People with aneurysms (weakened blood vessels in the brain) were at higher risk of developing mental illness than those without aneurysms. The highest risk was found in patients under the age of 40, according to a study published today in Stroke, a peer-reviewed scientific journal from the American Stroke Association, a division of the American Heart Association.
Unruptured intracranial aneurysms occur when the walls of blood vessels in the brain weaken and bulge, posing a potential risk of rupturing in the future and causing life-threatening intracerebral hemorrhage.
As a neurosurgeon treating brain aneurysms, I often see patients who are not undergoing surgery but who are fearful and anxious about their condition before undergoing imaging and screening tests to monitor their condition. Even when it has been medically determined and explained to them that observation rather than surgery is the best option for treating their aneurysm, they continue to worry about the extremely remote possibility of having a fatal brain hemorrhage.”
Nare Yang, MD, study co-author and assistant professor of neurosurgery at Ewha Women's University Mokdong Hospital, Seoul, South Korea
“This study did not specifically target brain aneurysms that were small enough not to require treatment and were unlikely to rupture. It included all diagnosed, untreated brain aneurysms under observation,” Yang said. “The reason for only observation rather than treatment may be that the aneurysms were small and unlikely to rupture, so no treatment was necessary. However, this decision may have been based on a variety of circumstances, such as the patient's overall condition, and such specific reasons were not captured by this study group.”
While other studies have looked at patterns of stress and anxiety in patients diagnosed with aneurysms, the researchers said this is one of the first large-scale studies to estimate the risk of mental illness following an aneurysm diagnosis.
In the study, researchers looked at data from South Korea's National Health Information Database. The database contains health data from more than 20 years (2004 to 2024) on more than 85,000 people who received treatment at hospitals, clinics, and pharmacies across the country. It is one of the largest and most comprehensive health information databases in the world. The researchers compared how many people developed mental illnesses, such as anxiety, stress, depression, bipolar disorder, eating disorders, insomnia, and alcohol and drug abuse, more than six months after their aneurysm diagnosis. They then compared this to the rate of mental illness diagnoses in similar adults without aneurysms who were treated for upper respiratory tract infections.
The analysis was carried out over a 10-year period, and when compared to people without aneurysms, the results were as follows:
People with aneurysms were 10% more likely to be diagnosed with a mental illness, and the risk of mental illness was particularly pronounced in people under 40 with aneurysms; the difference was even greater if the mental illness had been diagnosed by a psychiatrist, with a three-fold increased risk.
“Our findings of high rates of severe mental illness among young adults with aneurysms highlight the significant mental burden for this group of patients who may already be dealing with other life stressors, such as building a career or raising children,” Yang said. “This high rate of mental illness suggests that young people may be particularly vulnerable and highlights the need for targeted mental health supports and interventions for this age group, including providing clear explanations and tailoring treatment decisions for each individual.”
Aneurysms may be diagnosed when a person undergoes an imaging test (such as a CT scan or MRI) to evaluate for neurological symptoms (such as headaches or vision changes), or they may be discovered incidentally when a person undergoes an imaging test for an unrelated problem.
Study limitations include that the analysis was based on diagnosis and prescription codes from a national database, which may be inaccurate and may not reflect nuances in individual patient care and mental health status. Also, the specific size and location of the aneurysm were not taken into account. This study design highlights a possible association between the diagnosis of aneurysm and subsequent mental health status, but cannot establish causality. Because this study population is a Korean population, the results may not be consistent with populations in other countries.
Study details, background, or design:
The study compared the 10-year occurrence of several psychiatric disorders in 85,438 adults (51% male, mean age 56 years) who were diagnosed with and untreated for aneurysms between 2011 and 2019 with more than 331,000 adults without aneurysms (49% male, mean age 57 years) who were treated for acute upper respiratory tract infections during the same period. The adults without aneurysms were matched to the diagnostic groups for age, sex, economic status, and the presence of other medical conditions. Mental disorders were defined as a diagnosis of anxiety, stress, depression, bipolar disorder, eating disorder, insomnia, or alcohol or drug abuse according to the International Classification of Diseases coding database. Cases defined as having a diagnosis of a mental disorder and being treated by a psychiatrist included psychotherapy with or without medication. Differences in risk of mental disorders were calculated after adjusting for several factors, including age, sex, health insurance status, disability, other medical conditions, smoking, alcohol intake, and obesity.
sauce:
American Heart Association
Journal References:
Kim, YG, et al. (2024) Patients with diagnosed but untreated unruptured intracranial aneurysms are at high risk for psychiatric disorders: Results from a nationwide cohort study. Stroke. doi.org/10.1161/STROKEAHA.123.045393.
