Depression or Anxiety According to Management Modalities in Patients With Unruptured Intracranial Aneurysms

Abstract

BACKGROUND: In the treatment of unruptured intracranial aneurysms, the risk was usually estimated by objective neurological sequelae. However, their effects on depression and anxiety are rare and remain controversial. We aimed to evaluate the risk of depression and anxiety in patients with unruptured intracranial aneurysm stratified by management strategies in a population-based, longitudinal cohort study. METHODS: Using the Korean National Health Insurance Research Database, 71 750 patients with unruptured intracranial aneurysms between 2008 and 2011 were identified and followed up until the end of 2020. The risk of depression and anxiety was compared among management strategies with respect to age, sex, and medical comorbidities. RESULTS: The Kaplan-Meier survival curves indicated that the treatment (clipping and endovascular treatment) group developed depression more frequently than the observation group ( P <0.001). The adjusted hazard ratio was 1.11 (95% CI, 1.07–1.15) in the treatment group. According to the management modality, the Kaplan-Meier survival curves indicated that clipping and endovascular treatment groups developed depression more frequently than the observation group ( P <0.0001). The adjusted hazard ratio was 1.15 (95% CI, 1.10–1.21) for clipping and 1.07 (95% CI, 1.02–1.12) for endovascular treatment. The depression risk was higher with advanced age (hazard ratio for 45–64 years, 1.37 [95% CI, 1.29–1.45] and hazard ratio for ≥65 years, 2.04 [95% CI, 1.92–2.17]). The risk for anxiety did not differ among the management modalities. CONCLUSIONS: In this study, the risk of depression was slightly greater after clipping surgery than endovascular treatment. Data on treatment-related, long-term psychological outcomes, such as depression, may aid decision-making for preventive treatment of asymptomatic unruptured intracranial aneurysm patients.

Social and Health Determinants of Quality of Life of Community-Dwelling Older Adults in Malaysia

“…It was postulated that the impacts of stroke on QOL might be mediated through these health problems. Functional disability was identified as a predictor for poor QOL among stroke patients in China [56], UK [58], and US [59], while the risk of depression was higher, especially among stroke patients in older age groups [60]. The study from China also found that stroke patients with a low income level had a poorer HRQoL [56].…”

“…Stroke is a major health problem with a significant impact on the QOL. Studies have shown that stroke patients are more likely to report a poorer QOL and health problems, such as disability or poor functional status [55][56][57][58][59] and anxiety or depression [60,61]. It was postulated that the impacts of stroke on QOL might be mediated through these health problems.…”

Outcomes of Bypass Surgery in Adult Moyamoya Disease by Onset Type

“…We identified patients newly diagnosed with MMD from January 1, 2008, to December 31, 2020, and we followed them up to December 31, 2021. A 1-year washout period (2007-2008) was used to prevent prevalent cases from interfering with the data for inclusion, exclusion, and confounding factors . We improved the accuracy of patient identification by using specific operational definitions.…”

“…A 1-year washout period (2007)(2008) was used to prevent prevalent cases from interfering with the data for inclusion, exclusion, and confounding factors. 11,12 We improved the accuracy of patient identification by using specific operational definitions. The diagnosis of MMD was established if International Statistical Classification of Diseases, Tenth Revision (ICD-10), code I67.5 and RID code V128 were newly recorded at least once in the database at hospital discharge or more than twice in the outpatient department.…”