Medicine and Health Sciences Commons^™

Maternal Dysbiosis Produces Long-Lasting Behavioral Changes In Offspring, Jacob Hudobenko, Claudia M Di Gesù, Patrick R Mooz, Joseph Petrosino, Nagireddy Putluri, Bhanu P Ganesh, Kristen Rebeles, Frank W Blixt, Venugopal R Venna, Louise D Mccullough

Faculty, Staff and Student Publications

Advanced maternal age (AMA) is defined as a pregnancy in a woman older than 35 years of age. AMA increases the risk for both maternal and neonatal complications, including miscarriage and stillbirth. AMA has also been linked to neurodevelopmental and neuropsychiatric disorders in the offspring. Recent studies have found that age-associated compositional shifts in the gut microbiota contribute to altered microbial metabolism and enhanced inflammation in the host. We investigated the specific contribution of the maternal microbiome on pregnancy outcomes and offspring behavior by recolonizing young female mice with aged female microbiome prior to pregnancy. We discovered that pre-pregnancy colonization …

Randomized Controlled Trial Of "Bounce Back Now," A Mobile App To Reduce Post-Disaster Symptoms Of Posttraumatic Stress, Depressed Mood, And Sleep Disturbance, Kenneth J Ruggiero, Arthur Andrews, Tatiana M Davidson, Yulia Gavrilova, Brian E Bunnell, Jennifer Dahne, Matthew Price, Zoe M F Brier, Gregory Cohen, Dean Kilpatrick, Ron Acierno, Sandro Galea

Faculty, Staff and Student Publications

Objective: There is tremendous public health interest in cost-efficient, scalable interventions to improve post-disaster mental health. The authors examined the efficacy of Bounce Back Now (BBN), a mobile application, versus an enhanced usual care app (EUC).

Methods: A population-based trial was conducted with a diverse sample of 1,357 adults affected by Hurricane Harvey, Irma, Maria, Florence, or Michael in 2017 and 2018. Participants were eligible if they were ≥18 years of age, had access to an Internet-accessible device, were English speaking, and lived in a hurricane-affected area. BBN is designed to address symptoms of posttraumatic stress, depression, and sleep disturbance …

Understanding The Association Between Mental Health And Medication Adherence In Adolescents With Chronic Kidney Disease, Christabelle Ayensu-Asiedu, Cozumel Pruette, Tammy Brady, Michelle Eakin, Kristin Riekert, Cyd Eaton

Research Day

Background

Adolescents with CKD often face significant mental health challenges that may affect their medication adherence. Despite the high prevalence of mental health concerns (specifically internalizing symptoms) in this population, the association between the severity of these symptoms and medication adherence remains underexplored.

Methods

The current cross-sectional study included adolescents with CKD who were prescribed an antihypertensive medication and completed the Behavior Assessment System for Children, 2nd edition Self-report (BASC-SRP-2). Antihypertensive medication adherence was objectively evaluated over 2 weeks using the MEMS cap. We used the BASC-SRP-2 depression, anxiety, somatization, and internalizing scales and classified participants into sub-clinical (T-score < 60) and at-risk (T-score ≥ 60) groups. We examined the associations between the selected BASC-SRP-2 domains and medication adherence using Wilcoxon rank-sum tests. Adjusted associations were evaluated with logistic regression models dichotomizing adherence as < 75% or ≥75% (covariates were age, race, sex, and income).

Results …

Depressive Symptoms And Associated Factors Among Men Who Have Sex With Men In Malaysia, Fiora Lena

Honors Scholar Theses

There is a high prevalence of mental health issues, including depressive symptoms, among men who have sex with men (MSM) globally. Such a study has not been done in Malaysia, a setting where stigma and discrimination are particularly high and same-sex behaviors are criminalized. While HIV and sexual behavior among MSM in Malaysia are well studied, their depressive symptoms remain underexplored. Therefore, the purpose of this study was to determine the proportion of MSM in Malaysia who experience depressive symptoms. In this study, we conducted a secondary data analysis of the baseline data of the Project JomPrEP, which is a …

The Effects Of Prescribed Medications On Depressive Symptoms And Neurocognitive Performance In People With Hiv, Asante R Kamkwalala, Avery Matthews, Ankita Garg, Upal Roy, Qing Ma, Maile Karris, Erin Sundermann, Ronald J Ellis, Patricia K Riggs, Mattia Trunfio, Jennifer Blanchard, David J Moore, Leah H Rubin, Scott L Letendre

Faculty, Staff and Student Publications

Background: Alterations in brain function and structure, such as depression and neurocognitive impairment, continue to occur in people with human immunodeficiency virus (HIV, PWH) taking suppressive antiretroviral therapy (ART). The lifespan of PWH has improved but the healthspan remains worse than people without HIV, in part because of aging-related diseases. As a result, polypharmacy is common and increases the risk of drug-drug interactions and adverse reactions.

