Depression is common after stroke and has previously been linked with impaired cognition and function, increased suicidality and mortality. To date, systematic evidence regarding trends in diagnosis of post-stroke depression remains limited.

To characterize trends in the diagnosis of depression after stroke by gender and race/ethnicity from 2003-2019 in a cohort of privately insured individuals.

The Optum Clinformatics Data Mart Database is a large, de-identified commercial and Medicare Advantage claims database with follow-up from 2003–2019. We calculated rates of post-stroke depression in the year following stroke as the number of depression diagnoses per 1,000 person-years of follow-up. We used Cox proportional hazard models adjusted for gender, age, race/ethnicity, region, and calendar year to examine individual-level determinants of depression diagnosis among individuals with stroke.

We identified 831,486 with acute ischemic stroke (AIS), intraparenchymal hemorrhage (IPH), or subarachnoid hemorrhage (SAH). Approximately two-thirds were 65 years of age or older (67.8%) and 73.6% were white. Over the 16-year study period, the overall rate of post-stroke depression was highest for IPH (15.2; 95% CI: 14.8–15.5) and lowest for AIS (11.4; 95% CI: 11.3–11.5) one-year post-stroke with an increase in annual rates from 8.2 (95% CI: 7.9–8.5) in 2003 to 11.9 (95% CI: 11.7–12.1) in 2019. In adjusted Cox models, women were more likely to be diagnosed with post-stroke depression than men (HR: 1.56, 95% CI: 1.54–1.58) and post-stroke depression was diagnosed less frequently in patients who were Asian (HR: 0.60, 95% CI: 0.58–0.62), Black (HR: 0.78, 95% CI: 0.76–0.79), or Hispanic (HR: 0.89, 95% CI: 0.88–0.91) as compared with white patients.

Rates of post-stroke depression diagnosis increased over the study period, differed by stroke type, and differed significantly by individual characteristics such as race and gender.