Dysphagia Associated with Risk of Depressive Symptoms among Stroke Survivors after Discharge from a Cluster of Inpatient Rehabilitation Facilities.

Objectives: To examine the association of stroke-induced dysphagia during an inpatient rehabilitation facility (IRF) stay and depressive symptoms at a 3-month follow-up.

Methods: A retrospective cross-sectional design using the Stroke Recovery in Underserved Populations 2005-2006 study database. Hierarchical logistic regression models were utilized to examine if stroke-induced dysphagia is a significant predictor for depressive symptoms at 3-month follow-up across the stepwise introduction of the demographics and clinical characteristics at the IRF discharge and 3-month follow-up. Multiple imputations with Markov-chain Monte Carlo method was used to address the covariates with missing observations.

Results: In a total of 1,045 stroke survivors, 335 (32.1%) stroke survivors had dysphagia and 710 (67.9%) stroke survivors did not have dysphagia during the IRF stay. The adjusted logistic regression model and multiple imputation method revealed that stroke survivors with dysphagia are more likely to have depressive symptoms at 3-month follow-up (Odds ratio [OR] 3.169, 95% confidence interval [CI] 1.379-7.283; OR 1.746, 95% CI 1.153-2.642, respectively). A high level of functional and cognitive status, functional support, and community participation at the 3-month follow-up was inversely associated with depressive symptoms (OR 0.973, 95% CI 0.951- 0.995; OR 0.884, 95% CI 0.829-0.942; OR 0.793, 95% CI 0.714-0.882).

Discussion: Stroke survivors experiencing dysphagia during the IRF stay had a higher risk of developing depressive symptoms compared to those without dysphagia at 3-month follow-up. Healthcare providers should pay attention to dysphagia care in IRFs which might prevent the development of depressive symptoms when the stroke survivors are discharged and back in their communities.