Methods: This cross-sectional project investigated the relationship between 7 medication-related metrics (including anticholinergic burden), depressive symptoms, and neurocognitive performance in 491 PWH at a single center in the United States. All participants were taking …

The Relationship Between Climate Change Awareness And Mental Health Among Adults In The United States, Stanley Nkemjika

Walden Dissertations and Doctoral Studies

Understanding the connection between climate change awareness and overall well-being is crucial, particularly regarding its impact on the environment and mental health. However, there is a need for more research on this topic, especially within the American context. The mental health implications of climate change are not yet fully understood, and there is a gap in the literature. This gap was addressed by exploring climate change awareness effects on mental health among U.S. adults. The social ecological model provided a framework to examine the impact of climate change awareness on mental health, considering individual, interpersonal, community, and societal factors. This …

Effects Of Hyperglycemia In Cognition And Sex, Erin E. Mcdonald

Senior Honors Theses

An empirical study tested the effects of Type 1 Diabetes (T1D) on cognitive function in a hyperglycemic mouse model. Strong correlations between mental illnesses, such as major depressive disorder, neuropathologies like Alzheimer’s disease, and diabetes suggest comorbid pathology. Considering the prevalence of both T1D and cognitive decline within the general population, the findings were relevant and aimed to identify early signs of cognitive decline in diabetic patients. Behavioral tests and immunohistochemical staining were utilized to determine the cognitive function of the mice, revealing decline or deterioration caused by hyperglycemia. Data gathered from the hyperglycemic or control mice were analyzed based …

Impact Of Antidiabetic Medication Type On A New Episode Of Depression: A Retrospective Cohort Study In Texas, Usa, Lin-Na Chou, Mukaila A Raji, Holly M Holmes, Yong-Fang Kuo

Faculty, Staff and Student Publications

Objectives: To examine the associations between antidiabetic medication type and a new episode of depression using 100% Texas Medicare database during 2009 and 2018.

Design: A retrospective cohort study.

Setting: A population-based study using the Texas Medicare data.

Interventions: 11 common antihyperglycaemic medication types, alone and in combinations: metformin-only, five non-metformin-containing regimens (dipeptidyl peptidase-4 inhibitor (DPP4i) only, sulfonylureas (SU) only, thiazolidinediones (TZD) only, SU/DPP4i and SU/TZD) and five metformin-containing combination treatments (metformin/DPP4i, metformin/SU, metformin/TZD, metformin/SU/DPP4i and metformin/SU/TZD).

Participants: This study included 59 057 type 2 diabetes (T2D) patients from a cohort of Texas Medicare beneficiaries who were aged ≥66 years, …

Enhancing Provider Knowledge With Phq-9 Education, Laurette Abunaw

Walden Dissertations and Doctoral Studies

Depression represents a significant public health concern that often remains undiagnosed or untreated, primarily due to insufficient systematic screening in primary care settings. The lack of standardized screening tools such as the Patient Health Questionnaire-9 (PHQ-9) elevates patient risks, increasing symptom severity, increasing suicide rates, and delaying interventions. Research studies show that a significant number of individuals with depression go untreated for long durations, with primary care settings recognizing only a small percentage of cases. The PHQ-9 is an effective tool for assessing and monitoring depression in a primary care setting, leading to early detection of symptom severity. Clinical practice …

Discovering The Cultural Impacts On Asian American, Pacific Islander (Aapi) Occupations From Adolescent Experiences, Jasmine Chew, Karen Park

Spring 2025 OTD Capstone Symposium

Background: Among the Asian American Pacific Islander (AAPI) population, there is a gap in mental health (MH) utilization and seeking support for anxiety and depression (Wu et al., 2021). Adolescents experience a higher risk for self-isolating behaviors and struggle to find appropriate support (Ai et al., 2022; Santos & Kawabata, 2023). Based on cultural and socio-political contexts, what is the occupational impact on AAPI adolescents? How do cultural factors impact the utilization of community-based MH services?

