Depressive Disorders Increase Discharge to Care Facilities Following Ischemic and Hemorrhagic Strokes

Background and/or Objectives: Examine if patients with depression hospitalized for stroke have increased likelihood of discharge to institutions for rehabilitation and recovery (e.g., inpatient rehabilitation, skilled nursing, intermediate care facilities) after index admission.

Design: Retrospective cohort study

Setting : Inpatient admissions

Participants : We queried the National Inpatient Sample between 2016-2020 for all patients ≥18 years old admitted for a primary diagnosis of ischemic or hemorrhagic stroke.

Interventions: Not applicable

Main Outcome Measures: The primary outcome was the proportion of patients who were discharged to institutions (inpatient rehabilitation facilities, skilled nursing facilities, or any other facilities) from their inpatient stay based on depressive disorder status. Multivariate logistic and linear regression models were constructed to evaluate independent effects of depressive disorders on outcomes, controlling for age, sex, race, household income, insurance status, and comorbidities (hypertension, diabetes, obesity, malignancy, or lung disease). Admission length of stay (LOS) was a secondary outcome compared between groups.

Results: Among 3,101,545 patients hospitalized for ischemic or hemorrhagic stroke, 342,420 (11.0%) had a concurrent depressive disorder. Patients with depressive disorders were discharged more frequently to institutions when compared with counterparts (51.8% vs. 46.5%; p < 0.001). This association was independently observed in multivariate logistic regression, with depressive disorder diagnosis being significantly associated with greater odds of institutional discharge (aOR: 1.25; 95% CI: 1.22-1.27). On linear regression, patients with depression had longer LOS when compared with counterparts (β: 0.53, SE: 0.037; p < 0.001).

Conclusions: In a nationwide cohort of patients admitted to inpatient units for stroke, presence of concurrent depressive disorders increased the likelihood of being discharged to institutional care instead of to home and was independently associated with longer LOS. Major depression is an important, addressable condition that physiatrists can prioritize screening and managing in post-stroke recovery, including index admission and inpatient rehabilitation.