Sensitivity reaction to phenindione with urticaria, hepatitis, and pancytopenia.

Abstract

<h3>Background and Objectives:</h3> Depression is highly prevalent and persistent among survivors of stroke. It is unknown how treatment for depression among survivors of stroke has changed in the evolving context of stroke care and mental health care in the general United States (US) population, especially among vulnerable sociodemographic subgroups who bear higher risks for stroke and unfavorable post-stroke outcomes and experience disparities in access to and quality of stroke and mental health care. The study examined temporal trends in outpatient treatment for depression among survivors of stroke in the US between 2004 and 2017. <h3>Methods:</h3> The study sample consisted of 10243 adult survivors of stroke and 264645 adults without stroke drawn from the Medical Expenditure Panel Survey, a nationally representative survey in the US. Trends in outpatient treatment for depression and potential unmet needs in the stroke population, including variations across sociodemographic subgroups, were examined and compared with the non-stroke population. <h3>Results:</h3> The rate of receipt of outpatient treatment for depression among survivors of stroke was 17.7% in 2004-2005 and 16.0% in 2016-2017 (adjusted odds ratio for period change [aOR]=0.90, 95% CI=0.71-1.15). Older, male, non-Hispanic Black and Hispanic survivors of stroke were less likely to receive treatment for depression. Approximately two-thirds of survivors of stroke that screened positive for depression received no outpatient treatment during a calendar year. The sociodemographic disparities and treatment gap persisted during the study period, which differed from the non-stroke population. Among survivors of stroke who received any treatment for depression, there was a remarkable increase in use of psychotherapy (aOR=2.26, 95% CI=1.28-4.01), despite its less frequent use compared with pharmacotherapy. <h3>Discussion:</h3> Although depression is common after stroke, the majority of survivors of stroke receive no mental health treatment. This gap has remained largely unchanged over the past decades, with substantial sociodemographic differences. Efforts are needed to improve depression care for survivors of stroke and reduce disparities.