Depression Following Aneurysmal Subarachnoid Hemorrhage: Associations with Hemorrhage Severity and Functional Outcome

Abstract

Depression is a common neuropsychiatric sequela after aneurysmal subarachnoid hemorrhage (aSAH), yet its relationship to hemorrhage severity, aneurysm location, and functional outcome remains unclear. We examined associations of post-aSAH depression with Fisher grade, aneurysm location, and modified Rankin Scale (mRS) score in a single-center cohort.

A retrospective observational study included 606 adult patients with aSAH. Only patients with documented outpatient follow-up assessing depression status were analyzed. Depression was defined as a clinical diagnosis documented during follow-up. A Fisher grade was assigned based on admission computed tomography (CT) imaging analysis. Functional outcomes were measured using the mRS. Group comparisons used chi-squared or Fisher's exact tests for categorical variables and Welch's t-tests for continuous variables. Ordinal logistic regression evaluated associations between Fisher grade, mRS, and depression.

Depression was documented in 53 patients (8.7%). Age did not differ between groups (p = 0.654), and female sex showed a nonsignificant trend toward higher depression prevalence (Fisher's exact p = 0.078). Aneurysm circulation and anatomical location were not associated with depression (p = 0.409 and 0.151, respectively). Depression frequency increased with higher Fisher grades; ordinal modeling showed that each 1-grade increase was associated with higher odds of depression (OR: 1.21, 95% CI: 1.02–1.42; p = 0.027). Worse functional outcomes were strongly associated with depression, with each 1-point increase in mRS conferring higher odds (OR: 1.70, 95% CI: 1.39–2.08; p < 0.001).

Post-aSAH depression was associated with hemorrhage severity and poorer functional outcomes but not with aneurysm location. These findings support structured depression surveillance in patients with higher Fisher grades and worse mRS scores.