title: Depression and other mental health diagnoses after stroke increase inpatient and outpatient medical utilization three years poststroke.
abstract: OBJECTIVE
  Poststroke depression (PSD) has been linked to negative outcomes, including mortality and decreased functioning. However, the effect of PSD and other mental health conditions on inpatient and outpatient healthcare utilization after stroke has not been examined. The primary objective of this study was to evaluate the relationship between PSD and healthcare utilization after stroke. The secondary objective was to evaluate the relationship between other mental health diagnoses and medical utilization after stroke.
  
  
  METHODS
  We examined 3 years of poststroke healthcare utilization data in a national cohort of veterans with ischemic stroke. Mental health diagnoses were identified with inpatient International Classification of Diseases, 9th Revision codes. Multivariate analysis of variance was used to compare patient characteristics and multivariate linear regression to model utilization in: 1) patients with PSD, 2) patients diagnosed with other mental health conditions poststroke, and 3) patients with no mental health diagnosis.
  
  
  RESULTS
  Of 51,119 veterans identified, 2405 (5%) received a PSD diagnosis and 2257 (4%) received a diagnosis of another mental health condition after their stroke. Patients with PSD had significantly more inpatient hospitalization days and outpatient visits than those without any mental health diagnosis, even after adjusting for the number of mental health clinic visits. Likewise, patients diagnosed with other mental health diagnoses had greater medical utilization than patients without any mental health diagnosis. Both PSD and other mental health diagnoses independently predicted medical utilization.
  
  
  CONCLUSIONS
  Mental health diagnosis after stroke increases inpatient and outpatient healthcare utilization in the first 3 years poststroke. Additional biologic and psychosocial factors should be investigated.
authors.affiliation: Mental Health Services Consulting, Appleton, WI, USA.
authors.forename: Sushmita Shoma
authors.initials: SS
authors.lastname: Ghose
authors.forename: Linda S
authors.initials: LS
authors.lastname: Williams
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Swindle
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000209:etiology / Q000523:psychology; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D008297:Male; D001523:Mental Disorders / Q000209:etiology* / Q000523:psychology*; D010045:Outpatients; D011379:Prognosis; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D019966:Substance-Related Disorders / Q000209:etiology / Q000523:psychology; D014481:United States; D014493:United States Department of Veterans Affairs