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

Table 1 Baseline characteristics of 1268 aneurysmal subarachnoid hemorrhage patients, n (%)

Characteristics	Short term (n = 562)	Long term (n = 706)	Total (n = 1268)	P value
Female	317 (56.4)	418 (59.2)	735 (58.0)	0.32
Age	55.1 (10.7)	54.6 (10.7)	54.8 (10.7)	0.37
Age > 60	201 (35.8)	254 (36)	455 (35.9)	0.94
Smoking	142 (25.3)	212 (30)	354 (27.9)	0.06
Alcohol abuse	114 (20.3)	175 (24.8)	289 (22.8)	0.06
Hypertension	295 (52.5)	389 (55.1)	684 (53.9)	0.35
Hyperlipidemia	37 (6.6)	54 (7.6)	91 (7.2)	0.47
Diabetes	55 (9.8)	52 (7.4)	107 (8.4)	0.12
Multiple aneurysms	48 (8.5)	67 (9.5)	115 (9.1)	0.56
Family history of cerebral bleeding	15 (2.7)	26 (3.7)	41 (3.2)	0.31
HH grade	41 (7.3)	47 (6.7)	88 (6.9)	0.66
WFNS grade	86 (15.3)	90 (12.7)	176 (13.9)	0.19
mFS grade	331 (58.9)	442 (62.6)	773 (61.0)	0.17
Anterior circulation aneurysms	513 (91.3)	637 (90.2)	1150 (90.7)	0.09
Surgical clipping	258 (45.9)	347 (49.2)	605 (47.7)	0.03

HH: Hunt and Hess; WFNS: World Federation of Neurosurgical Societies; mFS: Modified Fisher Scale.

Table 2 Treatment details and clinical outcomes, n (%)

Characteristics	Short term (n = 562)	Long term (n = 706)	Total (n = 1268)	P value
Follow-up duration, mean ± SD	33.9 ± 14.56, 23.8 ± 7.3	42.0 ± 15.14, 58.5 ± 13.6	40.5 ± 15.06	< 0.001
Follow-up duration > 36 months	0 (0.00)	706 (55.70)	706 (55.7)	< 0.001
Treatment methods				0.03
Coiling	324 (48.9)	339 (51.1)	663 (52.3)
Clipping	258 (45.9)	347 (49.2)	605 (47.7)
MRS score at discharge: MRS score < 3	436 (77.6)	546 (77.3)	982 (77.4)	0.29
Functional improvement at the final follow-up1	248 (44.1)	313 (44.3)	561 (44.2)	0.38
MRS score at the final follow-up < 3	528 (94.0)	667(94.5)	1195 (94.2)	0.42

¹Functional improvement was defined as modified Rankin Scale score descended at follow-up than at discharge.

MRS: Modified Rankin Scale.

Table 3 Complications during hospitalization, n (%)

Complications during hospitalization	Short term (n = 562)	Long term (n = 706)	Total (n = 1268)	P value
Seizures	19 (3.4)	24 (3.4)	43 (3.4)	1.000
Intracranial infection	67 (11.9)	75 (10.6)	142 (11.2)	0.462
Pneumonia	113 (20.1)	152 (21.5)	265 (20.9)	0.515
Stress ulcer bleeding	51 (9.1)	60 (8.5)	111 (8.8)	0.688
Hypoproteinemia	151 (26.9)	190 (26.9)	341 (26. 9)	1.000
Deep vein thrombosis	32 (5.7)	33 (4.7)	65 (5.1)	0.611
Rebleeding	12 (2.1)	12 (1.7)	24 (1.9)	0.762
Delayed cerebral ischemia	95 (16.9)	99 (14.0)	194 (15.3)	0.295

Table 4 Statistical results of patients’ anxiety status, n (%)

Indicator	Short term (n = 562)	Long term (n = 706)	Total (n = 1268)	P value
Anxiety score, mean ± SD	6.8 ± 2.6	8.0 ± 3.1	7.5 ± 2.9	< 0.001
Anxiety at follow up	168 (29.9)	274 (38.8)	442 (34.9)	< 0.001
Mild	98 (17.5)	164 (23.2)	262 (20.7)
Moderate	60 (10.7)	104 (14.7)	164 (12.9)
Severe	10 (1.8)	6 (0.9)	16 (1.3)

Table 5 Statistical results of patients’ depression status, n (%)

