Abstract P199: Predictors of Early Change in PHQ-9 Depression Scores Following Acute Stroke: A Secondary Analysis of the Michigan Stroke Transitions Trial

Abstract

Introduction: Predictors of changes in depression in the early transitional period following an acute stroke are not well understood. We conducted a secondary analysis of patients enrolled in the Michigan Stroke Transitions Trial (MISTT) to characterize factors associated with changes in depressive symptoms from 7 to 90 days after returning home. Methods: MISTT was an open, parallel, randomized clinical trial testing the efficacy of social worker case management alone or in conjunction with a website to improve outcomes following acute stroke. Patient-reported outcomes including PHQ-9 were collected via telephone interviews conducted 7 and 90 days after patients returned home. PHQ-9 score ranges from 0-27 with higher scores indicating more severe symptoms. Key demographic variables were extracted from medical records. Multivariable linear regression was used to identify independent predictors of change in PHQ-9 score from 7 to 90 days using the GLM procedure in SAS. All analyses were adjusted for baseline (7-day) PHQ-9 score and pre-specified confounders (Table). We accounted for missing data using inverse probability weighting. Results: Of 265 patients enrolled in MISTT, 164 had PHQ-9 scores available at both 7 and 90 days and were included in the analysis. The mean PHQ-9 score was 5.4 at 7 days and 4.9 at 90 days. The mean within person change from 7 to 90 days was -0.5. In the final model, being unmarried (versus married), and moderate or severe stroke severity (versus mild) were associated with an increase in depressive symptoms (Table). As expected, 7-day PHQ-9 score was a strong predictor of 90-day score. Accounting for missing data did not meaningfully change model results. Conclusions: Increases in PHQ-9 scores following stroke hospitalization were seen in unmarried patients and those with greater stroke severity. Identifying factors associated with worsening symptoms over time may help guide clinical management during the early transition period.