Method: A convergent mixed methods study of unobtrusive data (n = 14), surveys (n = 29), and interviews (n = 4) was …

Pharmacogenomics-Guided Treatment Of Depression Evidence-Based Practice Scholarly Project, Richard A. Sonnier

Doctoral Dissertations and Projects

Pharmacogenomics is a popular topic in psychiatry today that is poised to replace the outdated trial-and-error paradigm of prescribing psychotropic medications. For patients suffering from a myriad of psychiatric disorders, it has been a frustrating period for those who have struggled with multiple failed trials of medications before finding relief from debilitating depression, anxiety, and many other mood-dysregulating disorders. Often, patients are forced to endure several weeks or months of trying psychotropic agents with poor responses and intolerable side effects before finally finding a medication that yields a desired outcome. In some cases, no therapeutic response is ever achieved. With …

An Uncharacteristic Case Presentation Of Functional Vision Disorder, Ramandeep Kaur Od, Theresa Zerilli-Zavgorodni Od, Nancy Shenouda-Awad Od

Optometric Clinical Practice

Background: Functional Vision Disorder (FVD), also commonly referred to as functional vision loss (FVL) or non-organic vision loss (NOVL), is defined as a visual acuity (VA) loss and/or visual field (VF) loss, without any identifiable ocular or cortical pathology. Many clinicians look at FVD as a diagnosis of exclusion and while it is imperative to rule out organic pathology, FVD diagnosis must be supported by clinical findings that prove normal visual function. Incorporating supplementary tests specific for demonstrating the integrity of the visual system and the non-organic nature of the symptoms will allow clinicians to be more confident when diagnosing …

Heterozygous Hereditary Vitamin D-Dependent Rickets Type 2a (Vddr2a) In A Patient Presenting With Pseudoarthrosis, Risa Goldberg, Gunjan Umarji, Serge Jabbour

Division of Endocrinology, Diabetes and Metabolic Diseases Faculty Papers

This case report is centered on an atypical presentation of Hereditary Vitamin D-dependent Rickets 2A (VDDR2A), a rare disorder caused by defects in the gene encoding the vitamin D receptor (VDR). While this disorder is primarily autosomal recessive in inheritance, this case demonstrates that a single heterozygous variant in the VDR gene could be linked to both phenotypic and laboratory manifestations of this condition. To understand the pathogenesis of this condition, one must know the typical roles of vitamin D, calcium, and parathyroid hormone (PTH) in maintaining homeostasis in the body. This case report focuses on the underlying pathogenesis of …

The Association Of Sleep Quality And Depression On Having Three Vs. All Five Diagnostic Criteria Of Metabolic Syndrome, Nina Pollard

Walden Dissertations and Doctoral Studies

Metabolic syndrome is increasing in prevalence in the United States. To be diagnosed, three of the five diagnostic criteria must be met. There is a higher risk of metabolic syndrome due to lifestyle and social factors, with increased criteria occurring as an individual has unmet social determinants of health. This quantitative quasi-experimental/quasi-comparative study examined the association between education level, with sleep quality and depression as moderators, on a diagnosis of metabolic syndrome with all five criteria versus three criteria using a binary logistic regression while controlling for age, race, gender, income, employment, and marital status. Bronfenbrenner’s social ecological theory served …

A Long Non-Coding Erna Forms R-Loops To Shape Emotional Experience-Induced Behavioral Adaptations, Rose Marie Akiki

MUSC Theses and Dissertations

Emotional experiences often evoke neural plasticity that supports adaptive changes in behavior, including maladaptive plasticity associated with mood and substance use disorders. These adaptations are supported in part by experience-dependent activation of immediate-early response genes, such as Npas4. We discovered that a conserved, long non-coding enhancer RNA (lnc-eRNA) transcribed from an activity-sensitive enhancer produces DNA-RNA hybrid R-loop structures that support 3D chromatin-looping of the enhancer and proximal promoter and stimulus-induced, rapid Npas4 gene induction. We also show that this Npas4 lnceRNA and its R-loops are required for the development of behavioral adaptations produced by chronic psychosocial stress or cocaine exposure, …

