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(Stroke. 2008;39:132.)
© 2008 American Heart Association, Inc.

Original Contributions

Impact of Preexisting Depression on Length of Stay and Discharge Destination Among Patients Hospitalized for Acute Stroke

Linked Register-Based Study

Jasper Nuyen, MSc; Peter M. Spreeuwenberg, MSc; Peter P. Groenewegen, PhD; Geertrudis A.M. van den Bos, PhD François G. Schellevis, MD, PhD

From the NIVEL (J.N., P.M.S., P.P.G., F.G.S.), Netherlands Institute for Health Services Research, Utrecht; the Trimbos Institute (J.N.), Netherlands Institute of Mental Health and Addiction, Utrecht; the Academic Medical Center (G.A.M.v.d.B.), University of Amsterdam, Amsterdam; and the Institute for Research in Extramural Medicine (EMGO) (F.G.S.), VU University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands.

Correspondence to Jasper Nuyen, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Da Costakade 45, PO Box 725, 3500 AS Utrecht, The Netherlands. E-mail jnuijen{at}trimbos.nl

Background and Purpose— There exists limited knowledge regarding the relation between depression and healthcare utilization in stroke patients. The objective of this register-based study was to examine the impact of having preexisting depression at the time of hospital admission for acute stroke on length of hospital stay and discharge destination.

Methods— Data from a general-practice database were linked to those of a hospital database to identify patients hospitalized for stroke and were used to categorize these patients into 3 groups based on preexisting mental health (MH) status at admission, ie, those with preexisting depression, those with another preexisting MH condition, and those without any preexisting MH condition. Multilevel analyses controlling for several potentially important covariates were performed to estimate the associations under study.

Results— Both patients with preexisting depression (n=41) and those with another preexisting MH condition (n=62) did not differ significantly from patients without any preexisting MH condition (n=211) regarding length of hospital stay for acute stroke. Among patients who survived hospitalization, those with preexisting depression had significantly higher odds of being discharged to an institution instead of their home than did patients without any preexisting MH condition. Having another preexisting MH condition had no significant effect on discharge destination.

Conclusions— Having preexisting depression at admission seems to be a relevant factor in determining discharge to institutional care after acute stroke hospitalization. Further research is needed to determine the mechanism(s) through which preexisting depression decreases the chances of being discharged to home.

Key Words: discharge destination • length of stay • preexisting depression • stroke

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