Deans' stroke musings: Postdiagnostic Anxiety and Depression Increase Rupture Risk and Mortality in Unruptured Intracranial Aneurysms

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, April 17, 2026

Postdiagnostic Anxiety and Depression Increase Rupture Risk and Mortality in Unruptured Intracranial Aneurysms

Of course your anxiety will be off the charts since you know that if a hemorrhagic stroke occurs you know your doctor HAS NOTHING GUARANTEED FOR RECOVERY!

Postdiagnostic Anxiety and Depression Increase Rupture Risk and Mortality in Unruptured Intracranial Aneurysms

Muhammed Amir Essibayi, MD, MSc https://orcid.org/0000-0001-8325-2382 m.amir.essibayi@gmail.com,

Ahmed Y. Azzam, MD, MEng https://orcid.org/0000-0002-4256-0159,

Hamza Adel Salim, MD https://orcid.org/0000-0002-5208-8425, Alireza Karandish, BA,

Mustafa S. Alhasan, MBBS, DABR https://orcid.org/0009-0002-4401-5127, Dhairya A. Lakhani, MD https://orcid.org/0000-0001-7577-1887,

Huanwen Chen, MD https://orcid.org/0000-0003-2455-748X, Dheeraj Gandhi, MD https://orcid.org/0000-0001-6741-5970,

Adam A. Dmytriw, MD, MPH, MSc https://orcid.org/0000-0003-0131-5699, Deepak Khatri, MD https://orcid.org/0000-0003-1902-9623,

Neil Haranhalli, MD, MSc, and David J. Altschul, MD https://orcid.org/0000-0002-5130-1378Author Info & Affiliations

Stroke

New online

https://doi.org/10.1161/STROKEAHA.126.054546

BACKGROUND:

Postdiagnostic anxiety and depression’s impact on management and outcomes in patients with unruptured intracranial aneurysms remains underexplored. We assessed associations with treatment patterns and outcomes using a large multi-institutional database.

METHODS:

This retrospective cohort study used TriNetX Global Collaborative Network records (2015–2025; >130 million patients across ≈250 health care organizations), identifying 127 361 adults with unruptured intracranial aneurysms. Addressing immortal time bias, we used a 127-day landmark analysis (median time to psychiatric diagnosis), requiring event-free survival before cohort assignment. Of 119 211 patients surviving to the landmark, those with anxiety/depression diagnosed within 0 to 127 days (n=7250) were 1:1 propensity score matched to controls (n=111 961), yielding 6800 per cohort. Cox proportional hazards models evaluated outcomes from a landmark.

RESULTS:

Matched cohorts (6800 each) had balanced characteristics (all standardized mean differences <0.10) and comparable follow-up (median, 1550 versus 1600 days). Anxiety/depression was associated with higher all-cause mortality (6.3% versus 4.5%; hazard ratio [HR], 1.28 [95% CI, 1.11–1.48]; P<0.001) and rupture (3.1% versus 2.2%; HR, 1.33 [95% CI, 1.08–1.64]; P=0.007). Five-year survival was 93.7% in the anxiety/depression cohort versus 95.5% in matched controls. Preventive treatment showed nonsignificant trends toward lower rates (odds ratio, 0.80 [95% CI, 0.62–1.03]; P=0.082). Sensitivity analysis using a 365-day landmark (n=10 200 per cohort) expanded eligibility by including diagnoses between days 128 and 365, and confirmed findings (mortality HR, 1.22 [95% CI, 1.08–1.38]; rupture HR, 1.28 [95% CI, 1.08–1.52]). Fine-Gray competing risk models yielded consistent results (mortality subdistribution HR, 1.27; rupture subdistribution HR, 1.31). Dose-response patterns emerged for psychiatric medication adherence: low (mortality HR, 1.50 [95% CI, 1.12–2.00]; P=0.006), moderate (HR, 1.29 [95% CI, 0.98–1.70]; P=0.071), and high (HR, 1.16 [95% CI, 0.89–1.51]; P=0.270). E values were 1.88 for mortality and 1.99 for rupture.

CONCLUSIONS:

Postdiagnostic anxiety and depression are associated with increased rupture risk and mortality in patients with unruptured intracranial aneurysms. Residual confounding cannot be excluded. These findings require further investigation to establish causality and suggest that an integrated psychiatric assessment may be considered in unruptured intracranial aneurysm management.