Advisor(s)
Virginia Howard
Committee Member(s)
Chen Lin
Melissa Smith
Nicole Wright
Shakia Hardy
School
School of Public Health
Document Type
Dissertation
Department (new version)
Epidemiology
Date of Award
1-6-2025
Abstract
Depression is a mental health crisis affecting 21 million Americans. Consequently, antidepressants are one of the most prescribed classes of medications in the American population. Depression is also a common adverse outcome after stroke with one in three patients having depressive symptoms within the first year of their stroke recovery phase. Antidepressants are effective in the treatment and prevention of depressive symptoms in stroke patients. However, the overall antidepressant use in the acute post-stroke phase and the patient characteristics influencing the prevalence of receiving antidepressant prescriptions during acute stroke hospitalization are not known. Depression is also associated with higher risk of incident and recurrent strokes. Given that antidepressants are an effective management strategy for depression, their use would be hypothesized to be associated with a lower risk of stroke. But studies suggest that antidepressants are associated with a higher risk of incident and recurrent strokes. It is unclear whether the association between antidepressant use and higher stroke risk is due to the effect of antidepressant medication itself or if it is a product of confounding by indication wherein the presence of depressive symptoms influences this association through its mediating effect. Additionally, the time-varying nature of depressive symptoms is not taken into consideration while assessing this phenomenon. To that end, the purpose of this dissertation was to (1) assess the prevalence of antidepressant use in patients during the acute stroke hospitalization phase and identify factors that influenced higher prevalence of antidepressant prescriptions, (2) evaluate the association between antidepressant use and incident stroke risk, assess whether accounting for time-varying depressive symptoms attenuated this association, and evaluate whether this association differed by age, sex, and race, and (3) measure the association between antidepressant use and recurrent stroke risk and assess the impact of baseline depressive symptom score on this association. For Aim 1, data from the stroke registry at a Southeastern referral hospital were used. Female sex, White race, higher number of clinical comorbidities, having a history of depression, and being discharged to an inpatient rehabilitation facility as opposed to home were found to be significantly associated with a higher antidepressant prescription prevalence at the end of acute stroke hospitalization. For Aims 2 and 3, data from the REasons for Geographic and Racial Differences in Stroke cohort were used. Antidepressant use was associated with a significantly higher risk of incident stroke, which was not attenuated remarkably after accounting for time-varying depressive symptoms. Antidepressant use was associated with a higher risk of recurrent stroke but this association was not statistically significant, and remained the same after accounting for baseline depressive symptom score.
ProQuest ID
Recommended Citation
Nanavati, Hely Divyanshu, "Predictors Of Antidepressant Use In Stroke Survivors And Evaluating The Role Of Time-Varying Depressive Symptoms On The Association Between Antidepressant Use And Stroke" (2025). All ETDs from UAB. 7259.
https://digitalcommons.library.uab.edu/etd-collection/7259
