{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T21:52:28Z","timestamp":1777672348363,"version":"3.51.4"},"reference-count":40,"publisher":"BMJ","issue":"3","funder":[{"name":"NINDS Stroke Intramural Research Program","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R35AG071916"],"award-info":[{"award-number":["R35AG071916"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["K23NS123340"],"award-info":[{"award-number":["K23NS123340"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Depression is a common neuropsychiatric consequence of stroke, but there is little empiric evidence regarding clinical diagnosis and management of poststroke depression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective cohort study among 831 471 privately insured patients with first stroke in the USA from 2003 to 2020. We identified diagnoses of poststroke depression using codes from the International Classification of Diseases. We identified treatment based on prescriptions for antidepressants. We used Cox proportional hazards regression analysis to examine rates of poststroke depression diagnosis by gender, age and race\/ethnicity. Among individuals who received a diagnosis of poststroke depression, we estimated treatment rates by gender, race\/ethnicity and age using negative binomial regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Annual diagnosis and treatment rates for poststroke depression increased from 2003 to 2020 (both p for trend&lt;0.001). Diagnosis rates were higher in women than men (HR 1.53, 95% CI 1.51 to 1.55), lower among members of racial\/ethnic minorities (vs white patients: Asian HR 0.63, 95% CI 0.60 to 0.66; Black HR 0.76, 95% CI 0.74 to 0.78; Hispanic HR 0.88, 95% CI 0.86 to 0.90) and varied by age. Among individuals diagnosed with poststroke depression, 69.8% were prescribed an antidepressant. Rates of treatment were higher in women vs men (rate ratio, RR=1.19, 95% CI: 1.17 to 1.21), lower among members of racial\/ethnic minorities (vs white patients: Asian RR 0.85, 95% CI 0.80 to 0.90; Black RR 0.92, 95% CI 0.89 to 0.94; Hispanic RR 0.96, 95% CI 0.93 to 0.99) and higher among older patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this insured population, we identify potential inequities in clinical management of poststroke depression by gender, race\/ethnicity and age that may reflect barriers other than access to healthcare.<\/jats:p><\/jats:sec>","DOI":"10.1136\/jnnp-2022-330179","type":"journal-article","created":{"date-parts":[[2022,11,18]],"date-time":"2022-11-18T18:20:22Z","timestamp":1668795622000},"page":"220-226","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Trends and inequities in the diagnosis and treatment of poststroke depression: a retrospective cohort study of privately insured patients in the USA, 2003\u20132020"],"prefix":"10.1136","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1781-904X","authenticated-orcid":false,"given":"Holly","family":"Elser","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Caunca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David H","family":"Rehkopf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6375-7367","authenticated-orcid":false,"given":"Wells","family":"Andres","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca F","family":"Gottesman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott E","family":"Kasner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristine","family":"Yaffe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea L C","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,11,18]]},"reference":[{"key":"2023051801101508000_94.3.220.1","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1017\/S0033291718002003","article-title":"Prevalence of pre-stroke depression and its association with post-stroke depression: a systematic review and meta-analysis","volume":"49","author":"Taylor-Rowan","year":"2019","journal-title":"Psychol Med"},{"key":"2023051801101508000_94.3.220.2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.037740"},{"key":"2023051801101508000_94.3.220.3","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.111.107664"},{"key":"2023051801101508000_94.3.220.4","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12357"},{"key":"2023051801101508000_94.3.220.5","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.09.047","article-title":"Patterns and predictors of depression treatment among stroke survivors with depression in ambulatory settings in the United States","volume":"27","author":"Bhattacharjee","year":"2018","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2023051801101508000_94.3.220.6","doi-asserted-by":"publisher","DOI":"10.1007\/s11065-017-9356-2"},{"key":"2023051801101508000_94.3.220.7","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2015.15030363"},{"key":"2023051801101508000_94.3.220.8","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.pharmthera.2017.11.005","article-title":"Post-Stroke depression: mechanisms and pharmacological treatment","volume":"184","author":"Villa","year":"2018","journal-title":"Pharmacol Ther"},{"key":"2023051801101508000_94.3.220.9","doi-asserted-by":"publisher","DOI":"10.3109\/15622975.2011.562242"},{"key":"2023051801101508000_94.3.220.