Mental health, anxiety, and depression in patients with cerebral aneurysms

Joseph T. King Jr. M.D., M.S.C.E.1, Amin B. Kassam M.D.1, Howard Yonas M.D.1, Michael B. Horowitz M.D.1, and Mark S. Roberts M.D., M.P.P.1
View More View Less
  • 1 Section of Neurosurgery, VA Connecticut Healthcare System, West Haven; Department of Neurosurgery, Yale University, New Haven, Connecticut; Section of Decision Sciences and Clinical Systems Modeling, Division of General Internal Medicine, Department of Medicine; Center for Research on Health Care; and Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object. Aneurysm disease and its treatment can have an adverse impact on mental health, yet the affects of cerebral aneurysms on general mental health, anxiety, and depression are poorly understood.

Methods. Patients with cerebral aneurysms who were seen at a neurosurgery clinic underwent a structured interview, completed the Hospital Anxiety and Depression Scale and the Medical Outcomes Study 12-item Short Form Health Survey (providing a mental component summary [MCS] score for general mental health), and were assigned functional status scores based on the Glasgow Outcome Scale (GOS), Rankin Scale, and Barthel Index. Rank-order methods were used to assess the relationship between mental health, aneurysm characteristics and history, and functional status. Data were collected in 166 patients (71% women) with a mean age of 53.7 years. Depression was present in 8% of the study population and an anxiety disorder in 17%. Patients with both an unsecured aneurysm and a history of subarachnoid hemorrhage (SAH) tended toward higher anxiety scores (p = 0.086). Higher depression scores were associated with a decreased functional status on the GOS (p = 0.015) and Rankin Scale (p = 0.010). The mean 6 standard deviation adjusted MCS score (37.9 ± 7.1) was significantly less than that of the US population (p < 0.001). Lower MCS scores were associated with a decreased functional status on the GOS (p = 0.052), Rankin Scale (p < 0.001), and Barthel Index (p = 0.002).

Conclusions. Patients with cerebral aneurysms have increased levels of anxiety and depression and poor general mental health. Those who have experienced an SAH and harbor an unsecured cerebral aneurysm demonstrate increased levels of anxiety. A lower functional status in patients with aneurysms is associated with depression and decreased general mental health.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    Anderson KO, , Keefe FJ, , Bradley LA, , McDaniel LK, , Young LD, & Turner RA, et al: Prediction of pain behavior and functional status of rheumatoid arthritis patients using medical status and psychological variables. Pain 33:2532, 1988 Anderson KO, Keefe FJ, Bradley LA, McDaniel LK, Young LD, Turner RA, et al: Prediction of pain behavior and functional status of rheumatoid arthritis patients using medical status and psychological variables. Pain 33:25–32, 1988

    • Search Google Scholar
    • Export Citation
  • 2.

    Anonymous: The Dutch TIA trial: protective effects of low-dose aspirin and atenolol in patients with transient ischemic attacks or nondisabling stroke. The Dutch TIA Study Group. Stroke 19:512517, 1988 Anonymous: The Dutch TIA trial: protective effects of low-dose aspirin and atenolol in patients with transient ischemic attacks or nondisabling stroke. The Dutch TIA Study Group. Stroke 19:512–517, 1988

    • Search Google Scholar
    • Export Citation
  • 3.

    Anonymous: Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. The International Study of Unruptured Intracranial Aneurysm Investigators. N Engl J Med 339:17251733, 1998 Anonymous: Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. The International Study of Unruptured Intracranial Aneurysm Investigators. N Engl J Med 339:1725–1733, 1998

    • Search Google Scholar
    • Export Citation
  • 4.

    Berkman LF, , Berkman CS, , Kasl S, , Freeman DH Jr, , Leo L, & Ostfeld AM, et al: Depression symptoms in relation to physical health and functioning in the elderly. Am J Epidemiol 124:372388, 1986 Berkman LF, Berkman CS, Kasl S, Freeman DH Jr, Leo L, Ostfeld AM, et al: Depression symptoms in relation to physical health and functioning in the elderly. Am J Epidemiol 124:372–388, 1986

    • Search Google Scholar
    • Export Citation
  • 5.

    Brilstra EH, , Rinkel GJ, , van der Graaf Y, , Sluzewski M, , Groen RJ, & Lo RT, et al: Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolization with coils. A prospective, observational study. Cerebrovasc Dis 17:4452, 2004 Brilstra EH, Rinkel GJ, van der Graaf Y, Sluzewski M, Groen RJ, Lo RT, et al: Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolization with coils. A prospective, observational study. Cerebrovasc Dis 17:44–52, 2004

    • Search Google Scholar
    • Export Citation
  • 6.

    Chen ML, , Chang HK, & Yeh CH: Anxiety and depression in Taiwanese cancer patients with and without pain. J Adv Nurs 32:944951, 2000 Chen ML, Chang HK, Yeh CH: Anxiety and depression in Taiwanese cancer patients with and without pain. J Adv Nurs 32:944–951, 2000

    • Search Google Scholar
    • Export Citation
  • 7.