Safety And Efficacy Of 112 Mg Intranasal Esketamine In Patients With Treatment-Resistant Depression: A Retrospective Observational Study From Outpatient Community Clinics, Kirsten Brinkmeier, Michael Kritzer, Brandon Doan, Cecilia Li, Nicholas Mischel

Medical Student Research Symposium

This retrospective study examined the safety and efficacy of 56, 84, and 112 mg intranasal (IN) esketamine via medical record review of 24 patients with treatment resistant depression (TRD). Doses ranged from 56 mg to 112 mg and were titrated across sessions to maximize individual response while considering tolerability. Treatment response was defined by reduction in average Patient Health Questionnaire-9 (PHQ-9) scores. Tolerability was defined by blood pressures at baseline, 40 minutes after, and 2 hours after drug administration. Patients ranged from 19 to 60 years old (average 38.87), and 15 (62.5%) were female. Patients received an average of 1 …

Assessment Of Cognitive Domains In Major Depressive Disorders Using The Cambridge Neuropsychological Test Automated Battery (Cantab): Systematic Review And Meta-Analysis Of Cross-Sectional And Longitudinal Studies, Danilo Arnone, Reshma Ramaraj, Linda Östlundh, Teresa Arora, Syed Javaid, Romona Devi Govender, Emmanuel Stip, Allan H. Young

All Works

Cognitive difficulties are known to persist after remission of symptoms and to affect psychosocial functioning and quality of life. Cognitive function, measured with the Cambridge Neuro-psychological Test Automated Battery (CANTAB), is a reliable approach to measure cognitive function in major depression. This systematic review and meta-analysis appraise cross-sectional and longitudinal studies that used specific CANTAB tests to measure cognitive function in major depression and the effect of treatment (PROSPERO ID: CRD42022355903). 1212 studies were identified and 41 were included, 1793 patients and 1445 healthy controls. Deficits in executive functions were detected with the Stocking Of Cambridge (SOC) ‘number of problems …

Effects Of Acute Stress On Executive Functions In Depression, Generalised Anxiety And Borderline Personality Disorder, T. M. Scott, Joanne M. Dickson

Research outputs 2022 to 2026

Background: Acute stress adaptively alters executive functions (EFs) essential for emotion regulation. Emerging systems of psychiatric classification, such as the Hierarchical Taxonomy of Psychopathology (HiTOP) and the Research Domain Criteria, emphasise the underlying mechanisms and dimensional nature of psychopathology. Distress disorders—a subfactor within the HiTOP model including major depressive disorder, generalised anxiety disorder and borderline personality disorder—are characterised by altered stress reactivity, impaired emotion regulation, and modest responsiveness to first-line psychotherapies. This systematic review sought to examine whether distress disorders and their related symptoms confer heightened vulnerability to transient EF impairment under conditions of acute stress. Methods: A comprehensive search …

Assessing Nerve Block And Opioid Analgesics On Anxiety And Depression In Patients With Lumbar Radiculopathy, Ashley Deng, Liying Wei, Eduardo Espiridion

Tower Health Research Day

No abstract provided.

Prevalence Of Psychiatric And Sleep Disorders And Their Impact On Quality Of Life In Children With Hypermobile Ehlers-Danlos Syndrome: An Observational Study., Amanda K. Hertel, Jordan T. Jones, Ashley Lytch, Emily Cramer, Ariana Schroeder, William R. Black

Manuscripts, Articles, Book Chapters and Other Papers

Hypermobile Ehlers-Danlos Syndrome (hEDS) is the most common connective tissue disorder. However, few studies exist on psychiatric and sleep disorders in pediatric patients with hEDS. This study aims to describe psychiatric and sleep disorders and evaluate their impact on health-related quality of life (HRQoL) in pediatric patients with hEDS. As part of a longitudinal study, a convenience sample of 123 pediatric patients with hEDS, were recruited at a hEDS multidisciplinary clinic in sequential order over a seven-month period. Patient-reported outcomes were completed (Patient Reported Outcomes Measurement Information System Pediatric Profile Version 2 [PROMIS], Generalized Anxiety Disorder-7 [GAD-7], Adolescent Sleep Wake …

