Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1074 — Medical Comorbidity and its Relationship to Post-Stroke Depression

Williams LS (Indianapolis COE) , Bravata D (Yale/New Haven VAMC, Stroke QUERI), Plue LD (Indianapolis COE), Brizendine E (Indiana University School of Medicine), Tu W (Indiana University School of Medicine), Bakas T (Indiana University School of Nursing), Hendrie H (Indiana University School of Medicine), Kroenke K (Indianapolis COE)

Objectives:
Medical conditions including coronary artery disease, diabetes, and sleep apnea have been associated with non-stroke related depression. Prior studies have related increased overall medical comorbidity to increased risk of developing post-stroke depression (PSD). Whether specific comorbidities are especially likely to confer added PSD risk is largely unexplored.

Methods:
Patients were enrolled in a longitudinal cohort study assessing depression and stroke outcomes at baseline (1-2 months post-stroke), 3, and 6 months. Non-depressed subjects were matched and enrolled 1:1 to depressed subjects. Depression diagnosis was determined using the Structured Clinical Interview for Depression. Only baseline data are used in this analysis. Medical comorbidity was measured using the Cumulative Illness Rating Scale (CIRS). Scores in each category of the CIRS were determined by patient interview and medical record review. A standardized manual for chart abstraction was used and scores were reviewed by a general internist. Variables were compared between depressed and non-depressed subjects using Chi-square and t-tests. Stepwise multiple logistic regression was used to determine variables independently related to the presence of PSD.

Results:
Of 392 subjects, 188 were depressed at baseline. Characteristics associated with PSD in bivariate analyses included: younger age; increased stroke severity; prior history of depression; lower social support; lower optimism, self esteem, and sense of control; and higher total CIRS scores. Of the CIRS categories, subjects with PSD had increased respiratory, endocrine, and neurologic comorbidity scores. Variables independently related to PSD included: younger age (p = .002), history of depression (p < .001), lower self esteem (p < .001), and increased total CIRS score (p < .001).

Implications:
Younger stroke survivors with prior history of depression, low self esteem, and increased medical comorbidity are more likely to develop PSD. In addition to neurologic comorbidity, medical conditions affecting the respiratory and endocrine systems may be especially associated with the development of PSD.

Impacts:
These data may help identify stroke survivors at risk for PSD. Veterans with respiratory and endocrine comorbid medical conditions may be at especially high risk of PSD. In addition to PSD treatment, other targeted interventions focused on their comorbidity may also help reduce depression symptoms post-stroke.