Racial Disparities in Mental Health Among Stroke Survivors in the REDUCE Study
Hailey Brigger1, Rachel Forman1, Emma Peasley1, Ian Johnson1, Joel Smith1, Alison Champagne1, Julia Zabinska1, Guido Falcone1, Lauren Sansing1, Rohan Arora2, Carlos Mena-Hurtado1, Munachi Okpala3, Cheryl Bushnell4, Michael Mullen5, Jordana Cohen6, Debbie Cohen6, Adam De Havenon1, Steven Messe7, Kevin Sheth1
1Department of Neurology, Yale School of Medicine, 2Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 3Department of Neurology, University of Texas Health Science Center, 4Wake Forest University School of Medicine, 5Department of Neurology, Lewis Katz School of Medicine at Temple University, 6Department of Medicine, Renal-Electrolyte and Hypertension Division, University of Pennsylvania, 7Department of Neurology, Hospital of the University of Pennsylvania
Objective:
To compare mental health status between Black and Non-Black patients recovering from stroke.
Background:
One in three patients in the U.S. are diagnosed with depression after their stroke. This analysis focuses on mental health scores as opposed to clinical diagnoses of depression, broadening its applicability. Mental health disparities between racial groups are a significant concern, given that racial minorities face worse health outcomes following a stroke.
Design/Methods:
The REDUCE trial is an ongoing, multicenter, open label, randomized clinical trial comparing standard of care anti-hypertensive medication regimens vs spironolactone-containing regimens in stroke patients. Mental health scores are collected from patients post-stroke through the PROMIS Global Health survey. The raw total Mental Health score is then converted to a T-score. We evaluated whether there was a difference in Mental Health scores using an unpaired t-test followed by a linear regression to account for the influence of demographic and clinical variables.
Results:
113 (62.9±11.8, 63% male, 62% White) patients have completed the PROMIS questionnaire during REDUCE enrollment post-stroke. Black patients (n=35) had a lower mean Mental Health T-score than Non-Black patients (n=78; 70 White, 2 Asian, 6 Unknown) (43.4±10.9 vs 48.3±9.5, p=0.014). PROMIS considers the threshold for between group comparisons as 3.0 T-score points. Mental health scores remained significantly lower for Black patients after controlling for demographics (age, sex, ethnicity, education, household net worth) and clinical variables (PROMIS Physical Health, mRS, MOCA, number of medications, hypertension, and time since stroke) (p=0.002, β=6.576, 95.0% CI[2.389, 10.762]).
Conclusions:
This study demonstrates a significant difference in PROMIS Mental Health scores between Black and Non-Black patients recovering from stroke in the REDUCE trial. The lack of available pre-stroke mental health history is a limitation in this analysis. These findings emphasize the importance of targeted interventions to specific groups and the need to further address underlying factors contributing to this disparity.
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