Abstract 27: Risk Factors Associated With Post-Stroke Readmissions for Depression and Suicide Attempt in a Nationally Representative Dataset


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Abstract

Introduction: Post-stroke depression (PSD) occurs in approximately one third of stroke patients. Existing literature has elucidated pathophysiology, risk factors, impact, and treatment for PSD. However, there is a lack of nationally representative data assessing patient characteristics and demographics associated with the most severe PSD, manifested by hospitalization for suicide attempt (SA) or depression.Methods: The 2013 Nationwide Readmissions Database contains >14 million U.S. readmissions for all payers and the uninsured. We used validated International Classification of Disease, Ninth Revision, Clinical Modification codes to identify index admission with stroke (n = 215, 802) and readmission with depression (n = 361) and SA (n = 108). We used Cox regression to calculate hazard ratios (HR) of hospital readmissions up to 1 year post-stroke for depression and SA, adjusting for patient and demographic characteristics.Results: Readmission rates with depression were 28 per 100,000, 59 per 100,000 and 82 per 100,000 at 30, 60, and 90 days respectively. Readmission rates with SA were 29 per 100,000, 38 per 100,000, and 43 per 100,000 at 30, 60, and 90 days respectively. For depression readmissions, psychiatric history had the greatest HR of 3.25 (95% CI 2.63-4.01, p <2x10-16), followed closely by alcoholism (HR of 2.36, 95% CI 1.60-3.50, p = 1.82 x10-5). For SA readmissions, alcoholism had the greatest HR of 3.96 (95% CI 2.22-7.05, p = 2.98 x10-6), followed by psychiatric history (HR 2.87, 95% CI 1.93-4.25, p = 1.52x10-7). Age >70 was protective against readmission with depression and SA, with a HR of 0.45 (95% CI 0.36-0.57, p = 1.86 x10-11) and 0.28 (95% CI 0.18-0.45, p = 1.47 x10-7) respectively. Discharge home was protective against readmissions due to depression only, with a HR 0.71 (95% CI 0.57-0.89, p = 3.1 x10-3).Conclusion: Stroke patients with a history of alcoholism or psychiatric illness are more likely to be admitted with depression or SA in the first year. Age >70 is protective against such readmissions, and discharge home is protective against depression readmissions but failed to reach statistical significance for SA readmission. These factors may be used to screen and identify stroke patients at risk of severe PSD requiring hospitalization.

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