Racial and ethnic disparities in post-stroke depression detection.
OBJECTIVE
Post-stroke depression (PSD) is common among stroke survivors and is associated with increased morbidity and mortality. Little is understood about racial/ethnic differences in PSD detection. This study assessed the racial/ethnic disparities in PSD detection in a national cohort of Department of Veterans Affairs (VA) acute stroke patients.


METHODS
The study included VA patients who: received inpatient care for acute stroke within 2001; survived >60 days post-index hospitalization; had an index stay <365 days; and were confirmed VA healthcare enrollees. PSD was established if a patient had a depression diagnosis in VA or Medicare inpatient or outpatient files, or was dispensed an antidepressant with guideline recommended minimum daily dosage during the 12 months post stroke. A multivariate logistic regression model was fitted to estimate the effects of race/ethnicity on PSD detection, adjusting for sociodemographic and clinical factors.


RESULTS
The study cohort (N = 5825) was comprised of 66% white, 22% black, 7% Hispanic, and 6% for all other racial/ethnic categories. Among these stroke patients, 39% had PSD. Black and 'all other' racial/ethnic categories were significantly less likely to be diagnosed with PSD than non-Hispanic whites, even adjusting for potential risk factors.


CONCLUSIONS
White, non-Hispanic VA acute stroke patients were more likely to be diagnosed with PSD, even controlling for sociodemographic and clinical characteristics. Whether these findings suggest racial/ethnic differences in symptom endorsement by patients or in symptom recognition by providers is not clear.
Jia
Huanguang
H
Department of Veterans Affairs (VA) Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.
Chumbler
Neale R
NR
Wang
Xinping
X
Chuang
Ho-Chih
HC
Damush
Teresa M
TM
Cameon
Randi
R
Williams
Linda S
LS
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D044466:Asian People / Q000706:statistics & numerical data*; D044383:Black People / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D020521:Stroke / Q000523:psychology*; D014728:Veterans / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data*
D000928:Antidepressive Agents