Research highlights:
People who are diagnosed with unruptured brain aneurysms (weakened areas of blood vessels in the brain) and are monitored without treatment are at higher risk of developing mental disorders compared to those who are not diagnosed with aneurysms. The greatest impact was in adults under 40 years old. A study conducted in South Korea found that the psychological burden caused by a diagnosis of an unruptured brain aneurysm may contribute to the development of mental disorders such as anxiety, stress, depression, eating disorders, bipolar disorder, insomnia, and alcohol and drug abuse over a 10-year period. The researchers suggest that providing support to help patients cope with the stress of the diagnosis may be an important part of comprehensive care.
Embargo until Monday, August 26, 2024 at 4AM CST/5AM EST
DALLAS, Aug. 26, 2024 — People with aneurysms (weakened areas in 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 scared and anxious about their condition before undergoing imaging or screening tests to monitor their condition. Even if it has been medically determined and explained that observation rather than surgery is the best option for their aneurysm, they are still worried about the extremely rare possibility of experiencing a fatal brain hemorrhage,” said Yang Na-rae, MD, PhD, assistant professor of neurosurgery at Ewha Women's University Mokdong Hospital in Seoul, South Korea, and co-author of the study.
“This study did not specifically target brain aneurysms that are small enough not to require treatment and are unlikely to rupture. It targeted all diagnosed, untreated brain aneurysms under observation,” Yang said. “The reason for only observation without treatment may be that the aneurysm is small and unlikely to rupture, making treatment unnecessary. However, this decision may be 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 psychological 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 support 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.
Co-authors, disclosures, and funding sources are listed in the manuscript.
Research published in the American Heart Association's scientific journals is peer-reviewed. The statements and conclusions of each paper are those of the study authors and do not necessarily reflect the policies or positions of the Association. The Association makes no representations or warranties as to their accuracy or reliability. The Association is primarily funded by individuals, but foundations and corporations (including pharmaceutical companies, device manufacturers, and other businesses) also make donations and fund certain Association programs and events. The Association has strict policies to ensure that these relationships do not influence the scientific content. Revenues from pharmaceutical companies, biotechnology companies, device manufacturers, and health insurers, as well as the Association's overall financial information, can be found here.
Additional resources:
###
About the American Stroke Association
The American Stroke Association is dedicated to saving people from stroke, the second leading cause of death and leading cause of serious disability in the world. We work with millions of volunteers, fund innovative research, advocate for stronger public health policies, and provide life-saving tools and information to prevent and treat stroke. Based in Dallas, we formally launched as a division of the American Heart Association in 1998. To learn more or get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, X.
Media Inquiries and AHA/ASA Expert Opinions: 214-706-1173
Karen Astle: [email protected]
Public Inquiries: 1-800-AHA-USA1 (242-8721)
heart.org and stroke.org
