2024 American Academy of Neurology Abstract Website

Objective:

To assess risk factors for the undertreatment of Post Stroke Depression (PSD) with a focus on social determinants of health.

Background:

PSD is a widely recognized complication of stroke that impedes the recovery of CVA-associated motor and cognitive deficits and increase mortality and disability. Previous PSD studies estimate that roughly one-third of stroke survivors suffer from PSD. Despite its devastating effects, PSD remains an under-diagnosed and under-treated condition.

Design/Methods:

We collected and analyzed data from the National Health and Nutrition Examination Survey (NHANES). Survey participants’ responses between 2007-2018 were combined. Survey questions included information about history of stroke, depression score, treatment for PSD, and annual income. Depression was determined by a score of 5 or greater in the Patient Health Questionnaire-9 (PHQ9). Income was assessed by Poverty Index Ratio (PIR), which was derived by dividing survey respondents’ annual income by the national poverty threshold. The association between untreated PSD and PIR was analyzed using logistic regression with adjustments for relevant covariates.

Results:

480 NHANES survey participants with mean age 62.68±13.76 were included in our study. 78.5% of PSD participants reported that they did not receive treatment while 21.4% reported that they had. Participants who did not receive PSD treatment had 96% greater odds of having severely low PIR (<1.23) compared to those who received treatment (OR=1.96, 95% CI=1.08-3.52, p=0.003). Participants who did not receive PSD treatment had 134% greater odds of being greater than 60 years old compared to those who received treatment (OR=2.34, 95% CI=1.12-4.89, p=0.02).

Conclusions:

Our study demonstrates that adults with low PIR and older age are significantly more likely to report untreated PSD compared to those with treated PSD. These findings elucidate the importance of screening for patients in these vulnerable populations that can benefit greatly from treatment.