The paper
Tjokrowijoto P, Stolwyk RJ, Ung D, Kneebone I, Kilkenny MF, Kim J, Olaiya MT, Dalli LL, Cadilhac DA, Nelson MR, Lannin NA, Andrew NE; PRECISE Investigators*. Receipt of Mental Health Treatment in People Living With Stroke: Associated Factors and Long-Term Outcomes. Stroke. 2023 Jun;54(6):1519-1527.
What was this research about?
Not surprisingly, anxiety and/or depression are very common after a stroke. These mental health conditions have a negative impact on recovery and make it more likely that someone will experience another stroke or even death. Anxiety/depression can also increase the burden on carers.
Anxiety/depression are very treatable after a stroke by using pharmacotherapy combined with psychological therapy. But we suspect from small studies that most people living with stroke who have mental health conditions are not being identified or treated in Australia.
This paper used data from the Australian Stroke Clinical Registry (AuSCR, a national clinical quality registry designed to monitor and improve stroke care) to identify patients with self-reported anxiety/depression. Registry data were linked with administrative claims datasets such as Medicare and the Pharmaceutical Benefits Scheme to see who had received government-funded treatment.
With 7,214 participants, this study was the largest ever conducted into provision of mental health support for people with stroke in Australia. It was a sub-study of the PRECISE project, an observational cohort study using linked population data.
What did the paper show?
The paper found that 39% of the participants reported anxiety or depression at 3 to 6 months after their stroke. Of these, only 54% received treatment.
The most common treatment (88%) was antidepressant medication. Only 13% received a combination of psychological management and mood medication, which has been shown to be the most effective treatment for anxiety/depression after stroke.
Men, older adults, and those who had not previously received mental health treatment were potentially underserviced populations.
The main barriers to identifying people who needed treatment were communication - which can be more challenging after a stroke - as well as language and financial barriers. For patients, barriers included the cost of services, being from a non-English speaking background, or living rurally or remotely.
What is the significance of these findings?
For the first time, this important paper provides population-level evidence of how Commonwealth Government-funded mental health treatments are used following stroke.
The findings confirm the long-held clinical impression that there is limited service provision in this area in Australia. The paper provides firm evidence to support calls for increased resources and services for this aspect of stroke care.
It also highlights the pivotal role of primary care physicians in the pathway to mental health care for stroke patients. It suggests that access to Medicare-funded chronic disease management plans may provide opportunities to provide more holistic care after a stroke.
What happens next?
Based on these findings, the authors recommend that health professionals should screen for mental health problems and introduce treatment options, with particular attention to individuals who are at risk of not receiving treatment. These recommendations will be submitted for inclusion in the Stroke Foundation’s living guidelines.
Talking to people with stroke about their lived experiences may provide further insights into better ways of connecting patients with the mental health support so many of them need.