Dossa A (Bedford), Berlowitz D
(Bedford), Loveland S
(Bedford), Hoenig H
This study examined the impact of psychiatric comorbidity on stroke rehabilitation outcomes in patients undergoing inpatient rehabilitation.
We used the 2001 VA Integrated Stroke Outcomes Database that included clinical, administrative, and mortality data. The sample consisted of 2545 stroke patients with a mean age of 68 years. Outcome variables included 3- and 6-month mortality post-discharge, 3- and 6-month rehospitalization post-discharge, and functional change post-inpatient rehabilitation. We defined psychiatric comorbidity as having any mental health or substance abuse diagnosis. Our models examined associations between the presence of outcomes and: psychiatric comorbidity; any mental health diagnoses or substance abuse; depression, psychosis, anxiety; and psychiatric diagnoses > 1 versus 1 diagnosis and none, as independent variables. Covariates included the Charlson index, demographics, discharge setting, length of stay, rehabilitation setting, and admission functional status.
Logistic regressions showed that having any psychiatric comorbidity predicted 6- month rehospitalization (OR: 1.25, p = .04). Having any mental health diagnosis was significantly associated with 6-month rehospitalization (OR: 1.09, p = .04) but substance abuse was not significant. Depression was significantly associated with 6-month rehospitalization (OR: 1.47, p = .005). Patients without psychiatric comorbidity were significantly less likely to be rehospitalized at six months compared to those with > 1 psychiatric comorbidity (OR: .69, p = .02). Logistic regressions showed that anxiety was significantly associated with 3- and 6-month mortality (OR: 2.12, p = .02; OR: 2.37, p = .001). Generalized linear models showed that patients with anxiety tended towards more functional change than those without anxiety (p = .06).
We found weak associations between psychiatric variables and rehospitalization and mortality. Functional change was not impacted by psychiatric variables, possibly because stroke patients accepted into rehabilitation programs may not have severe behavioral issues or because the VA has successfully intervened for these problems.
Since rehospitalizations can impact function, quality of life, and cost of care in stroke patients, we need to continue working on successful interventions to address psychiatric comorbidity in this population. Further research is needed on impact of psychiatric comorbidity and specific psychiatric diagnoses on functional change in older veterans with different diagnoses and with high disability risk.