title: 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 χ(2) and t tests were used to investigate if patients who returned the questionnaires were different from those who did not reply. Non-parametric tests (χ(2) 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.
authors.affiliation: Brain Center Rudolf Magnus and Centre of Excellence for Rehabilitation Medicine, University Medical Centre Utrecht and De Hoogstraat, Utrecht, The Netherlands.
authors.forename: J M A
authors.initials: JM
authors.lastname: Visser-Meily
authors.forename: G J E
authors.initials: GJ
authors.lastname: Rinkel
authors.forename: M D I
authors.initials: MD
authors.lastname: Vergouwen
authors.forename: P E C A
authors.initials: PE
authors.lastname: Passier
authors.forename: M J E
authors.initials: MJ
authors.lastname: van Zandvoort
authors.forename: M W M
authors.initials: MW
authors.lastname: Post
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome