Association of select psychiatric disorders with incident brain aneurysm and subarachnoid hemorrhage among veterans

Daniel L Cooke; Hui Shen; Madhavi Duvvuri; Daniel Thompson; Thomas Neylan; William Wolfe; Steven Hetts; Bruce Ovbiagele; Mary Whooley; Beth Cohen

doi:10.3389/fnint.2023.1207610

Association of select psychiatric disorders with incident brain aneurysm and subarachnoid hemorrhage among veterans

Front Integr Neurosci. 2023 Aug 2:17:1207610. doi: 10.3389/fnint.2023.1207610. eCollection 2023.

Authors

Affiliations

¹ Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States.
² San Francisco Veterans Affairs Medical Center, School of Medicine, University of California, San Francisco, San Francisco, CA, United States.
³ Department of Psychiatry, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States.
⁴ Department of Neurology, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States.
⁵ Department of Medicine, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States.

Abstract

Background: Brain aneurysms represent a significant cause of hemorrhagic stroke. Prior research has demonstrated links between stress and stroke, including brain aneurysms. We aimed to determine relationships between select psychiatric disorders and aneurysms and aneurysmal SAH.

Methods: We performed retrospective, case-control study of a National Veterans Affairs population with two experimental groups (aneurysm-only and aneurysmal SAH) and 10-fold controls per group matched by age, date, and clinical data source. The studied the presence of 4 psychiatric disorders: Posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and other mood disorders. Our main outcomes Unadjusted and multivariable adjusted ORs of PTSD, MDD, GAD, and mood disorders within aneurysm-only and aSAH groups.

Results: In 6,320,789 US Veterans who were enrolled for at least 5 years in Medicare and/or the Veterans Health Administration, we identified 35,094 cases of aneurysm without SAH and 5,749 cases of aneurysm with SAH between 1/2005 and 12/2019. In analyses adjusted for sex, hypertension, and tobacco use, patients with aneurysm were more likely than matched controls to have a history of PTSD (OR 1.48), MDD (OR 1.33), GAD (OR 1.26), and other mood disorders (OR 1.34) (all p-values < 0.0001). Similarly, patients with aSAH were more likely than controls to have a history of PTSD (OR 1.35), MDD (OR 1.38), GAD (OR 1.18), and other mood disorders (OR 1.30) (all p-values < 0.0001).

Conclusion: The study, the largest of its kind, further suggests links between psychiatric disorders and stroke. This is important as patients with aneurysms are not routinely screened for such psychiatric risk factors. Additional research on this topic could lead to novel strategies to improve stroke prevention.

Keywords: aneurysm; depression; generalized anxiety disorder; posttraumatic stress disorder (PTSD); stroke.

Grants and funding

This study was funded by the VA Health Services Research and Development (HSR&D) Service, VA Information Resource Center (Project Numbers SDR 02-237 and 98-004), and the San Francisco VA Health Care System Measurement Science QUERI (Project Number QUE 20-009).