Trends in mental health, use of mental health services and disparities among stroke survivors in the United States: 2004-2016

项目总结/摘要 过去几十年中卒中存活率的提高突出了卒中后治疗的重要性。 成果研究。抑郁和心理困扰是中风后最常见的精神疾病之一， 健康状况。近三分之一的中风幸存者在中风后的某个时候经历过抑郁症。 尽管美国心脏协会/美国中风协会指南建议进行筛查， 治疗中风患者的抑郁症，中风后抑郁症仍然诊断不足， 管理不善抑郁症状不仅本身是残疾的，而且还会干扰功能性的。 复苏抗抑郁药，中风后抑郁症的一线治疗，也越来越多地 在过去的十年里，中风康复机构为运动恢复开了处方。然而，最近随机 对照试验证据使抗抑郁药对功能结果的使用处于争论之中。同时 自20世纪90年代以来，一般人群中精神卫生服务使用的急剧增加也可能导致 影响中风人群的趋势。然而，没有人口层面的心理健康概况， 美国中风幸存者的状况和服务使用情况，对精神健康知之甚少 以及中风和中风护理发展背景下的精神卫生保健差异。这个项目的总体目标是 一项建议是审查国家精神卫生趋势、精神卫生服务的使用情况以及 2004年至2016年的中风幸存者。具体而言，我们将使用来自医疗保健行业的全国代表性数据。 支出小组调查，以审查（1）抑郁症和严重抑郁症流行率的国家趋势 心理困扰，（2）使用和未充分使用精神卫生服务的国家趋势，包括 心理治疗和抗抑郁药，（3）这些趋势在社会人口群体中的潜在差异， 以及（4）中风幸存者的心理健康趋势在多大程度上归因于他们 使用心理健康服务。研究的结果将提供对差距和机会的见解后， 中风精神卫生保健，并确定需要更多关注的弱势社会人口群体。

PROJECT SUMMARY/ABSTRACT The improvement in stroke survivorship over the past decades highlights the importance of post-stroke outcome research. Depression and psychological distress are among the most common post-stroke mental health conditions. Nearly one-third of stroke survivors experience depression at some point after stroke. Although the American Heart Association/American Stroke Association guidelines recommend screening and treatment for depression in stroke patients, post-stroke depression remains underdiagnosed and undermanaged. Depressive symptoms are not only disabling in their own right, but also interfere with functional recovery. Antidepressants, the first-line treatment for post-stroke depression, have also been increasingly prescribed for motor recovery in stroke rehabilitation settings in the past decade. However, recent randomized controlled trial evidence puts antidepressant use for functional outcomes under debate. Meanwhile, the dramatic increase in mental health service use in the general population since the 1990s may also have influenced trends in the stroke population. However, there is no population-level overview of mental health status and services use among stroke survivors in the United States, and little is known about mental health and mental health care disparities in the evolving context of stroke and stroke care. The overall goal of this proposal is to examine national trends in mental health, use of mental health services and disparities among stroke survivors from 2004 to 2016. Specifically, we will use nationally representative data from the Medical Expenditure Panel Survey to examine (1) national trends in prevalence of depression and serious psychological distress, (2) national trends in use and underuse of mental health services, including psychotherapy and antidepressants, (3) potential differences in these trends across sociodemographic groups, and (4) the extent to which trends in mental health among stroke survivors are attributable to changes in their use of mental health services. Findings of the research will provide insights into gaps and opportunities in post- stroke mental health care, and identify vulnerable sociodemographic groups in need of increased attention.