Skip to main content

Advertisement

SpringerLink
Log in

A meta-analysis on the prevalence of anxiety and depression in patients with unruptured intracranial aneurysms: exposing critical treatment gaps

  • Short Review
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Unruptured intracranial aneurysms (UIAs) are a significant cause of anxiety and depression. Though the annual rupture rate is relatively low, ensuing mortality and morbidity may be high. Most published studies have focused on functional outcomes; however, limited studies have explored and reported on psychiatric outcomes, which are equally important. We aimed to review existing data on anxiety and depression in patients with UIAs. We systematically searched the databases of Pubmed, Cochrane, Scopus, EBSCOHOST, and ClinicalTrials.gov for studies that reported on anxiety and depression in patients with UIAs. Where available, we also reported data on aneurysm characteristics, treatment modalities, and functional outcomes of these populations. We performed a meta-analysis of proportions by random-effects modeling to compute the prevalence of anxiety and depression in patients with UIAs. Eighteen studies reporting a total of 1413 patients with UIAs were included in the systematic review. The mean age was 57.8 (range 27–79); 64% of whom were female. Random-effect modeling analysis showed an overall estimated prevalence of 28% [95% CI: 0.17–0.42] for anxiety and 21% [95% CI: 0.13–0.33] for depression among patients with UIAs. No significant difference was found in the prevalence of these conditions between treated vs untreated aneurysms. Our review highlights the heterogeneity of data from existing studies and the lack of standardized methodologies in determining psychiatric outcomes in patients with UIAs. It was also limited by the small sample sizes and patient counseling bias in the included studies. Larger, well-designed epidemiologic studies on patients with UIA should include more representative samples, assess for predictors of psychological outcomes, and explore the most optimal psychiatric assessment tools.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

Supplemental material are available as electronic files.

Code availability

Not applicable.

References

  1. Algra AM, Lindgren A, Vergouwen MDI, Greving JP, Van Der Schaaf IC, Van Doormaal TPC, Rinkel GJE (2019) Procedural clinical complications, case-fatality risks, and risk factors in endovascular and neurosurgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis. JAMA Neurol 76:282–293. https://doi.org/10.1001/jamaneurol.2018.4165

    Article  PubMed  Google Scholar 

  2. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders. American Psychiatric Association

  3. Brilstra EH, Rinkel GJE, van der Graaf Y, Sluzewski M, Groen RJ, Lo RTH, Tulleken CAF (2004) Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolisation with coils. Cerebrovasc Dis 17:44–52. https://doi.org/10.1159/000073897

    Article  PubMed  Google Scholar 

  4. Buijs JE, Greebe P, Rinkel GJE (2012) Quality of life, anxiety, and depression in patients with an unruptured intracranial aneurysm with or without aneurysm occlusion. Neurosurgery 70:868–872. https://doi.org/10.1227/NEU.0b013e3182367295

    Article  PubMed  Google Scholar 

  5. Darsaut TE, Findlay JM, Magro E, Kotowski M, Roy D, Weill A, Bojanowski MW, Chaalala C, Iancu D, Lesiuk H, Sinclair J, Scholtes F, Martin D, Chow MM, O’Kelly CJ, Wong JH, Butcher K, Fox AJ, Arthur AS, Guilbert F, Tian L, Chagnon M, Nolet S, Gevry G, Raymond J (2017) Surgical clipping or endovascular coiling for unruptured intracranial aneurysms: a pragmatic randomised trial. J Neurol Neurosurg Psychiatry 88:663–668. https://doi.org/10.1136/jnnp-2016-315433

    Article  PubMed  Google Scholar 

  6. Garzon-Muvdi T, Yang W, Luksik AS, Ruiz-Valls A, Tamargo RJ, Caplan J, Tamargo RJ (2017) Postoperative delayed paradoxical depression after uncomplicated unruptured intracranial aneurysm surgery. World Neurosurg 99:63–69. https://doi.org/10.1016/j.wneu.2016.11.101

    Article  PubMed  Google Scholar 

  7. Gholampour S, Mehrjoo S (2021) Effect of bifurcation in the hemodynamic changes and rupture risk of small intracranial aneurysm. Neurosurg Rev 44:1703–1712. https://doi.org/10.1007/s10143-020-01367-3

    Article  PubMed  Google Scholar 

  8. Hackett ML, Yapa C, Parag V, Anderson CS (2005) Frequency of depression after stroke. Stroke 36:1330–1340. https://doi.org/10.1161/01.STR.0000165928.19135.35

    Article  PubMed  Google Scholar 

  9. Hajirayat K, Gholampour S, Sharifi I, Bizari D (2017) Biomechanical simulation to compare the blood hemodynamics and cerebral aneurysm rupture risk in patients with different aneurysm necks. J Appl Mech Tech Phys 58:968–974. https://doi.org/10.1134/S0021894417060025

