PROJECT SUMMARY/ABSTRACT The improvement in stroke survivorship over the past decades highlights the importance of post-stroke outcome research. Depression and psychological distress are among the most common post-stroke mental health conditions. Nearly one-third of stroke survivors experience depression at some point after stroke. Although the American Heart Association/American Stroke Association guidelines recommend screening and treatment for depression in stroke patients, post-stroke depression remains underdiagnosed and undermanaged. Depressive symptoms are not only disabling in their own right, but also interfere with functional recovery. Antidepressants, the first-line treatment for post-stroke depression, have also been increasingly prescribed for motor recovery in stroke rehabilitation settings in the past decade. However, recent randomized controlled trial evidence puts antidepressant use for functional outcomes under debate. Meanwhile, the dramatic increase in mental health service use in the general population since the 1990s may also have influenced trends in the stroke population. However, there is no population-level overview of mental health status and services use among stroke survivors in the United States, and little is known about mental health and mental health care disparities in the evolving context of stroke and stroke care. The overall goal of this proposal is to examine national trends in mental health, use of mental health services and disparities among stroke survivors from 2004 to 2016. Specifically, we will use nationally representative data from the Medical Expenditure Panel Survey to examine (1) national trends in prevalence of depression and serious psychological distress, (2) national trends in use and underuse of mental health services, including psychotherapy and antidepressants, (3) potential differences in these trends across sociodemographic groups, and (4) the extent to which trends in mental health among stroke survivors are attributable to changes in their use of mental health services. Findings of the research will provide insights into gaps and opportunities in post- stroke mental health care, and identify vulnerable sociodemographic groups in need of increased attention.