Editors' Note: Risk and Predictors of Depression Following Acute Ischemic Stroke in the Elderly

Dr. Mayman et al. evaluated the risk and predictors of poststroke depression compared with postmyocardial infarction (MI) depression in a retrospective cohort study using Medicare data in patients aged 65 years or older. Among 174,901 patients with stroke and 193,418 patients with MI, patients with stroke were more likely to develop depression. A history of anxiety was a key predictor of poststroke depression. The authors concluded that a stroke-specific process may be increasing the risk of depression in these patients and that consistent depression screening protocols are needed in patients with stroke. In response, Dr. Patel et al. suggested stratifying the poststroke depression analyses by different treatment settings to account for potential variability in screening results or depression in more acute settings. They also note that other studies have indicated a higher frequency of poststroke depression in the 12 months after stroke, with the frequency then decreasing. They suggest separately analyzing the patients who had a minimum of 12 and 18 months of follow-up to further validate the study results. Responding to these comments, the authors acknowledge that screening practices and associated results for depression can vary by treatment settings but note that they sought to maximize sensitivity by including both inpatient and outpatient claims. They plan to run further analyses stratified by diagnosis setting and the length of follow-up as suggested. This exchange highlights the potential importance of interpreting the results of poststroke depression screening in the context of the setting and duration of the follow-up.

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