis was conducted to examine the association of individual level factors with depression treatment among stroke survivors with co-occurring depression.ResultsThe final study sample consisted 370 (unweighted) community-dwelling older adults with self-reported stroke and depression. The prevalence of co-occurring depression among stroke survivors was 22.03% [95% Confidence Interval (CI) 19.7–24.4%]. An overwhelming majority (87.6%) of stroke survivors with co-occurring depression reported some form of depression treatment. Antidepressants only and combination therapy was reported by 74.8% (95% CI, 71.6–78.0%] and 12.8% (95% CI, 10.5–15.1%) by stroke survivors with co-occurring depression respectively. Approximately, 61% of stroke survivors with co-occurring depression reported using SSRIs, followed by SNRIs (15.2%), miscellaneous antidepressants (12.1%), TCAs (9.8%), phenylpiperazine antidepressants (5.2%), and tetracyclic antidepressants (4%). Sertraline (15.8, 95% CI, 12.7–19.0%) had the highest reported use among individual antidepressants.ConclusionsVast majority (nearly 90%) of the study sample received some form of depression treatment and several individual level factors (such as age, education) were associated with the report of depression treatment use. Future longitudinal studies are warranted to assess the comparative treatment benefits of antidepressants, psychotherapy and their combination. Healthcare providers should carefully assess the risks and benefits of antidepressant (such as SSRIs or TCAs) use in this vulnerable population prior to their use.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1723-x) contains supplementary material, which is available to authorized users.

Antidepressants and health-related quality of life (HRQoL) for patients with depression: Analysis of the medical expenditure panel survey from the United States

“…The ICD-9 codes that were used to identify depression is not limited to depression per say, it rather includes all patients with mood disorders. However, these codes were confirmed to provide good estimate for patients with depression as at least 90% of these patients with mood disorder are essentially diagnosed with depression [ 26 ]. The study used the MEPS longitudinal data files which follow included subjects for two years but patients that were diagnosed with depression at the end of the first year, or later, were not included to allow for the comparison between baseline and follow-up variables for HRQoL.…”

“…The subset of patients with depression from the 11 medical condition files were then merged with the associated prescribed medicines data files from 2005–2015 to identify depression patients who utilized any antidepressant medication during the follow-up. The Multum drug database was used to identify antidepressant medications and the TC1 code of 242 and TC1S1 code of 249 were used to identify the use of any antidepressant medications in the prescribed medicines data files [ 26 ]. Consecutively, patients with depression disorder were separated into two groups based on the use of any antidepressant medications.…”

Robotic Table and Serious Games for Integrative Rehabilitation in the Early Poststroke Phase: Two Case Reports

“…The impaired UE limited reach was mapped to the full extent of VR scenes. Presenting fully functional avatars was aimed at making the games winnable to reduce depression [ 26 ]. Only a fraction of the maximal finger-extension range and maximal grasping force were used to control the game.…”

Novel integrative rehabilitation system for the upper extremity: Design and usability evaluation

“…As a consequence, the gains between physical movement and the corresponding avatar movement were dissimilar for the two UEs. Showing scenes with fully functional arms was also aimed at giving the patient a feeling of being in control and improving wellbeing (reducing depression typically seen in those with severe impairments 23 ).…”