Preexisting Depression and Ambulatory Status After Stroke: Florida–Puerto Rico Collaboration to Reduce Stroke Disparities
Publication: The Journal of Neuropsychiatry and Clinical Neurosciences
Abstract
Objective:
Stroke is a global public health burden, and therefore it is critical to identify modifiable risk factors to reduce stroke incidence and improve outcomes. Depression is such a risk factor; however, the association between preexisting depression and stroke outcomes, such as independent ambulation, is not well studied, especially among racial-ethnic minority groups. To address this gap in the literature, effects of preexisting depression on ambulatory status at hospital discharge after stroke were evaluated among individuals participating in the racially and ethnically diverse Florida–Puerto Rico Collaboration to Reduce Stroke Disparities project.
Methods:
Data were analyzed from a total of 42,031 ischemic stroke patients, who were independently ambulatory prior to their stroke, after discharge from 84 hospitals between 2014 and 2017. Preexisting depression was confirmed by medical history or antidepressant medication use. Multilevel multivariate logistic regression analyses were used to assess the association of preexisting depression with independent ambulation at hospital discharge. Effects of sex and race-ethnicity on this association were examined.
Results:
Of 42,031 participants (mean±SD age=70.4±14.2 years; 48% were female; race-ethnicity: 16% Black, 12% Hispanic living in Florida, and 7% Hispanic living in Puerto Rico), 6,379 (15%) had preexisting depression. Compared with participants without depression, those with preexisting depression were older, were more likely to be female and non-Hispanic White, and had a greater burden of vascular risk factors or comorbid conditions. Independent ambulation at hospital discharge was less frequent among women, Black participants, and individuals with vascular risk factors or comorbid conditions. In multivariate models, preexisting depression decreased the likelihood of independent ambulation at discharge (odds ratio=0.88, 95% CI=0.81, 0.97). No interactions were found between preexisting depression and race-ethnicity or sex.
Conclusions:
Preexisting depression was independently associated with dependent ambulation at hospital discharge after stroke, regardless of sex and race-ethnicity. Treating depression may contribute to primary stroke prevention and could improve ambulatory status at discharge.
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History
Received: 6 December 2022
Revision received: 24 February 2023
Accepted: 1 March 2023
Published online: 8 May 2023
Published in print: Fall 2023
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Competing Interests
Dr. Starosciak has served as a consultant to Viz.ai. Dr. Gutierrez has received research salary support from the Florida Department of Health. Dr. Rose has received honoraria for serving as a consultant for or on the speaker’s bureau of Boston Scientific, Chiesi USA, CSL Behring, and Medtronic. The other authors report no financial relationships with commercial interests.
Funding Information
Supported by the National Institute of Neurological Disorders and Stroke (grant U54-NS081763 to Drs. Sacco, Romano, and Rundek to establish the Florida–Puerto Rico Collaboration to Reduce Stroke Disparities); the Florida Department of Health for the ongoing Florida Stroke Registry (Dr. Sacco); NIH (grants R01-NS029993 and R01-NS040807 to Drs. Sacco and Rundek; grants U24-NS107267 and R01-MD012467 to Drs. Romano, Sacco, and Rundek; grant U19-AG056169 to Dr. Rundek; and grant R01-NS084288 to Dr. Romano); the National Center for Advancing Translational Sciences (grant UL1-TR002736 to Drs. Alkhachroum, Sacco, and Rundek and grant KL2-TR002737 to Drs. Sacco and Rundek); an institutional KL2 Career Development Award from the Miami Clinical and Translational Science Institute and the National Institute of Neurological Disorders and Stroke (grants K23-NS126577 and R21-NS128326) to Dr. Alkhachroum; and the Florida Stroke Registry (COHAN-A1 R2 contract) to Dr. Asdaghi.
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