Efficacy And Safety Of Behavioural Activation On Depression In People With Co-Occurring Non-Communicable Diseases: Systematic Review And Meta-Analysis, Engida Yisma, Kuda Muyambi, Sandra Walsh, Shwikar Othman, Richard Gray, Kuan Liung Tan, Mary Steen, Martin Jones

Research outputs 2022 to 2026

Background People with non-communicable diseases (NCDs) have a higher prevalence of comorbid depression than the general population. While previous research has shown that behavioural activation is effective for general depression, its efficacy and safety in treating depression associated with NCDs remains unclear. Aims To compare the efficacy and safety of behavioural activation against comparators in reducing depression symptoms in people with NCDs. Method We searched six databases from inception until 30 March 2023 (updated 23 September 2024) for randomised controlled trials (RCTs) comparing behavioural activation with comparators for depression in people with NCDs. Risk of bias was assessed using the …

Evaluation Of The Distress Thermometer In Older Patients With Cancer, Charlotte Zuber, Kristine Swartz, Andrew Chapman, Lora Rhodes, Tingting Zhan, Kuang-Yi Wen

Kimmel Cancer Center Faculty Papers

INTRODUCTION: The Geriatric Depression Scale is a useful tool in screening for depression in older adults, a particularly vulnerable population in oncology. The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) has been validated as a fast and effective screening tool for psychological distress in general oncology populations, and it could possibly be used as a surrogate for the longer Geriatric Depression Scale (GDS) test in older adults with cancer.

MATERIALS AND METHODS: In this retrospective cross-sectional study in older adults prior to starting cancer treatment, we evaluated the relationship between the DT and GDS by comparing 242 older adults …

Examining The Impact Of Depression And Anxiety On The Trajectory Of Executive Functioning And Processing Speed In Mild Cognitive Impairment (Mci), Luke Vaartstra

Clinical Psychology Dissertations

Mild cognitive impairment (MCI) is an intermediary state between normal aging and dementia which is growing in prevalence in the older adult population. Trajectories for MCI are variable and can result in a variety of outcomes including a rescinding of the MCI diagnosis, progression to dementia, or a new state of cognition. The current study examined the impact of depression and anxiety on the cognitive domains of executive functioning and processing speed in MCI trajectories. Data was used from the National Alzheimer’s Coordinating Center’s Uniform Data Set and included a sample of 2886 participants with and MCI diagnosis. Hierarchical linear …

Connections Between Co-Occurring Symptoms Of Eating Disorders, Gut Dysbiosis, Anxiety, And Depression, Erin L. Thomas

Doctoral Dissertations and Projects

Eating disorders (ED) are a pervasive mental health condition that puts individuals at risk for long-term physical consequences or even death, and current treatment methods typically do not offer long-term efficacy. The current study aims to examine relationships between co-occurring symptoms of EDs, gastrointestinal distress, anxiety, and depression to add to the scientific literature and point towards directions that may increase the benefits of treatment efforts. A total of 72 participants were asked to complete an online survey that consisted of measures from each variable and took about 20 minutes to finish. Participating individuals had to be at least 18 …

Mind Matters: How Anxiety And Depression Shape Low-Risk Prostate Cancer Active Surveillance Adherence In A Real-World Population, Zachariah Taylor, Kayla Meyer, Danielle Terrenzio, Ryan Wong, Sharon L. Larson, Stephanie Kjelstrom, Natalina Contoreggi, Laurence Belkoff, Ilia Zeltser

Jefferson Hospital Staff Papers and Presentations

PURPOSE: While the mental health impact of a prostate cancer diagnosis, including low-risk prostate cancer, is well-documented, the effect of pre-existing anxiety and/or depression on adherence to active surveillance protocols in low-risk prostate cancer patients remains unclear. This study assessed the association between prior anxiety and/or depression and active surveillance adherence in men with low-risk prostate cancer.

