https://orcid.org/0000-0002-8005-7845
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Abstract
Purpose
To describe types of mental health treatment accessed by community-based stroke survivors and factors associated with access.
Methods
A sub-group of registrants from the Australian Stroke Clinical Registry completed a supplementary survey 2.5 years post-stroke. Self-reported information about depression/anxiety and treatment access were collected. Demographic and clinical data were obtained through linkages with registry and government data. Staged multivariable logistic regression was conducted to examine factors associated with treatment access.
Results
Among 623 registrants surveyed (37% female, median age 69 years), 26% self-reported a medical diagnosis of depression/anxiety at 2.5 years post-stroke. Of these, only 30% reported having accessed mental health services, mostly through government-funded Medicare schemes. Younger age (odds ratio (OR) 0.95, 95% CI 0.93, 0.98), history of mental health treatment (OR 3.38, 95% CI 1.35, 8.48), feeling socially isolated (OR 2.32, 95% CI 1.16, 4.66), self-reported medical diagnosis of depression/anxiety (OR 4.85, 95% CI 2.32, 10.14), and government-subsidised team care plan arrangement (OR 4.05, 95% CI 1.96, 8.37) were associated with receiving treatment.
Conclusions
Many stroke survivors have untreated depression/anxiety. Primary care practitioners should be supported in undertaking effective detection and management. Older and newly diagnosed individuals should be educated about depression/anxiety and available supports.
Primary care providers play a pivotal role in the pathway to mental health care, and therefore should always screen for depression/anxiety and provide comprehensive assessment and referral to specialist services where necessary.
Targeted psychoeducation should be provided to survivors of stroke who are older and newly diagnosed with depression/anxiety, to increase awareness about mood problems following stroke.
Primary care providers should collaborate with other health professionals (e.g., through coordinating a team care arrangement plan), to address patients’ multiple and complex rehabilitation needs.
Rehabilitation professionals should remain informed about current evidence-based treatments for post-stroke depression/anxiety and pathways that enable their patients to access these services.
Implications for rehabilitation
Acknowledgements
We acknowledge members of the Australian Stroke Clinical Registry (AuSCR) Steering Committee and staff from the Florey Institute of Neuroscience and Mental Health who manage the AuSCR. We also acknowledge the staff from the state and commonwealth units which undertook the data linkage for this project and each state data collection agency that provided access to these data, including, the Victorian Government Department of Health and Human Services (source of the Victorian Admitted Episodes Dataset (VAED) and the Victorian Emergency Minimum Dataset (VEMD), the Centre for Victorian Data Linkage (for provision of Victorian data linkage), the Queensland Department of Health, and the Australian Institute of Health and Welfare.
Disclosure statement
Prof Cadilhac is the current Data Custodian for the Australian Stroke Clinical Registry (AuSCR). Prof Cadilhac and A/Prof Kilkenny are members of the AuSCR Steering or Management Committees. Prof Cadilhac reports receiving restricted grants from Amgen Australia, Boehringer Ingelheim, Ipsen, Medtronic, and Shire outside the submitted work. A/Prof Kilkenny reports receiving restricted grants from Amgen Australia outside the submitted work. All other authors report no conflicts.