Depressed mood and quality of life after subarachnoid hemorrhage.
BACKGROUND
Cognitive impairment is widely considered the main cause of disability and handicap after subarachnoid hemorrhage (SAH). The impact of depression on recovery after SAH remains poorly defined. We sought to determine the frequency of post-SAH depression, identify risk factors for its development, and evaluate the impact of depression on quality of life (QOL) during the first year of recovery.


METHODS
We prospectively studied 216 of 534 SAH patients treated between July 1996 and December 2001 with complete one-year follow-up data. Depression was evaluated with the Center for Epidemiological Studies Depression (CES-D) scale, cognitive status with the Telephone Interview for Cognitive Status (TICS), and QOL with the Sickness Impact Profile (SIP) 3 and 12 months after SAH.


RESULTS
Depressed mood occurred in 47% of patients during the first year of recovery; 26% were depressed at both 3 and 12 months. Non-white ethnicity predicted early (3 month) and late (12 month) depressions; early depression was also predicted by previously-diagnosed depression, cigarette smoking, and cerebral infarction, whereas late depression was predicted by prior social isolation and lack of medical insurance. Depression was associated with inferior QOL in all domains of the SIP, and changes in depression status were associated with striking parallel changes in QOL, disability, and cognitive function during the first year of recovery. CES-D scores accounted for over 60% of the explained variance in SIP total scores, whereas TICS performance accounted for no more than 6%.


CONCLUSIONS
Depression affects nearly half of SAH patients during the first year of recovery, and is associated with poor QOL. Systematic screening and early treatment for depression are promising strategies for improving outcome after SAH.
Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, United States.
Kurt T
KT
Kreiter
Axel J
AJ
Rosengart
Jan
J
Claassen
Brian F
BF
Fitzsimmons
Shelley
S
Peery
Y Evelyn
YE
Du
E Sander
ES
Connolly
Stephan A
SA
Mayer
D000368:Aged; D003863:Depression / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012189:Retrospective Studies; D018434:Sickness Impact Profile; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging / Q000523:psychology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed
Cerebral aneurysm; Cognitive function; Depression; Outcomes; Quality of life; Recovery; Subarachnoid hemorrhage