Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Access to mood screening and psychological services after stroke in Australian acute and rehabilitation services: 2011-2021 (#172)

Shaun Hancock 1 2 , Tara Purvis 1 , Tash Thayabaranathan 1 , Rene Stolwyk 3 , Jan Cameron 1 , Lachlan Dalli 1 , Megan Reyneke 1 , Kelvin Hill 4 , Dominique Cadilhac 1 2
  1. Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
  2. Public Health - Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
  3. Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
  4. Stroke Foundation, Melbourne, Victoria, Australia

Background: Approximately one-third of stroke survivors will experience a mood impairment (such as depression, anxiety, or emotional lability) within 6 months of their stroke. Timely diagnosis of mood impairment is essential for facilitating early access to treatment.

Aims: To describe the trends over time in access to mood screening and management in Australian acute and rehabilitation hospitals from 2011-2021.

Methods: Cross-sectional data were used from the Stroke Foundation Audit program of inpatient services that alternates each year between Acute Services (2011/2013/2015/2017/2019/2021) and Rehabilitation Services (2010/2012/2014/2016/2018/2020). The Audit program includes a self-reported organisational survey of services (e.g., access to psychologists) and retrospective clinical audit of 40 consecutive medical records from each hospital including processes of care indicators (e.g., mood screening). Multivariable, multilevel logistic regression was used to estimate proportions in each year with adjustment for age, sex, and stroke severity. Cochrane Armitage tests for trends (ptrend) were used to compare results from each cycle.

Results: Between 2011-2021, 142 acute hospitals participated. Access to a psychologist involved in stroke care increased from 18% to 45% (ptrend=0.002). The adjusted proportion of patients with stroke who had their mood screened increased from 16% to 33% (ptrend<0.001). However, the adjusted proportion of mood impaired patients seen by a psychologist did not increase (2011 7%, 2021 9%, ptrend=0.24).

Between 2012-2020, 130 rehabilitation hospitals participated. Access to a psychologist involved in stroke rehabilitation increased over time (2012 38%; 2020 68%, ptrend<0.001), and more patients had their mood screened (adjusted proportion 2012 35%, 2020 61%, ptrend<0.001). The adjusted proportion of mood impaired patients seen by a psychologist also increased from 31% to 50% (ptrend<0.001).

Conclusion: Although clinical processes of care around in-patient management of mood improved over the 10 years within acute and rehabilitation services, gaps in care still exist. Revised pathways to increase access to mood screening and the detection of mood impairments are needed.