Factors associated with antidepressant use following hospitalization for acute stroke

Abstract

Objective

Depression is the most common mental health complication after stroke, leading to poor post-stroke outcomes. Few observational studies have reported factors associated with antidepressant use in these patients. Therefore, this study assessed patient and clinical characteristics associated with receiving antidepressant prescriptions at discharge following hospital admission for acute stroke.

Methods

Identified were patients admitted with acute stroke or transient ischemic attack from an institutional stroke registry (October 1, 2019, through October 31, 2020). Electronic health record review was used to assess antidepressant prescription at discharge and predictors such as demographics, health behaviors, clinical comorbidities, and stroke prognostic characteristics.

Results

Out of 803 patients with stroke, 220 (27.4%) received an antidepressant prescription at discharge, including 82 (12.8%) patients who were started on antidepressants at discharge. A multivariable model indicated that sex (female vs. male OR = 1.53; 95% CI = 1.09-2.16), race (Black vs. White: OR = 0.67; 95% CI = 0.47-0.96), number of clinical comorbidities (OR = 1.16; 95% CI = 1.03-1.32), history of depression (OR = 4.91; 95% CI = 2.59-9.31), and discharge disposition (to inpatient rehabilitation facility vs. home: OR = 1.52; 95% CI = 1.01-2.30) were significantly associated with receipt of antidepressant prescriptions among all users. Discharge disposition (to an inpatient rehabilitation facility) was the only variable associated with initiating an antidepressant prescription at discharge (OR = 2.92; 95% CI = 1.62-5.28).

Conclusion

Antidepressant prescriptions for poststroke patients were more frequent among females, White adults, and those discharged to an inpatient rehabilitation facility. These findings describing antidepressant prescription patterns underscore the need for specific guidelines aiding antidepressant use after stroke.