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Depression Characterization and Race Among Stroke Survivors Receiving Inpatient Rehabilitation

Pugh, Terrence, MD; Hirsch, Mark A., PhD; Nguyen, Vu Q. C., MD; Rhoads, Charles F. 3rd, MD; Harris, Gabrielle M., FNP, RN; Yang, Qing, PhD; Thomas, J. George, MD; Guerrier, Tami, BS; Hamm, Deanna, BS; Pereira, Carol, BS; Yao, Jia, MA; Bettger, Janet A. Prvu, ScD

American Journal of Physical Medicine & Rehabilitation: April 2019 - Volume 98 - Issue 4 - p 325–330
doi: 10.1097/PHM.0000000000001037
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Race and ethnicity play a significant role in poststroke outcomes. This brief report describes the presence of depression among stroke survivors who received inpatient rehabilitation and whether depression differs by race. Data from eRehabData and electronic medical records were analyzed for patients who received rehabilitation after an acute ischemic or hemorrhagic stroke. Of 1501 stroke patients, 61.3% were white, 33.9% were African American, and 4.8% were of other race/ethnic backgrounds. By retrospective clinical review, depression was documented for 29.7% of stroke patients. Premorbid versus new onset of poststroke depression was documented for 13.4% and 21.6% of whites, 7.5% and 11.5% of African American, and 0% and 16.7% of patients of other race/ethnic groups. Compared with whites, African American and people of other races had a lower odds of poststroke depression (African American adjusted odds ratio = 0.52, 95% confidence interval = 0.41–0.68; other races odds ratio = 0.37, 95% confidence interval = 0.19–0.71), after adjusting for all other significant risk factors identified in the bivariate analysis (sex, hyperlipidemia, cognitive deficit, neglect). Depression was documented for one in three stroke survivors who received inpatient rehabilitation and highest among whites especially for prestroke depression. Addressing depression in rehabilitation care needs to consider individual patient characteristics and prestroke health status.

From the Carolinas Medical Center, Department of Physical Medicine and Rehabilitation, Charlotte, North Carolina (TP, MAH, VQCN, CFR, JGT, TG, DH); William Jennings Bryan Dorn Veterans Administration Medical Center, Department of Physical Medicine and Rehabilitation, Columbia, South Carolina (CFR); Duke University School of Nursing, Durham, North Carolina (GMH, QY, JY, JAPB); Duke University, Duke Clinical Research Institute, Durham, North Carolina (CP, JAPB); Duke University, Center for Health Policy and Inequalities Research, Durham, North Carolina (JY); and Duke University, Department of Orthopaedic Surgery, Durham, North Carolina (JAPB).

All correspondence should be addressed to: Janet A. Prvu Bettger, ScD, FAHA, DUMC 2919, 40 Medicine Circle, Durham, NC 27710.

This study was supported in part by NIH NR25GM102739, NIH/NINR P30NR014139, and institutional grants from Duke University School of Nursing and Cannon Research Center Carolinas Medical Center.

Preliminary findings for this study were presented by GMH at the International Stroke Conference on February 12, 2015, in Nashville, Tennessee. The presentation was entitled: “Depression differs by race among stroke survivors receiving inpatient rehabilitation” and the abstract was published as Harris GM, Thomas JG, Nguyen V, Hirsch MA, Guerrier T, Hamm D, Pereira C, Bettger JP. Depression differs by race among stroke survivors receiving inpatient rehabilitation. Stroke 2015;46(suppl 1):ATP129-ATP129.

Gabrielle M. Harris is in training.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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