title: Subarachnoid hemorrhage treated with clipping: long-term effects on employment, relationships, personality, and mood.
abstract: OBJECTIVE
  Only one-third of patients regain functional independence after aneurysmal subarachnoid hemorrhage (SAH). Despite this recovery, many of these patients experience psychosocial problems. We assessed the long-term effects of SAH on employment, relationships, personality, and mood.
  
  
  METHODS
  We included patients who had been treated by clipping after SAH between 1985 and 2001 and who resumed independent living. Patients underwent structured interviews regarding employment, relationships, and personality before and after the SAH. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale, and scores were compared between the study group and a control population.
  
  
  RESULTS
  Six hundred and ten patients were interviewed (mean follow-up after SAH, 8.9 yr). Of the employed patients, 26% stopped working and 24% worked shorter hours or had a position with less responsibility. On average, patients returned to work 9.4 months after discharge (range, 0-96 mo). Seven percent of patients were divorced because of SAH-related problems. Fifty-nine percent of the patients reported changes in personality, with the most commonly noted changes being increased irritability (37%) or emotionality (29%). Patients with SAH had a statistically significant higher mean depression score than the control population. Approximately 10% of the patients had a Hospital Anxiety and Depression Scale score in the range of a probable depressive or anxious state. Only 25% reported a complete recovery without psychosocial or neurological problems.
  
  
  CONCLUSIONS
  The long-term psychosocial effects of SAH are considerable, even in patients who regain functional independence. Treating physicians should be aware of these long-term effects of SAH when discussing prognosis and reintegration to work after initial recovery with patients and family.
authors.affiliation: Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands. m.wermer@umcutrecht.nl
authors.forename: Marieke J H
authors.initials: MJ
authors.lastname: Wermer
authors.forename: Hieke
authors.initials: H
authors.lastname: Kool
authors.forename: Kees W
authors.initials: KW
authors.lastname: Albrecht
authors.forename: Gabriël J E
authors.initials: GJ
authors.lastname: Rinkel
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D004651:Employment / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation*; D010551:Personality; D011788:Quality of Life / Q000523:psychology; D012917:Social Adjustment; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000523:psychology / Q000601:surgery*; D013525:Surgical Instruments; D013995:Time