    Article  Google Scholar 

  10. Juvela S (2019) Growth and rupture of unruptured intracranial aneurysms. J Neurosurg 131:843–851. https://doi.org/10.3171/2018.4.JNS18687

    Article  Google Scholar 

  11. Kubo Y, Ogasawara K, Kashimura H, Otawara Y, Kakino S, Sugawara A, Ogawa A (2010) Cognitive function and anxiety before and after surgery for asymptomatic unruptured intracranial aneurysms in elderly patients. World Neurosurg 73:350–353. https://doi.org/10.1016/j.wneu.2010.01.001

    Article  PubMed  Google Scholar 

  12. Lemos M, Román-Calderón JP, Calle G, Gómez-Hoyos JF, Jimenez CM (2020) Personality and anxiety are related to health-related quality of life in unruptured intracranial aneurysm patients selected for non-intervention: a cross sectional study. PLoS ONE 15:e0229795. https://doi.org/10.1371/journal.pone.0229795

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Lemos M, Román-Calderón JP, Restrepo J, Gómez-Hoyos JF, Jimenez CM (2020) Cognitive behavioral therapy reduces illness perceptions and anxiety symptoms in patients with unruptured intracranial aneurysm. J Clin Neurosci 80:56–62. https://doi.org/10.1016/j.jocn.2020.07.071

    Article  PubMed  Google Scholar 

  14. Li Y, Dai W, Zhang J (2017) Anxiety, depression and quality of life in patients with a treated or untreated unruptured intracranial aneurysm. J Clin Neurosci 45:223–226. https://doi.org/10.1016/j.jocn.2017.07.019

    Article  PubMed  Google Scholar 

  15. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P (2005) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and. Lancet 366:809–817. https://doi.org/10.1016/S0140-6736(05)67214-5

    Article  PubMed  Google Scholar 

  16. Mori K, Wada K, Otani N, Tomiyama A, Toyooka T, Tomura S, Takeuchi S, Yamamoto T, Nakao Y, Arai H (2018) Long-term neurological and radiological results of consecutive 63 unruptured anterior communicating artery aneurysms clipped via lateral supraorbital keyhole minicraniotomy. Oper Neurosurg 14:95–103. https://doi.org/10.1093/ons/opx244

    Article  Google Scholar 

  17. Murad MH, Sultan S, Haffar S, Bazerbachi F (2018) Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 23:60–63. https://doi.org/10.1136/bmjebm-2017-110853

    Article  PubMed  PubMed Central  Google Scholar 

  18. Otawara Y, Ogasawara K, Kubo Y, Tomitsuka N, Watanabe M, Ogawa A, Suzuki M, Yamadate K (2004) Anxiety before and after surgical repair in patients with asymptomatic unruptured intracranial aneurysm. Surg Neurol 62:28–31. https://doi.org/10.1016/j.surneu.2003.07.012

    Article  PubMed  Google Scholar 

  19. Pala A, Pawlikowski A, Brand C, Schmitz B, Wirtz CR, König R, Kapapa T (2019) Quality of life after treatment of unruptured intracranial aneurysms. World Neurosurg 121:e54–e59. https://doi.org/10.1016/j.wneu.2018.09.010

    Article  PubMed  Google Scholar 

  20. Pietrantonio A, Trungu S, Raco A (2017) Clinical and neuropsychological outcome after microsurgical and endovascular treatment of ruptured and unruptured anterior communicating artery aneurysms: a single-enter experience. pp 173–177

  21. Ruan C, Long H, Sun H, He M, Yang K, Zhang H, Mao B (2015) Endovascular coiling vs. surgical clipping for unruptured intracranial aneurysm: a meta-analysis. Br J Neurosurg 29:485–492. https://doi.org/10.3109/02688697.2015.1023771

    Article  PubMed  Google Scholar 

  22. Solheim O, Eloqayli H, Muller TB, Unsgaard G (2006) Quality of life after treatment for incidental, unruptured intracranial aneurysms. Acta Neurochir (Wien) 148:821–830. https://doi.org/10.1007/s00701-006-0804-7

    Article  CAS  Google Scholar 

  23. Su S-H, Xu W, Hai J, Yu F, Wu Y-F, Liu Y-G, Zhang L (2014) Cognitive function, depression, anxiety and quality of life in Chinese patients with untreated unruptured intracranial aneurysms. J Clin Neurosci 21:1734–1739. https://doi.org/10.1016/j.jocn.2013.12.032

    Article  PubMed  Google Scholar 

  24. Thompson BG, Brown RD, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES, Duckwiler GR, Harris CC, Howard VJ, Johnston SC, Meyers PM, Molyneux A, Ogilvy CS, Ringer AJ, Torner J (2015) Guidelines for the management of patients with unruptured intracranial aneurysms. Stroke 46:2368–2400. https://doi.org/10.1161/STR.0000000000000070