Indicator	Short term (n = 562)	Long term (n = 706)	Total (n = 1268)	P value
Depression, mean ± SD	6.9 ± 2.5	7.8 ± 3.0	7.4 ± 2.7	< 0.001
Depression at follow up	153 (27.2)	250 (35.4)	403 (31.8)	0.002
Mild	94 (16.7)	149 (21.1)	243 (19.2)
Moderate	47 (8.4)	81 (11.5)	128 (10.1)
Severe	12 (2.1)	20 (2.8)	32 (2.5)

Table 6 Univariate and multivariate analysis of anxiety symptoms at follow-up

Variables	Univariate			Multivariate
	P value	Exp	95%CI	P value	Exp	95%CI
Gender	0.001	1.473	1.161-1.868	0.006	1.579	1.143-2.180
Age > 60	0.095	0.813	0.637-1.037	0.197	0.839	0.643-1.095
Smoking	0.002	0.658	0.504-0.860	0.162	0.769	0.533-1.111
Alcohol abuse	0.054	0.757	0.570-1.005	0.631	1.097	0.751-1.605
Hypertension	0.142	0.841	0.667-1.060
Diabetes	0.77	1.068	0.685-1.665
Hyperlipidemia	0.123	0.708	0.457-1.098
Multiple aneurysms	< 0.001	2.573	1.746-3.792	0.035	1.663	1.036-2.669
Family history of cerebral bleeding	< 0.001	7.085	3.350-14.984	< 0.001	4.968	2.108-11.708
HH grade 4 and 5	0.218	1.32	0.849-2.053
WFNS grade 4 and 5	0.428	1.143	0.822-1.589
MFS grade 3 and 4	0.203	1.167	0.920-1.482
Posterior aneurysm1	0.215	0.77	0.509-1.164
Surgical clipping	< 0.001	3.966	3.098-5.076	< 0.001	4.025	3.108-5.214
Clinical outcomes2	0.694	1.103	0.676-1.801
Function-improvement3	0.002	1.459	1.153-1.846	0.16	1.204	0.929-1.56

¹Posterior aneurysm means the ruptured aneurysms locates on posterior circulation.

²Clinical outcomes represent favorable functional outcomes identified as modified Rankin Scale ≤ 2.

³Function-improvement means modified Rankin Scale score descended at follow-up than at discharge.

HH: Hunt and Hess; WFNS: World Federation of Neurosurgical Societies; mFS: Modified Fisher Scale; CI: Confidence interval.

Table 7 Univariate and multivariate analysis of depression symptoms at follow-up

Variables	Univariate			Multivariate
	P value	Exp	95%CI	P value	Exp	95%CI
Gender	< 0.001	1.803	1.407-2.309	0.029	1.429	1.037-1.970
Age > 60	< 0.001	1.759	1.379-2.242	< 0.001	0.581	0.451-0.749
Smoking	< 0.001	0.569	0.429-0.753	0.484	0.877	0.607-1.267
Alcohol abuse	< 0.001	< 0.001	0.375-0.697	0.087	0.711	0.481-1.051
Hypertension	0.514	0.924	0.729-1.171
Diabetes	0.653	0.899	0.564-1.432
Hyperlipidemia	0.666	1.097	0.721-1.669
Multiple aneurysms	0.003	1.813	1.229-2.675	0.003	1.844	1.234-2.757
Family history of cerebral bleeding	0.741	1.117	0.579-2.154
HH grade 4 and 5	0.472	1.181	0.750-1.861
WFNS grade 4 and 5	0.719	1.064	0.758-1.494
MFS grade 3 and 4	0.774	1.036	0.813-1.321
Posterior aneurysm1	0.079	1.419	0.960-2.097	0.018	1.652	1.091-2.502
Surgical clipping	0.001	1.477	1.165-1.873	0.187	1.189	0.920-1.537
Clinical outcomes2	0.006	1.951	1.212-3.141	0.001	2.264	1.375-3.730
Function-improvement3	0.001	1.481	1.163-1.886	< 0.001	1.604	1.242-2.071

¹Posterior aneurysm means the ruptured aneurysms locates on posterior circulation.

²Clinical outcomes represent favorable functional outcomes identified as modified Rankin Scale ≤ 2.

³Function-improvement means modified Rankin Scale score descended at follow-up than at discharge.

HH: Hunt and Hess; WFNS: World Federation of Neurosurgical Societies; mFS: Modified Fisher Scale; CI: Confidence interval.