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuropharm.2011.07.036"},{"key":"2023051801101508000_94.3.220.11","doi-asserted-by":"crossref","first-page":"4847","DOI":"10.1007\/s12035-016-0032-y","article-title":"The neurobiology of depression: an integrated overview from biological theories to clinical evidence","volume":"54","author":"Ferrari","year":"2017","journal-title":"Mol Neurobiol"},{"key":"2023051801101508000_94.3.220.12","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.24.1.52"},{"key":"2023051801101508000_94.3.220.13","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.65.11.1296"},{"key":"2023051801101508000_94.3.220.14","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000231387.58943.1f"},{"key":"2023051801101508000_94.3.220.15","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-006-0058-6"},{"key":"2023051801101508000_94.3.220.16","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318210435e"},{"key":"2023051801101508000_94.3.220.17","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000098"},{"key":"2023051801101508000_94.3.220.18","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.genhosppsych.2020.06.011","article-title":"Updated review","volume":"2020","author":"Medeiros","year":"2020","journal-title":"Gen Hosp Psychiatry"},{"key":"2023051801101508000_94.3.220.19","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jad.2018.12.082","article-title":"Does depression after stroke negatively influence physical disability? A systematic review and meta-analysis of longitudinal studies","volume":"247","author":"Bl\u00f6chl","year":"2019","journal-title":"J Affect Disord"},{"key":"2023051801101508000_94.3.220.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2011.05.028"},{"key":"2023051801101508000_94.3.220.21","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.112.673947"},{"key":"2023051801101508000_94.3.220.22","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000174293.17959.a1"},{"key":"2023051801101508000_94.3.220.23","doi-asserted-by":"crossref","unstructured":"McLeod AI . Kendall rank correlation and Mann-Kendall trend test. R package Kendall; 2005.","DOI":"10.1002\/0471743984.vse5991"},{"key":"2023051801101508000_94.3.220.24","unstructured":"Kleinbaum DG , Klein M . Survival analysis. Vol 3. Springer, 2010."},{"key":"2023051801101508000_94.3.220.25","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000165928.19135.35"},{"key":"2023051801101508000_94.3.220.26","doi-asserted-by":"publisher","DOI":"10.1177\/0891988714527514"},{"key":"2023051801101508000_94.3.220.27","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12356"},{"key":"2023051801101508000_94.3.220.28","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.50.6.563"},{"key":"2023051801101508000_94.3.220.29","doi-asserted-by":"crossref","first-page":"e2184","DOI":"10.1212\/WNL.0000000000011828","article-title":"Risk and predictors of depression following acute ischemic stroke in the elderly","volume":"96","author":"Mayman","year":"2021","journal-title":"Neurology"},{"key":"2023051801101508000_94.3.220.30","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.23.3095"},{"key":"2023051801101508000_94.3.220.31","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.175.2.163"},{"key":"2023051801101508000_94.3.220.32","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.117.004222"},{"key":"2023051801101508000_94.3.220.33","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318271f848"},{"key":"2023051801101508000_94.3.220.34","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70314-8"},{"key":"2023051801101508000_94.3.220.35","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32823-X"},{"key":"2023051801101508000_94.3.220.36","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(20)30207-6"},{"key":"2023051801101508000_94.3.220.37","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.020067"},{"key":"2023051801101508000_94.3.220.38","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/S1474-4422(20)30219-2","article-title":"Safety and efficacy of fluoxetine on functional recovery after acute stroke (effects): a randomised, double-blind, placebo-controlled trial","volume":"19","author":"","year":"2020","journal-title":"Lancet Neurol"},{"key":"2023051801101508000_94.3.220.39","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1111\/ane.12947","article-title":"Prescription and predictors of post-stroke antidepressant treatment: a population-based study","volume":"138","author":"Mortensen","year":"2018","journal-title":"Acta Neurol Scand"},{"key":"2023051801101508000_94.3.220.40","doi-asserted-by":"crossref","unstructured":"Hackett ML , Anderson CS , House A , et al . Interventions for treating depression after stroke. Cochrane Database Syst Rev 2008;241 Suppl 1.doi:10.1002\/14651858.CD003437.pub3","DOI":"10.1002\/14651858.CD003437.pub3"}],"container-title":["Journal of Neurology, Neurosurgery &amp; Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jnnp-2022-330179","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T08:12:14Z","timestamp":1684397534000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnnp.bmj.com\/lookup\/doi\/10.1136\/jnnp-2022-330179"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,18]]},"references-count":40,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2,14]]},"published-print":{"date-parts":[[2023,3]]}},"alternative-id":["10.1136\/jnnp-2022-330179"],"URL":"https:\/\/doi.org\/10.1136\/jnnp-2022-330179","relation":{},"ISSN":["0022-3050","1468-330X"],"issn-type":[{"value":"0022-3050","type":"print"},{"value":"1468-330X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,18]]}}}