Psychiatric sequelae following aneurysmal subarachnoid hemorrhage: Insights from a high-volume neurosurgical center in northern China

Abstract

BACKGROUND

Aneurysmal subarachnoid hemorrhage (aSAH), a particularly devastating subtype of stroke, is associated with substantial rates of mortality and long-term functional impairment. Despite notable progress in therapeutic strategies, a considerable proportion of aSAH survivors continue to suffer from neuropsychiatric complications, most commonly anxiety and depression, which detrimentally impact their overall quality of life.

AIM

To investigate the prevalence of anxiety and depressive symptoms in patients with aSAH and to identify associated clinical risk factors.

METHODS

Clinical records of 1268 consecutive patients diagnosed with aSAH and treated between 2016 and 2022 were retrospectively reviewed. At follow-up, psychological assessments were performed using the Hospital Anxiety and Depression Scale to quantify symptoms of anxiety and depression. To identify independent predictors associated with these psychological outcomes post-aSAH, both univariate and multivariate statistical analyses were employed.

RESULTS

Among the studied cohort, 34.9% of patients presented with anxiety symptoms, while 31.8% demonstrated depressive features. Multivariate analysis identified female sex, presence of multiple aneurysms, a positive family history of cerebral hemorrhage, and receiving surgical clipping as independent predictors of anxiety. In contrast, significant predictors of depression included female sex, multiplicity of aneurysms, posterior circulation aneurysm localization, and poor clinical outcome. Notably, age above 60 years and documented functional recovery were associated with a reduced risk of depression.

CONCLUSION

Anxiety and depression are common neuropsychiatric sequelae in survivors of aSAH, each associated with a distinct set of risk factors. Early identification and targeted management of these risk profiles may facilitate more effective intervention strategies for psychological comorbidities, ultimately contributing to improved long-term patient outcomes.

Keywords: Aneurysmal subarachnoid hemorrhage; Anxiety; Depression; Risk factors; Psychological outcomes

Core Tip: In this large-scale, single-center analysis from northern China, anxiety and depression were observed in 34.9% and 31.8% of aneurysmal subarachnoid hemorrhage survivors, respectively. Female sex and the presence of multiple aneurysms were significantly associated with heightened psychological vulnerability. Additional risk factors for depression included posterior circulation aneurysm location, a family history of cerebral hemorrhage, and poor clinical outcomes. Conversely, advanced age and functional recovery emerged as protective factors. Timely identification, standardized screening, and individualized interventions may facilitate early management of post-aneurysmal subarachnoid hemorrhage emotional disturbances and ultimately enhance long-term recovery and quality of life.