Anxiety and Depression May Raise Risk for Aneurysm Rupture

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Anxiety and Depression May Raise Risk for Aneurysm Rupture

TOPLINE:

Anxiety or depression after a diagnosis of unruptured intracranial aneurysms (UIAs) was associated with a 33% increased risk for rupture and a 28% higher risk for mortality compared to not having a psychiatric disorder, a new retrospective cohort study showed.

METHODOLOGY:

• A retrospective cohort study used data for adults with UIAs from the TriNetX Global Collaborative Network between 2015 and 2025.
• A total of 6800 patients diagnosed with anxiety or depression at least 127 days after UIA diagnosis and without aneurysm rupture (mean age, 58 years; 69% female) were propensity score matched with 6800 individuals without a psychiatric diagnosis (control group). Mean follow-up durations were 1550 and 1600 days, respectively.
• Primary outcomes were all-cause mortality, aneurysm rupture, endovascular aneurysm treatment, and microsurgical clipping. Secondary outcomes were use of psychiatric medication and healthcare resources.
• Patients were followed until the first occurrence of the outcome of interest, death, the end of the 5-year follow-up period, or the end of data availability, whichever came first.

TAKEAWAY:

• The anxiety or depression group vs control group had significantly higher rates of all-cause mortality (6% vs 4.5%; adjusted hazard ratio [aHR], 1.28; P < .001) and aneurysm rupture (3% vs 2%; aHR, 1.33; P = .007).
• Endovascular treatment rates were higher in the anxiety or depression cohort than in the control cohort, albeit not significantly (3.2% vs 2.7%; aHR, 1.18), and surgical clipping rates were similar between the groups (0.7% for both).
• Psychiatric medication use was 60% in the anxiety or depression cohort vs 17% in the control cohort (risk ratio, 3.5; P < .001). Also higher were rates of any kind of hospitalization (25% vs 18.5%; odds ratio [OR], 1.47; P < .001) and emergency department visits (37% vs 29%; OR, 1.45; P < .001).
• Medication adherence showed a dose-response relationship with mortality: low adherence (proportion of days covered [PDC] < 50%) had an HR of 1.50 (P = .006), moderate adherence (PDC, 50%-79%) had an HR of 1.29, and high adherence (PDC ≥ 80%) had an HR of 1.16.

IN PRACTICE:

“These results highlight the potential importance of considering mental health during UIA surveillance, including awareness of adherence and follow-up. Future prospective studies are needed to clarify causal relationships and determine whether targeted mental health interventions improve outcomes,” the investigators wrote.

SOURCE:

The study was led by Muhammed Amir Essibayi, MD, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, and Ahmed Y. Azzam, MD, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia. It was published online on March 4 in Stroke.

LIMITATIONS:

The 127‑day landmark led to the exclusion of patients with early events. Individuals with severe psychiatric disorders such as schizophrenia were also excluded, potentially limiting generalizability. Residual confounding may explain some of the higher rupture and mortality rates observed in the psychiatric group, and key variables (such as race/ethnicity, medication side effects, psychosocial support, and detailed aneurysm characteristics) were not measured. Additionally, anxiety and depression were identified using diagnostic codes and prescription data, which may have missed milder cases or misclassified transient distress.

DISCLOSURES:

The study did not receive any funding. Four investigators reported having financial or other ties with various sources, which are fully listed in the original article. The other eight reported having no relevant financial relationships. Some of the findings were presented previously at the 2025 Congress of Neurological Surgeons Annual Meeting and the 2025 Society of Vascular and Interventional Neurology Annual Meeting.