In this retrospective study of 349 patients undergoing a procedure for cerebrovascular disease, we found that anxiety and depression (Anx/Dep) are associated with worse Global Mental Health (GMH) scores at 30 days post procedure without any differences in Global Physical Health (GPH) or functional capacity (mRS) scores. This study is novel due to its focus on cerebrovascular procedures and mental health. In addition, our study benefits from our collection of detailed hospital complications and baseline medical comorbidity data.
Depression is experienced by thirty-three percent of patients after a stroke (7). Our large sample size and collection of many confounding variables allowed us to confirm that our results were unaffected even after removing stroke patients and those with migraines from our analysis.
To our knowledge, there is one other study that focused on cerebral aneurysms and Anx/Dep. This study analyzed the mental health status of 166 patients who presented to a neurosurgery clinic with a cerebral aneurysm (4). They found that eight percent of their study population had depression and seventeen percent had anxiety (4). While the prevalence of Anx/Dep in patients in both this study and ours is similar, the studies are not entirely comparable. Our study focuses on quality of life outcomes (QOL) for patients with and without Anx/Dep who had a cerebrovascular procedure. Our patient sample is larger and includes a wider variety of cerebrovascular abnormalities.
Several studies have documented outcomes for patients with Anx/Dep who undergo other types of surgeries. For example, a study of male veterans who had a coronary artery bypass graft found that a history of depression contributed to increased cardiac hospitalizations, continued surgical pain, and decreased likelihood of returning to their previous level of activity (2). Our study adds to the literature that reports worse QOL outcomes for patients with poor mental health.
Contrary to our hypothesis that patients with Anx/Dep would have worse outcomes at all follow ups, we found that the initial effect of worse GMH scores at 30 day follow up disappeared by six months. A study of self-reported QOL outcomes for the endovascular repair of thoracoabdominal aortic aneurysms also described this in their cohort sample (5). Using the RAND SF-36, a short form questionnaire that assesses the effects of physical and mental health on overall QOL, researchers found that patients had reduced physical and mental health while in the hospital; however, they returned to their baseline QOL status by six months (5). Our broader inclusion criteria including age range and procedure type allowed for a more representative and generalizable sample in the setting of cerebrovascular disease. Additionally, cerebrovascular disease affects the brain, and therefore may differ in terms of mental and physical outcomes compared to repair of thoracoabdominal aortic aneurysms.
Our study had some limitations. First our study was retrospective in nature. Second, we relied on self-reported Anx/Dep from the patients’ medical records. Third, the sample lacked diversity in ethnicity. Fourth, patients who were lost to follow up at 30 days may have created a bias in the type of patient that was included in the analysis; however, we were most interested in QOL outcomes which required follow up data from at least one time point. We think it is less likely that we introduced a selection bias given that their baseline GMH scores and likelihood of Anx/Dep was not different between those who were included and those who were excluded from this study.
Our study has several strengths. First, we were able to use detailed sociodemographic and hospital complication data including many possible confounding variables to complete a multivariate analysis to determine QOL outcomes. Second, we focused on cerebrovascular procedures which, to our knowledge, has not been reported in the literature to date, and used widely accepted scales for functionality and overall global health. We also used a wider variety of cerebrovascular disease diagnoses than other studies, and had data available up to six months.