Abstract Details

Depression is common after stroke and has previously been linked with impaired cognition and function, increased suicidality and mortality. To date, systematic evidence regarding trends in diagnosis of post-stroke depression remains limited.

To characterize trends in the diagnosis of depression after stroke by gender and race/ethnicity from 2003-2019 in a cohort of privately insured individuals.

The Optum Clinformatics Data Mart Database is a large, de-identified commercial and Medicare Advantage claims database with follow-up from 2003–2019. We calculated rates of post-stroke depression in the year following stroke as the number of depression diagnoses per 1,000 person-years of follow-up. We used Cox proportional hazard models adjusted for gender, age, race/ethnicity, region, and calendar year to examine individual-level determinants of depression diagnosis among individuals with stroke.

We identified 831,486 with acute ischemic stroke (AIS), intraparenchymal hemorrhage (IPH), or subarachnoid hemorrhage (SAH). Approximately two-thirds were 65 years of age or older (67.8%) and 73.6% were white. Over the 16-year study period, the overall rate of post-stroke depression was highest for IPH (15.2; 95% CI: 14.8–15.5) and lowest for AIS (11.4; 95% CI: 11.3–11.5) one-year post-stroke with an increase in annual rates from 8.2 (95% CI: 7.9–8.5) in 2003 to 11.9 (95% CI: 11.7–12.1) in 2019. In adjusted Cox models, women were more likely to be diagnosed with post-stroke depression than men (HR: 1.56, 95% CI: 1.54–1.58) and post-stroke depression was diagnosed less frequently in patients who were Asian (HR: 0.60, 95% CI: 0.58–0.62), Black (HR: 0.78, 95% CI: 0.76–0.79), or Hispanic (HR: 0.89, 95% CI: 0.88–0.91) as compared with white patients.

Rates of post-stroke depression diagnosis increased over the study period, differed by stroke type, and differed significantly by individual characteristics such as race and gender.