Silent and Suffering: Untreated Depression Among Minority Stroke Survivors

A stroke is a life-altering event that occurs without warning. Strokes differ in severity with some being mild and others leaving survivors with permanent disabilities. While the physical and mental consequences of stroke can require extensive treatment and rehabilitation, the emotional ramifications are often ignored. In addition to outlining the prevalence and severity of depression among stroke survivors, this study examines the likelihood of mental health service utilization and barriers to care. Using data from the 2018 National Health Interview Survey, regression analysis evaluated the association between depression, depression frequency, and race/ethnicity controlling for income, insurance, and demographic characteristics among adult stroke survivors. Analyses also tested the likelihood of mental health services utilization and potential barriers to care among survivors who reported depression. Results indicated that Blacks and Hispanics stroke survivors were more likely to experience depression and experience depression more frequently than Whites. Minority groups were also less likely to utilize mental health services but did not cite lack of insurance or affordability as the reason for low utilization. This study found a higher prevalence and frequency of depression among Blacks and Hispanics and lower likelihood of receiving mental health services. Findings suggest lower mental health service utilization among depressed minority stroke survivors may be related to unobservable factors such as social stigma, lack of available care, inability to clearly identify depressive symptoms, and potentially greater resilience to overcome the negative impact of the condition. Impact Statement Black and Hispanic stroke survivors are not only more likely to experience depression, but also experience depression more frequently than Whites. Among stroke survivors reporting depression, racial and ethnic minorities are less likely to receive mental health services, but for reasons other than affordability and insurance limitations. These findings suggest that reasons such as access to care or social stigma prevent minority stroke survivors from receiving mental health care.