    Article  PubMed  Google Scholar 

  25. Toth G, Cerejo R (2018) Intracranial aneurysms: review of current science and management. Vasc Med (United Kingdom) 23:276–288. https://doi.org/10.1177/1358863X18754693

    Article  Google Scholar 

  26. Towfighi A, Ovbiagele B, El Husseini N, Hackett ML, Jorge RE, Kissela BM, Mitchell PH, Skolarus LE, Whooley MA, Williams LS (2017) Poststroke depression: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 48. https://doi.org/10.1161/STR.0000000000000113

  27. Wenz H, Wenz R, Ehrlich G, Groden C, Schmieder K, Fontana J (2015) Patient characteristics support unfavorable psychiatric outcome after treatment of unruptured intracranial aneurysms. Acta Neurochir (Wien) 157:1135–1145. https://doi.org/10.1007/s00701-015-2451-3

    Article  CAS  Google Scholar 

  28. Wenz H, Wenz R, Maros ME, Groden C, Schmieder K, Fontana J (2016) The neglected need for psychological intervention in patients suffering from incidentally discovered intracranial aneurysms. Clin Neurol Neurosurg 143:65–70. https://doi.org/10.1016/j.clineuro.2016.02.018

    Article  PubMed  Google Scholar 

  29. Wiebers DO (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110. https://doi.org/10.1016/S0140-6736(03)13860-3

    Article  PubMed  Google Scholar 

  30. De Wilde A, Greebe P, Rinkel GJE, Algra A (2019) Stress in patients with (Un)ruptured intracranial aneurysms vs population-based controls. Neurosurgery 84:1065–1070. https://doi.org/10.1093/neuros/nyy143

    Article  PubMed  Google Scholar 

  31. Wostrack M, Friedrich B, Hammer K, Harmening K, Stankewitz A, Ringel F, Shiban E, Boeckh-Behrens T, Prothmann S, Zimmer C, Meyer B, Förschler A, Ryang Y-M (2014) Hippocampal damage and affective disorders after treatment of cerebral aneurysms. J Neurol 261:2128–2135. https://doi.org/10.1007/s00415-014-7464-y

    Article  PubMed  Google Scholar 

  32. Yamashiro S, Nishi T, Koga K, Goto T, Kaji M, Muta D, Kuratsu J-i, Fujioka S (2006) Improvement of quality of life in patients surgically treated for asymptomatic unruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry 78:497–500. https://doi.org/10.1136/jnnp.2006.098871

    Article  PubMed  PubMed Central  Google Scholar 

  33. Yamashiro S, Nishi T, Koga K, Goto T, Muta D, Kuratsu J, Fujioka S (2007) Postoperative quality of life of patients treated for asymptomatic unruptured intracranial aneurysms. J Neurosurg 107:1086–1091. https://doi.org/10.3171/JNS-07/12/1086

    Article  PubMed  Google Scholar 

  34. Zhai X-D, Yu J-X, Ma Y-J, Xiang S-S, Li G-L, He C, Hu P, Zhang H-Q (2020) Prevalence of and risk factors for anxiety and depression in Chinese patients with unruptured intracranial aneurysms treated by endovascular intervention. BMC Psychiatry 20:430. https://doi.org/10.1186/s12888-020-02834-3

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Author notes

  1. Dr. Ignacio and Dr. Pascual are joint first authors.

Authors and Affiliations

  1. Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines

    Katrina Hannah D. Ignacio

  2. Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines

    Juan Silvestre G. Pascual & Kathleen Joy O. Khu

  3. Department of Psychiatry and Behavioral Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines

    Sedric John V. Factor

Authors
  1. Katrina Hannah D. Ignacio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juan Silvestre G. Pascual
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sedric John V. Factor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kathleen Joy O. Khu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Katrina Hannah D. Ignacio: conceptualization, data curation, formal analysis, interpretation of data, writing-original draft, writing-review, and editing; Juan Silvestre G. Pascual: conceptualization, data curation, formal analysis, interpretation of data, writing-original draft, writing-review, and editing; Sedric John V. Factor: conceptualization, data curation, formal analysis, interpretation of data, writing-original draft, writing-review, and editing; Kathleen Joy O. Khu: conceptualization, data curation, formal analysis, interpretation of data, writing-original draft, writing-review, and editing.

Corresponding authors

Correspondence to Katrina Hannah D. Ignacio or Juan Silvestre G. Pascual.

Ethics declarations

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 91 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ignacio, K.H.D., Pascual, J.S.G., Factor, S.J.V. et al. A meta-analysis on the prevalence of anxiety and depression in patients with unruptured intracranial aneurysms: exposing critical treatment gaps. Neurosurg Rev 45, 2077–2085 (2022). https://doi.org/10.1007/s10143-022-01768-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-022-01768-6

Keywords

Search

Navigation