Study: Higher Risk of Mental Health Conditions Present in Patients With an Aneurysm Diagnosis

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According to research published in Stroke, among people who had aneurysms, the risk of developing a mental health condition—including anxiety and insomnia as well as depressive, bipolar, and eating disorders—was higher compared with those who did not have an aneurysm. Specifically, the highest risk of developing mental health conditions was observed in those younger than 40 years of age.^1,2

“As a neurosurgeon who treats cerebral aneurysms, I often see people who do not undergo surgery yet feel fear and/or anxiety about their condition before each imaging or screening test to monitor their condition. Even when it is medically judged and explained that follow-up observation is the best course for their aneurysm rather than surgery, they still worry about the very slim chance of developing a fatal brain bleed,” Na-Rae Yang, MD, PhD, assistant professor of neurosurgery, department of neurosurgery at Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine in Seoul, South Korea, said in a news release.¹

For this study, the investigators compared the occurrence and frequency of mental health conditions over a 10-year period. A total of 85,438 adults (average age: 56 years) with untreated unruptured intracranial aneurysms (UIAs) who were diagnosed between 2011 and 2019 and compared with over 331,000 adults (average age: 57 years) without aneurysms who were treated for upper respiratory infections during the same period were enrolled in the study. Mental health conditions included anxiety, stress, depressive disorders, bipolar disorder, eating disorders, insomnia, and alcohol or substance misuse disorders, and were defined as “conditions” if patients were diagnosed and received treatment from a psychiatrist that included psychotherapy, either with or without medication.^1,2

According to the findings, the incidence of mental illness was much higher in the UIA group compared with those without UIAs (113.07 vs 90.41 per 1000 person-years; HR, 1.104 [95% CI, 1.089–1.119]). Additionally, the risk of mental illness varied somewhat by sex, with male patients shower a slightly higher incidence compared with female patients (males: HR, 1.131 [95% CI, 1.108–1.155]; females: HR, 1.082 [95% CI, 1.063–1.103]). The investigators also observed a peak in mental health illness presence in younger age groups (under the age of 40 years), a decrease in middle-aged groups, and another slight increase in older age groups. The slight increase in older groups was notable in those with severe mental health illness who were receiving psychotherapy.^1,2

“This study did not specifically target brain aneurysms that were small enough not to require treatment and had a low probability of rupture. We included all diagnosed, untreated brain aneurysms that were being followed,” said Yang in the news release. “The reason for not treating and only following up may be that the aneurysm is small and unlikely to rupture, making treatment unnecessary. However, the decision is likely based on various circumstances, including the patient's overall condition, and such specific reasons were not captured in this study group.”¹

The investigators note that other research has investigated patterns of stress and anxiety present in individuals living with an aneurysm diagnosis, but this is one of the first large studies to predict the risk of a mental health condition following an aneurysm diagnosis. Despite the study being a significant one in this space, there are still limitations, the authors note. Some limitations include the following: the analysis was based on diagnostic and prescription codes in a national database, and may not reflect distinctions of individualized patient care and mental health status; and the size and location of aneurysms were not considered.^1,2

“Our finding of a higher rate of a severe mental health condition in younger adults with aneurysm underscores the significant psychological burden for this group of patients who may already be dealing with other life stressors, such as building their career and/or raising a family,” said Yang in the news release. “This elevated rate of mental health conditions suggests that younger people might be particularly vulnerable, highlighting the need for targeted mental health support and interventions for this age group. This includes providing clear explanations and tailoring treatment decisions for each person.”¹

REFERENCES

1. American Heart Association. Knowing you have a brain aneurysm may raise anxiety risk, other mental health conditions. News release. August 26, 2024. Accessed August 28, 2024. https://www.eurekalert.org/news-releases/1055313

2. Kim, YG, An, H, Kim, GE, Lee, HW, Yang, NR. Higher Risk of Mental Illness in Patients With Diagnosed and Untreated Unruptured Intracranial Aneurysm: Findings From a Nationwide Cohort Study. Stroke. 2024;55(9) doi:10.1161/STROKEAHA.123.045393