METHODS: We conducted a retrospective, multicenter study involving 426 men diagnosed with low-risk prostate cancer who were recommended active surveillance as the primary management strategy. Active surveillance adherence was defined by completion of both a prostate-specific antigen test and a prostate biopsy within …

New-Onset Depression Following Total Shoulder Arthroplasty: The Impact Of Preoperative Patient Factors And Postoperative Complications, Kevin Xavier Farley, Robert Dean, J Michael Wiater

Conference Presentation Abstracts

INTRODUCTION: Depression has been well studied as a risk factor for postoperative complications following total shoulder arthroplasty (TSA). However, little is known about new-onset depression (NOD) following TSA. The purpose of this study is to determine the incidence of NOD following TSA and identify risk factors for its occurrence. METHODS: This was a retrospective review of patients undergoing TSA in the Truven Health MarketScan database. NOD was identified. Patients with pre-operative depression were excluded from analysis. Post-operative complications were identified, including the development of a prosthetic joint infection (PJI), need for revision surgery, and postoperative dislocation. If a complication occurred …

The Long-Term Effect Of Dolutegravir On Depressive Side Effects: A Charter Cohort Study On People With Hiv, Sonya A. Bhatia, Upal Roy, Ankita Garg, Asante R. Kamkwalala, Avery Matthews, David B. Clifford, Benjamin Gelman, Susan Morgell, Payal Patel, Leah H. Rubin, Donald Franklim, Robert K. Heaton, Ronald J. Ellis, Scott L. Letendre

Research Symposium

Background: Integrase strand transfer inhibitors (InSTIs) are first-line therapy in the U.S. and other countries. One InSTI drug, dolutegravir (DTG), has been linked to neuropsychiatric adverse events but few reports have used standardized assessments of depression or assessed the concomitant influence of age and antidepressant use. These analyses aimed to determine the relationships between InSTI use, aging, antidepressant use, and depressive symptoms in people with HIV (PWH).

Methods: All 280 participants were comprehensively assessed in the CHARTER Aging project; were taking cART; and had plasma HIV RNA ≤ 200 copies/mL. The project enrolled participants based on chronological age < or ≥ 60 years. The Beck Depression Inventory (BDI)-II and four subscales were compared to demographic characteristics, use of InSTIs and antidepressants, and clinical biomarkers in a cross-sectional design by multivariable linear regression, including backward selection by Akaike Information Criterion.

Results: Participant …

A Review Of Factors That Contribute To Negative Mental Health Among Health Profession Students And Current Interventions, Faith T. Allison, Acsw, Lindsay Gietzen, Phd, Pa-C

Pacific Journal of Health

The purpose of this literature review is to review literature surrounding behavioral health impacts of education on students seeking bachelor’s degrees or higher in the health care sector. The studies range from individuals in undergraduate programs to individuals in graduate programs such as medical school. This review aimed to identify commonalities in the existing literature pertaining to the contributing factors that have been shown to have a detrimental impact on the mental, emotional and physical well-being of the students. Students that are forced to navigate a complex academic landscape filled with rigor and intense competition may have difficulties coping as …

The Influence Of Stroke Characteristics On Gad-7 And Phq-9 Scores: A Retrospective Analysis In The Rio Grande Valley, Maria Sophia Zaraspe Malbas, Allison J. Mcadams, Julia Paz, Miguel Quintanilla, Karina Y. Zamora, Sowmya Duddu, Kelsey Baker

Research Symposium

Background: Strokes, also known as cerebral infarctions, are life-threatening emergencies. They involve blockage of blood flow to the brain and require prompt and critical management to prevent permanent damage or death. The long-term effects of a stroke may include impaired speech, restricted physical mobility, as well as depression and anxiety. The prevalence of anxiety and depression after a stroke is estimated between 20-25% and 20-40% of patients respectively. Just as it is imperative to treat strokes as they transpire, it is equally important to initiate appropriate rehabilitation and therapy targeting post-stroke psychiatric outcomes. The Patient Health Questionnaire 9 (PHQ-9) …

Elder Mistreatment Within Stroke Family Caregiving, Carina Katigbak, Wesley R Browning, Sean Savitz, Carolyn E Z Pickering

Faculty, Staff and Student Publications

This secondary data analysis sought to identify characteristics associated with mistreatment among chronic stroke survivors who transition to dementia. We examined baseline data from a multi-time series survey study (n = 453; where caregivers of those with stroke n = 107, and those without stroke, n = 346) on caregiving experiences influencing dementia family caregivers’ abusive or neglectful behaviors. Inferential statistical analysis indicated that baseline mistreatment rates were similar across stroke and non-stroke subgroups, though this finding was not significant. Caregiver depression was significantly associated with mistreatment. Multi-morbidity, prescription medication use, and limited mobility were more common among stroke …