Abstract P240: Racial/ethnic Differences in Psychological Distress after Stroke
Introduction Psychological distress after stroke has received some attention, but little is known about the impact of race/ethnicity. We conducted a secondary analysis to investigate whether there were racial/ethnic differences in psychological distress among stroke/TIA survivors enrolled in the Stroke Warning Information and Faster Treatment (SWIFT) trial, while taking into account the longitudinal nature of the data.
Methods The SWIFT trial was a randomized stroke preparedness educational intervention, which prospectively enrolled mild and moderate stroke/TIA patients able to sign informed consent and identified at the NY Presbyterian Medical Center from 2005 to 2010.
Psychological distress, defined as having a CES-D score ≥16, was measured at baseline, 1 month, and 12 months. The multiethnic sample included non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. Additional predictors included treatment assignment, health status, marital status, and SES. Health status included stroke severity, as measured by the NIH Stroke Scale, stroke type (stroke vs TIA), sex, age, comorbidities, and CVD history. SES included education, employment, and insurance.
We used GEE to explore the change in psychological distress over time. Second, we examined if racial/ethnic differences existed in psychological distress and whether race/ethnicity modified the rate of change in psychological distress after adjustment for treatment assignment, health status, marital status, and SES.
Results Our study sample included 563 participants, of which 27.7% (n=156) were non-Hispanic White, 18.6% (n=105) were non-Hispanic Black, and 53.6% (n=302) were Hispanic. About 63% of the 563 participants assessed at baseline met the criteria for psychological distress. We observed substantial improvement in the odds of psychological distress between baseline and the twelve month assessment (OR=0.68, 95% CI=0.53-0.88), and also between baseline and the one month assessment (OR=0.79, 95% CI=0.64-0.98). A protective effect against psychological distress was observed among Hispanics compared to non-Hispanic Whites (OR=0.64, 95% CI=0.47-0.87). Race/ethnicity, however, did not modify the rate of improvement in psychological distress over time.
Conclusion While several factors including stroke severity and loss of independence have historically been linked to psychological distress after stroke, the nature of the protective effect among Hispanics compared to Whites, even after adjustment for important risk factors, needs further exploration.
- © 2013 by American Heart Association, Inc.