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Is Stroke Hospitalization Higher for Mentally Ill Veterans?

by U.S. Medicine

January 12, 2018

BALTIMORE—A recent study raises questions about whether stroke survivors with severe mental illness are at risk for increased nonpsychiatric hospitalization at the VHA compared to stroke survivors without prior psychiatric diagnoses.

The study published in PLoS One looked at risk of nonpsychiatric medical hospitalizations over five years after initial stroke at hospitals in the VA healthcare system. The retrospective cohort study was conducted by researchers from the VA Maryland Healthcare System and the University of Maryland, both in Baltimore.1

Included were 523 veterans who survived an initial stroke hospitalization in a VAMC during fiscal year 2003. Survivors—100 patients with SMI and 423 without—then were followed, using administrative data documenting inpatient stroke treatment, patient demographics, disease comorbidities, and VHA hospital admissions. The focus was on the relationship between patients with and without SMI diagnosis preceding the stroke and their experience with nonpsychiatric medical hospitalizations after the stroke.

Results indicate that unadjusted means for prestroke nonpsychiatric hospitalizations were higher (p = 0.0004) among SMI patients (1.47 ± 0.51) compared to those without SMI (1.00 ± 1.33), a difference which persisted through the first-year post-stroke (SMI: 2.33 ± 2.46; No SMI: 1.74 ± 1.86; p = 0.0004).

The study found, however, that the number of nonpsychiatric hospitalizations were not significantly different between the two groups after adjustment for patient sociodemographic, comorbidity, length of stay and inpatient stroke treatment characteristics. Researchers also reported that antithrombotic medications significantly lowered risk (OR = 0.61; 95% CI: 0.49-0.73) for stroke-related readmission within 30 days of discharge.

“No significant differences in medical hospitalizations were present after adjusting for comorbid and sociodemographic characteristics between SMI and non-SMI stroke patients in the five-year follow-up,” study authors concluded. “However, unadjusted results continue to draw attention to disparities, with SMI patients experiencing more non-psychiatric hospitalizations both prior to and up to one year after their initial stroke. Additionally, stroke survivors discharged on antithrombotic medications were at lower risk of re-admission within 30 days suggesting the VHA should continue to focus on effective stroke management irrespective of SMI.”

  1. Lilly FR, Culpepper J, Stuart M, Steinwachs D. Stroke survivors with severe mental illness: Are they at-risk for increased non-psychiatric hospitalizations? PLoS One. 2017 Aug 11;12(8):e0182330. doi: 10.1371/journal.pone.0182330. eCollection 2017. PubMed PMID: 28800605; PubMed Central PMCID: PMC5553814.

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