    Collin C, , Wade DT, , Davies S, & Horne V: The Barthel ADL index: a reliability study. Int Disabil Stud 10:6163, 1988 Collin C, Wade DT, Davies S, Horne V: The Barthel ADL index: a reliability study. Int Disabil Stud 10:61–63, 1988

    • Search Google Scholar
    • Export Citation
  • 8.

    Crawford JR, , Henry JD, , Crombie C, & Taylor EP: Normative data for the HADS from a large non-clinical sample. Br J Clin Psychol 40:429434, 2001 Crawford JR, Henry JD, Crombie C, Taylor EP: Normative data for the HADS from a large non-clinical sample. Br J Clin Psychol 40:429–434, 2001

    • Search Google Scholar
    • Export Citation
  • 9.

    Cronbach LJ: Coefficient alpha and the internal structure of tests. Psychometrika 16:297334, 1951 Cronbach LJ: Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334, 1951

    • Search Google Scholar
    • Export Citation
  • 10.

    Cuzick J: A Wilcoxon-type test for trend. Stat Med 4:8790, 1985 Cuzick J: A Wilcoxon-type test for trend. Stat Med 4:87–90, 1985

  • 11.

    Dew MA, , Kormos RL, , DiMartini AF, , Switzer GE, , Schulberg HC, & Roth LH, et al: Prevalence and risk of depression and anxiety-related disorders during the first three years after heart transplantation. Psychosomatics 42:300313, 2001 Dew MA, Kormos RL, DiMartini AF, Switzer GE, Schulberg HC, Roth LH, et al: Prevalence and risk of depression and anxiety-related disorders during the first three years after heart transplantation. Psychosomatics 42:300–313, 2001

    • Search Google Scholar
    • Export Citation
  • 12.

    Ghika-Schmid F, & Bogousslavsky J: Affective disorders following stroke. Eur Neurol 38:7581, 1997 Ghika-Schmid F, Bogousslavsky J: Affective disorders following stroke. Eur Neurol 38:75–81, 1997

    • Search Google Scholar
    • Export Citation
  • 13.

    Goethe JW, , Maljanian R, , Wolf S, , Hernandez P, & Cabrera Y: The impact of depressive symptoms on the functional status of innercity patients with asthma. Ann Allergy Asthma Immunol 87:205210, 2001 Goethe JW, Maljanian R, Wolf S, Hernandez P, Cabrera Y: The impact of depressive symptoms on the functional status of innercity patients with asthma. Ann Allergy Asthma Immunol 87:205–210, 2001

    • Search Google Scholar
    • Export Citation
  • 14.

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480484, 1975 Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975

    • Search Google Scholar
    • Export Citation
  • 15.

    Keith RA, , Granger CV, , Hamilton BB, & Sherwin FS: The functional independence measure: a new tool in rehabilitation. Adv Clin Rehab 1:618, 1987 Keith RA, Granger CV, Hamilton BB, Sherwin FS: The functional independence measure: a new tool in rehabilitation. Adv Clin Rehab 1:6–18, 1987

    • Search Google Scholar
    • Export Citation
  • 16.

    Kotila M, , Numminen H, , Waltimo O, & Kaste M: Post-stroke depression and functional recovery in a population-based stroke register. The Finnstroke study. Eur J Neurol 6:309312, 1999 Kotila M, Numminen H, Waltimo O, Kaste M: Post-stroke depression and functional recovery in a population-based stroke register. The Finnstroke study. Eur J Neurol 6:309–312, 1999

    • Search Google Scholar
    • Export Citation
  • 17.

    Mahoney FI, & Barthel DW: Functional evaluation: the Barthel Index. Md State Med J 14:6165, 1965 Mahoney FI, Barthel DW: Functional evaluation: the Barthel Index. Md State Med J 14:61–65, 1965

    • Search Google Scholar
    • Export Citation
  • 18.

    Mann HB, & Whitney DR: On a test of whether one of two random variables is stochatistically larger than the other. Ann Math Statistics 18:5060, 1947 Mann HB, Whitney DR: On a test of whether one of two random variables is stochatistically larger than the other. Ann Math Statistics 18:50–60, 1947

    • Search Google Scholar
    • Export Citation
  • 19.

    Martensson J, , Dracup K, , Canary C, & Fridlund B: Living with heart failure: depression and quality of life in patients and spouses. J Heart Lung Transplant 22:460467, 2003 Martensson J, Dracup K, Canary C, Fridlund B: Living with heart failure: depression and quality of life in patients and spouses. J Heart Lung Transplant 22:460–467, 2003

    • Search Google Scholar
    • Export Citation
  • 20.

    Nunally JC, & Bernstein IH: Psychometric Theory, ed 2. New York: McGraw-Hill, 1994 Nunally JC, Bernstein IH: sychometric Theory, ed 2. New York: McGraw-Hill, 1994

    • Search Google Scholar
    • Export Citation
  • 21.

