Abstract
OBJECTIVES: The objectives of this study were to examine national-level patterns and predictors of depression treatment among community-dwelling stroke survivors with comorbid depression METHODS: This study adopted a retrospective, cross-sectional study design using multiple alternate years of Medical Expenditure Panel Survey (MEPS) [2002, 2004, 2006, 2008, 2010, 2012] data. The study sample consisted of older adults (age ≥ 50 years) who were stroke (ICD-9-CM codes of 430. xx-438.xx) survivors with comorbid depression (ICD-9-CM code of 296.xx, or 311.xx) and did not die during the calendar year. Depression treatment, identified by antidepressant medication use with or without psychotherapy, was the dependent variable of this study. Multinomial logistic regression analysis was conducted to examine the association of factors with depression treatment in the study sample. Depression treatment categories included antidepressant use only; combination therapy of antidepressant and psychotherapy; and no depression treatment. RESULTS: An overwhelming majority (87.6%) of the study sample (unweighted N=370) reported some form of depression treatment. Antidepressants only and combination therapy were reported by 74.8% and 12.8% of study sample respectively. Selective serotonin reuptake inhibitor (61%) was the most commonly reported antidepressant class, while sertraline (15.8%) was the highest reported individual antidepressant. Depression treatment was associated with age, education, poverty status, perceived mental health status, functional disability, presence of other chronic conditions, body mass index, smoking, metro status, and region. For example, among stroke survivors with comorbid depression, those who were 65 years and older were nearly six times more likely (Odds Ratio=5.80, 95% CI 2.48-13.5) to report use of antidepressants only compared to those who were 50-64 years old. CONCLUSIONS: The majority of the study sample received some form of depression treatment and several individual-level factors were associated with the receipt of depression treatment. Future studies should assess outcomes associated with depression treatment in this vulnerable population.