Published Online
on September 28, 2006

A more recent version of this article appeared on November 1, 2006

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Submitted on July 27, 2006
Accepted on August 2, 2006

The Impact of Poststroke Depression on Healthcare Use by Veterans With Acute Stroke

Huanguang Jia PhD^*; Teresa M. Damush PhD; Haijing Qin MS; L. Douglas Ried PhD; Xinping Wang PhD; Linda J. Young PhD; and Linda S. Williams MD

From the VA Stroke QUERI Research Coordinating Center (H.J., H.Q., L.D.R., X.W., L.J.Y.), Gainesville, Florida; the VA Stroke QUERI Clinical Coordinating Center, Roudebush VAMC, the Department of Neurology, Indiana University School of Medicine, and Regenstrief Institute, Inc (T.M.D., L.S.W.), Indianapolis, Indiana; and the College of Pharmacy (L.D.R.), University of Florida, Gainesville, Florida.

^* To whom correspondence should be addressed. E-mail: Huanguang.Jia{at}med.va.gov.

Background and Purpose--Poststroke depression (PSD) is common among stroke survivors, and it is associated with worse functional outcomes and increased poststroke mortality. Limited information is available about its impact on healthcare use. This study assessed the impact of PSD on healthcare use by veterans with acute stroke.

Methods--In this retrospective, observational national study, 5825 veterans with acute stroke were identified from Veterans Affairs’ (VA) inpatient databases. To determine the patients’ comprehensive PSD and use status, VA and Medicare fee-for-service inpatient and outpatient as well as VA pharmacy data were used. PSD was established if a patient had an inpatient or outpatient depression diagnosis or if a patient received one of the antidepressants within the VA 12 months postindex stroke. Healthcare use referred to the number of hospital stays, outpatient visits, and cumulative length of inpatient stays under both VA and Medicare fee-for-service programs. Poisson regression was fitted to estimate the impact of PSD on use controlling for sociodemographic, clinical, and disease severity factors.

Results--Forty-one percent of the sample had PSD. After adjusting for patient demographic and clinical factors, we found that the patients with stroke with PSD had significantly (P<0.0001) more hospitalizations, outpatient visits, and longer length of stays 12 months poststroke compared with these patients with stroke without PSD.

Conclusions--Patients with PSD had greater 12-month poststroke healthcare use even when controlling for other demographic and clinical variables. Early detection and appropriate management of PSD for veterans with acute stroke may help reduce their poststroke healthcare use.

Key words: poststroke depression • use

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