Post-Traumatic Stress Disorder in Patients 3 Years after Aneurysmal Subarachnoid Haemorrhage

Abstract

Background: Subarachnoid haemorrhage (SAH) from a ruptured intracranial aneurysm accounts for approximately 5% of all strokes. Post-traumatic stress disorder (PTSD) is common in the early phase after recovery from aneurysmal SAH. The aim of our study was to examine the prevalence of PTSD 3 years after SAH, its predictors, and relationship with health-related quality of life (HRQoL) in patients living independently in the community. Methods: From a prospectively collected cohort of 143 patients with aneurysmal SAH who visited our outpatient clinic 3 months after SAH, 94 patients (65.7%) completed a mailed questionnaire 3 years after SAH. We assessed PTSD with the Impact of Event Scale and HRQoL with the Stroke-Specific Quality of Life Scale (SS-QoL). The χ² and t tests were used to investigate if patients who returned the questionnaires were different from those who did not reply. Non-parametric tests (χ² and Mann-Whitney tests) were used to test for differences between patients with and without PTSD. Relative risks and 95% confidence intervals were calculated. Results: No relevant differences in demographic (age, sex, education) or SAH characteristics (clinical condition on admission, complication, location of aneurysm, Glasgow Outcome Scale score at 3 months) were seen between participants and drop-outs. In 24 patients (26%), Impact of Event Scale scores indicated PTSD. Passive coping style (relative risk, 5.7; 95% confidence interval, 2.1-15.3), but none of the demographic or SAH-related factors, predicted PTSD. The mean SS-QoL total score was 4.2 (SD 1.1), indicative of a relatively satisfactory HRQoL. PTSD was associated with lower HRQoL (p < 0.001), a mean SS-QoL score of 4.4 (SD 1.0) without PTSD, and a mean SS-QoL score of 3.5 (SD 1.1) with PTSD. Conclusions: Even 3 years after SAH, 1 out of 4 patients had PTSD, which was associated with reduced HRQoL. Passive coping style was the most important predictor. There is a need to organize SAH care with more attention to and treatment of PTSD. Strategies shown to reduce PTSD in other conditions should be tested for effectiveness in SAH patients.

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“…12 However, disease-related complaints, such as cardiovascular health risks or anxiety, may limit the use of progressive CPET in individuals with a-SAH. 13,14 Moreover, progressive CPET measurements with gas-exchange analyses require specialized knowledge and infrastructure, with limited availability in most rehabilitation facilities.…”

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“…Therefore, it is crucial to investigate the emergence and course of those symptoms. Studies on the development of PTSD in medical settings have been mostly restricted to life-threatening conditions, such as myocardial infarction and intracranial bleeding due to an aneurysm rupture (Hutter & Kreitschmann-Andermahr, 2014; Visser-Meily et al, 2013; Wasson, Shaffer, Alcantara, Schwartz, & Edmondson, 2014). Because these conditions represent medical emergencies, it was impossible to conduct a baseline (pretrauma) psychological evaluation of these patients.…”

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“…The 6-month mortality rate ranges from 40 to 50 %, and 30 % of survivors harbor permanent neurological impairment [2]. In recent years, research has focused on neuropsychological sequels of aSAH patients [3][4][5][6][7] and on factors related to diminished quality of life in patients with good neurological recovery [8]. Several reports over the last decade have explored the relationship between Susanna Bacigaluppi and Nicola Bragazzi have contributed equally to this work.…”