Gender and Race/ethnic Disparities in Psychotropic Medication Prescription at Discharge Among TIA and Mild/moderate Stroke Patients in the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) Study.

Depression and anxiety are common after stroke. Little is known about the factors associated with prescription of antidepressants (AD) and anti-anxiety (AA) medications post-stroke. The study used data from DESERVE, a randomized educational trial to reduce vascular risk in a multi-ethnic cohort of TIA and mild/moderate stroke patients in New York City. The study outcome was any AD or AA prescription at discharge, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic and tetracyclic antidepressants, norepinephrine-dopamine reuptake inhibitors, serotonin antagonist and reuptake inhibitors, anxiolytics, and benzodiazepines. Chi-square, Fisher’s exact, and Wilcoxon rank sum tests were used to examine the association between patient characteristics and AD/AA prescription. Factors associated with the outcome at p<0.10 in bivariate analysis were examined using multiple logistic regression. Of the 236 patients with medication information, 21.2% were prescribed an AD or AA, most commonly SSRIs/SNRIs (82.0%) and benzodiazepines (31.4%). In the adjusted model, males (OR=0.37 95% CI: 0.16, 0.84) and Non-Hispanic black/other race patients (OR=0.08, 95% CI: 0.03, 0.24) had significantly lower odds of AD/AA prescription. Probable depression pre-discharge (Center for Epidemiologic Studies-Depression scale ≥ 16) (OR=4.11, 95% CI: 1.46, 11.55) and prior psychiatry history (OR=2.82, 95% CI: 1.02-7.83) were associated with greater odds of AD/AA prescription. Non-significant differences in AD/AA prescription were noted on the basis of stroke severity, modified Rankin scale, and Hispanic ethnicity (Table 1). Prescription of ADs/AAs at stroke discharge was common and associated with gender and race/ethnicity independent of other factors. Further research is needed to better understand disparities in post-stroke psychotropic medication prescription.