Brain Center Rudolf Magnus and Centre of Excellence for Rehabilitation Medicine, University Medical Centre Utrecht and De Hoogstraat, Utrecht, The Netherlands.
Cerebrovasc Dis. 2013;36(2):126-30. doi: 10.1159/000353642. Epub 2013 Sep 11.
Subarachnoid haemorrhage (SAH) from a ruptured intracranial aneurysm accounts for approximately 5% of all strokes. Post-traumatic stress disorder (PTSD) is common in the early phase after recovery from aneurysmal SAH. The aim of our study was to examine the prevalence of PTSD 3 years after SAH, its predictors, and relationship with health-related quality of life (HRQoL) in patients living independently in the community.
From a prospectively collected cohort of 143 patients with aneurysmal SAH who visited our outpatient clinic 3 months after SAH, 94 patients (65.7%) completed a mailed questionnaire 3 years after SAH. We assessed PTSD with the Impact of Event Scale and HRQoL with the Stroke-Specific Quality of Life Scale (SS-QoL). The χ(2) and t tests were used to investigate if patients who returned the questionnaires were different from those who did not reply. Non-parametric tests (χ(2) and Mann-Whitney tests) were used to test for differences between patients with and without PTSD. Relative risks and 95% confidence intervals were calculated.
No relevant differences in demographic (age, sex, education) or SAH characteristics (clinical condition on admission, complication, location of aneurysm, Glasgow Outcome Scale score at 3 months) were seen between participants and drop-outs. In 24 patients (26%), Impact of Event Scale scores indicated PTSD. Passive coping style (relative risk, 5.7; 95% confidence interval, 2.1-15.3), but none of the demographic or SAH-related factors, predicted PTSD. The mean SS-QoL total score was 4.2 (SD 1.1), indicative of a relatively satisfactory HRQoL. PTSD was associated with lower HRQoL (p < 0.001), a mean SS-QoL score of 4.4 (SD 1.0) without PTSD, and a mean SS-QoL score of 3.5 (SD 1.1) with PTSD.
Even 3 years after SAH, 1 out of 4 patients had PTSD, which was associated with reduced HRQoL. Passive coping style was the most important predictor. There is a need to organize SAH care with more attention to and treatment of PTSD. Strategies shown to reduce PTSD in other conditions should be tested for effectiveness in SAH patients.
蛛网膜下腔出血（SAH）是由颅内破裂动脉瘤引起的，约占所有中风的 5%。创伤后应激障碍（PTSD）在动脉瘤性 SAH 恢复后的早期阶段很常见。我们的研究目的是检查 3 年后 SAH 患者 PTSD 的患病率、其预测因素以及与独立居住在社区的患者健康相关生活质量（HRQoL）的关系。
从我们的门诊就诊的 143 例动脉瘤性 SAH 前瞻性收集的队列中，94 例患者（65.7%）在 SAH 后 3 个月完成了邮寄问卷。我们使用事件影响量表评估 PTSD，使用中风特异性生活质量量表（SS-QoL）评估 HRQoL。使用卡方检验和 t 检验来调查是否有差异。使用非参数检验（卡方检验和曼-惠特尼检验）来检验 PTSD 患者与非 PTSD 患者之间的差异。计算相对风险和 95%置信区间。
在人口统计学（年龄、性别、教育）或 SAH 特征（入院时的临床状况、并发症、动脉瘤位置、3 个月时的格拉斯哥结局量表评分）方面，参与者和未回复者之间没有发现任何相关差异。24 例患者（26%）的事件影响量表评分表明患有 PTSD。被动应对方式（相对风险，5.7；95%置信区间，2.1-15.3），但没有一个人口统计学或 SAH 相关因素，可预测 PTSD。SS-QoL 总分的平均值为 4.2（SD 1.1），表明 HRQoL 相对满意。PTSD 与较低的 HRQoL 相关（p < 0.001），无 PTSD 的 SS-QoL 平均得分为 4.4（SD 1.0），PTSD 的 SS-QoL 平均得分为 3.5（SD 1.1）。
即使在 SAH 后 3 年，仍有 1/4 的患者患有 PTSD，这与 HRQoL 降低有关。被动应对方式是最重要的预测因素。需要更加重视 SAH 护理，并对 PTSD 进行治疗。应测试在其他情况下减少 PTSD 的策略在 SAH 患者中的有效性。
