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Stroke survivors with severe mental illness: Are they at-risk for increased non-psychiatric hospitalizations?

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  • Flavius Robert Lilly
  • Joel Culpepper
  • Mary Stuart
  • Donald Steinwachs

Abstract

Background: This study examined outcomes for two groups of stroke survivors treated in Veteran Health Administration (VHA) hospitals, those with a severe mental illness (SMI) and those without prior psychiatric diagnoses, to examine risk of non-psychiatric medical hospitalizations over five years after initial stroke. Methods: This retrospective cohort study included 523 veterans who survived an initial stroke hospitalization in a VHA medical center during fiscal year 2003. The survivors were followed using administrative data documenting inpatient stroke treatment, patient demographics, disease comorbidities, and VHA hospital admissions. Multivariate Poisson regression was used to examine the relationship between patients with and without SMI diagnosis preceding the stroke and their experience with non-psychiatric medical hospitalizations after the stroke. Results: The study included 100 patients with SMI and 423 without SMI. Unadjusted means for pre-stroke non-psychiatric 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). Number of non-psychiatric hospitalizations were not significantly different between the two groups after adjustment for patient sociodemographic, comorbidity, length of stay and inpatient stroke treatment characteristics. Antithrombotic medications significantly lowered risk (OR = 0.61; 95% CI: 0.49–0.73) for stroke-related readmission within 30 days of discharge. Conclusions: 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. 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.

Suggested Citation

  • Flavius Robert Lilly & Joel Culpepper & Mary Stuart & Donald Steinwachs, 2017. "Stroke survivors with severe mental illness: Are they at-risk for increased non-psychiatric hospitalizations?," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-15, August.
    • Handle: RePEc:plo:pone00:0182330
    DOI: 10.1371/journal.pone.0182330
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    References listed on IDEAS

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    1. Montgomery, A.E. & Fargo, J.D. & Byrne, T.H. & Kane, V. & Culhane, D.P., 2013. "Universal screening for homelessness and risk for homelessness in the Veterans Health Administration," American Journal of Public Health, American Public Health Association, vol. 103(S2), pages 210-211.
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    1. Ann Elizabeth Montgomery, 2021. "Understanding the Dynamics of Homelessness among Veterans Receiving Outpatient Care: Lessons Learned from Universal Screening," The ANNALS of the American Academy of Political and Social Science, , vol. 693(1), pages 230-243, January.

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