Effects of stroke rehabilitation on incidence of poststroke depression: A population-based cohort study

Wen Hsuan Hou, Huey Wen Liang, Ching Lin Hsieh, Chieh Yi Hou, Pei Chun Wen, Chung Yi Li

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Abstract

Objective: To investigate the effects of rehabilitation intervention provided within the first 3 months after admission for stroke on the incidence of poststroke depression (diagnosed according to ICD-9-CM code 296, 309, or 311, or A-code A212 or A219). Method: This population-based cohort study examined medical claim data of a random sample of 1 million insured people registered in 2000 in Taiwan. Between 2000 and 2005, there were 7,677 patients admitted as first-time stroke patients. Of these, 1,285 (16.7%) received a rehabilitation regimen within the first 3 months of admission for stroke. The other 83.3% of patients (n = 6,482) belonged to the control group. All study subjects were followed to the end of 2009 to identify any ambulatory treatment for depression as the end point. The incidence density of poststroke depression was calculated assuming a Poisson process. A Cox proportional hazard model was used to estimate the relative risk of poststroke depression in relation to receipt of rehabilitation. Results: Over a 10-year follow-up, 75 patients (5.8%) with rehabilitation and 566 controls (8.7%) developed poststroke depression, representing incidence densities of 11.3 and 18.5 per 1,000 person-years, respectively. After analyses were controlled for potential confounders, rehabilitation was found to significantly reduce the risk of poststroke depression, with a hazard ratio (HR) of 0.57 (95% CI, 0.45-0.73). The effect was greater for men (HR = 0.52; 95% CI, 0.37-0.71), especially for elderly men (HR = 0.45; 95% CI, 0.28-0.71), than for women (HR = 0.69; 95% CI, 0.47-1.02). Conclusions: Stroke rehabilitation intervention in the first 3 months after admission for stroke may significantly reduce the risk of poststroke depression. Although this beneficial effect appears to be greater for men than for women, clinicians should also be alert for poststroke depression occurring in women.

Original languageEnglish
JournalJournal of Clinical Psychiatry
Volume74
Issue number9
DOIs
Publication statusPublished - 2013

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Cohort Studies
Rehabilitation
Stroke
Incidence
Population
International Classification of Diseases
Taiwan
Proportional Hazards Models
Stroke Rehabilitation
Control Groups
Therapeutics

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Effects of stroke rehabilitation on incidence of poststroke depression : A population-based cohort study. / Hou, Wen Hsuan; Liang, Huey Wen; Hsieh, Ching Lin; Hou, Chieh Yi; Wen, Pei Chun; Li, Chung Yi.

In: Journal of Clinical Psychiatry, Vol. 74, No. 9, 2013.

Research output: Contribution to journalArticle

Hou, Wen Hsuan ; Liang, Huey Wen ; Hsieh, Ching Lin ; Hou, Chieh Yi ; Wen, Pei Chun ; Li, Chung Yi. / Effects of stroke rehabilitation on incidence of poststroke depression : A population-based cohort study. In: Journal of Clinical Psychiatry. 2013 ; Vol. 74, No. 9.
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abstract = "Objective: To investigate the effects of rehabilitation intervention provided within the first 3 months after admission for stroke on the incidence of poststroke depression (diagnosed according to ICD-9-CM code 296, 309, or 311, or A-code A212 or A219). Method: This population-based cohort study examined medical claim data of a random sample of 1 million insured people registered in 2000 in Taiwan. Between 2000 and 2005, there were 7,677 patients admitted as first-time stroke patients. Of these, 1,285 (16.7{\%}) received a rehabilitation regimen within the first 3 months of admission for stroke. The other 83.3{\%} of patients (n = 6,482) belonged to the control group. All study subjects were followed to the end of 2009 to identify any ambulatory treatment for depression as the end point. The incidence density of poststroke depression was calculated assuming a Poisson process. A Cox proportional hazard model was used to estimate the relative risk of poststroke depression in relation to receipt of rehabilitation. Results: Over a 10-year follow-up, 75 patients (5.8{\%}) with rehabilitation and 566 controls (8.7{\%}) developed poststroke depression, representing incidence densities of 11.3 and 18.5 per 1,000 person-years, respectively. After analyses were controlled for potential confounders, rehabilitation was found to significantly reduce the risk of poststroke depression, with a hazard ratio (HR) of 0.57 (95{\%} CI, 0.45-0.73). The effect was greater for men (HR = 0.52; 95{\%} CI, 0.37-0.71), especially for elderly men (HR = 0.45; 95{\%} CI, 0.28-0.71), than for women (HR = 0.69; 95{\%} CI, 0.47-1.02). Conclusions: Stroke rehabilitation intervention in the first 3 months after admission for stroke may significantly reduce the risk of poststroke depression. Although this beneficial effect appears to be greater for men than for women, clinicians should also be alert for poststroke depression occurring in women.",
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AB - Objective: To investigate the effects of rehabilitation intervention provided within the first 3 months after admission for stroke on the incidence of poststroke depression (diagnosed according to ICD-9-CM code 296, 309, or 311, or A-code A212 or A219). Method: This population-based cohort study examined medical claim data of a random sample of 1 million insured people registered in 2000 in Taiwan. Between 2000 and 2005, there were 7,677 patients admitted as first-time stroke patients. Of these, 1,285 (16.7%) received a rehabilitation regimen within the first 3 months of admission for stroke. The other 83.3% of patients (n = 6,482) belonged to the control group. All study subjects were followed to the end of 2009 to identify any ambulatory treatment for depression as the end point. The incidence density of poststroke depression was calculated assuming a Poisson process. A Cox proportional hazard model was used to estimate the relative risk of poststroke depression in relation to receipt of rehabilitation. Results: Over a 10-year follow-up, 75 patients (5.8%) with rehabilitation and 566 controls (8.7%) developed poststroke depression, representing incidence densities of 11.3 and 18.5 per 1,000 person-years, respectively. After analyses were controlled for potential confounders, rehabilitation was found to significantly reduce the risk of poststroke depression, with a hazard ratio (HR) of 0.57 (95% CI, 0.45-0.73). The effect was greater for men (HR = 0.52; 95% CI, 0.37-0.71), especially for elderly men (HR = 0.45; 95% CI, 0.28-0.71), than for women (HR = 0.69; 95% CI, 0.47-1.02). Conclusions: Stroke rehabilitation intervention in the first 3 months after admission for stroke may significantly reduce the risk of poststroke depression. Although this beneficial effect appears to be greater for men than for women, clinicians should also be alert for poststroke depression occurring in women.

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