    Olfson M, , Shea S, , Feder A, , Fuentes M, , Nomura Y, & Gameroff M, et al: Prevalence of anxiety, depression, and substance use disorders in an urban general medicine practice. Arch Fam Med 9:876883, 2000 Olfson M, Shea S, Feder A, Fuentes M, Nomura Y, Gameroff M, et al: Prevalence of anxiety, depression, and substance use disorders in an urban general medicine practice. Arch Fam Med 9:876–883, 2000

    • Search Google Scholar
    • Export Citation
  • 22.

    Ormel J, , VonKorff M, , Ustun TB, , Pini S, , Korten A, & Oldehinkel T: Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA 272:17411748, 1994 Ormel J, VonKorff M, Ustun TB, Pini S, Korten A, Oldehinkel T: Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA 272:1741–1748, 1994

    • Search Google Scholar
    • Export Citation
  • 23.

    Rankin J: Cerebral vascular accidents in patients over the age of 60: II. Prognosis. Scot Med J 2:200215, 1957 Rankin J: Cerebral vascular accidents in patients over the age of 60: II. Prognosis. Scot Med J 2:200–215, 1957

    • Search Google Scholar
    • Export Citation
  • 24.

    Rinkel GJ, , Djibuti M, , Algra A, & van Gijn J: Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 29:251256, 1998 Rinkel GJ, Djibuti M, Algra A, van Gijn J: Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 29:251–256, 1998

    • Search Google Scholar
    • Export Citation
  • 25.

    Robinson RG, , Starr LB, , Lipsey JR, , Rao K, & Price TR: A two-year longitudinal study of post-stroke mood disorders: dynamic changes in associated variables over the first six months of follow-up. Stroke 15:510517, 1984 Robinson RG, Starr LB, Lipsey JR, Rao K, Price TR: A two-year longitudinal study of post-stroke mood disorders: dynamic changes in associated variables over the first six months of follow-up. Stroke 15:510–517, 1984

    • Search Google Scholar
    • Export Citation
  • 26.

    Spearman C: The proof and measurement of association between two things. Am J Psychol 15:72101, 1904 Spearman C: The proof and measurement of association between two things. Am J Psychol 15:72–101, 1904

    • Search Google Scholar
    • Export Citation
  • 27.

    Steffens DC, , O'Connor CM, , Jiang WJ, , Pieper CF, , Kuchibhatla MN, & Arias RM, et al: The effect of major depression on functional status in patients with coronary artery disease. J Am Geriatr Soc 47:319322, 1999 Steffens DC, O'Connor CM, Jiang WJ, Pieper CF, Kuchibhatla MN, Arias RM, et al: The effect of major depression on functional status in patients with coronary artery disease. J Am Geriatr Soc 47:319–322, 1999

    • Search Google Scholar
    • Export Citation
  • 28.

    van der Schaaf IC, , Brilstra EH, , Rinkel GJ, , Bossuyt PM, & van Gijn J: Quality of life, anxiety, and depression in patients with an untreated intracranial aneurysm or arteriovenous malformation. Stroke 33:440443, 2002 van der Schaaf IC, Brilstra EH, Rinkel GJ, Bossuyt PM, van Gijn J: Quality of life, anxiety, and depression in patients with an untreated intracranial aneurysm or arteriovenous malformation. Stroke 33:440–443, 2002

    • Search Google Scholar
    • Export Citation
  • 29.

    Ware J Jr, , Kosinski M, & Keller SD: A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220233, 1996 Ware J Jr, Kosinski M, Keller SD: A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233, 1996

    • Search Google Scholar
    • Export Citation
  • 30.

    Ware JE Jr, , Kosinski M, & Keller SD: SF-36 Physical and Mental Health Summary Scales: A User's Manual. Boston: The Health Assessment Lab, 1994,Ware JE Jr, Kosinski M, Keller SD: SF-36 Physical and Mental Health Summary Scales: A User's Manual. Boston: The Health Assessment Lab, 1994,

    • Search Google Scholar
    • Export Citation
  • 31.

    Ware JE Jr, & Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473483, 1992 Ware JE Jr, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483, 1992

    • Search Google Scholar
    • Export Citation
  • 32.

    Withers NJ, , Rudkin ST, & White RJ: Anxiety and depression in severe chronic obstructive pulmonary disease: the effects of pulmonary rehabilitation. J Cardiopulm Rehabil 19:362365, 1999 Withers NJ, Rudkin ST, White RJ: Anxiety and depression in severe chronic obstructive pulmonary disease: the effects of pulmonary rehabilitation. J Cardiopulm Rehabil 19:362–365, 1999

    • Search Google Scholar
    • Export Citation
  • 33.

    Zigmond AS, & Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361370, 1983 Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370, 1983

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 3269 1579 145
Full Text Views 351 34 6
PDF Downloads 134 15 3
EPUB Downloads 0 0 0