Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, United States.
J Neurol Sci. 2013 Dec 15;335(1-2):64-71. doi: 10.1016/j.jns.2013.08.024. Epub 2013 Aug 26.
Cognitive impairment is widely considered the main cause of disability and handicap after subarachnoid hemorrhage (SAH). The impact of depression on recovery after SAH remains poorly defined. We sought to determine the frequency of post-SAH depression, identify risk factors for its development, and evaluate the impact of depression on quality of life (QOL) during the first year of recovery.
We prospectively studied 216 of 534 SAH patients treated between July 1996 and December 2001 with complete one-year follow-up data. Depression was evaluated with the Center for Epidemiological Studies Depression (CES-D) scale, cognitive status with the Telephone Interview for Cognitive Status (TICS), and QOL with the Sickness Impact Profile (SIP) 3 and 12 months after SAH.
Depressed mood occurred in 47% of patients during the first year of recovery; 26% were depressed at both 3 and 12 months. Non-white ethnicity predicted early (3 month) and late (12 month) depressions; early depression was also predicted by previously-diagnosed depression, cigarette smoking, and cerebral infarction, whereas late depression was predicted by prior social isolation and lack of medical insurance. Depression was associated with inferior QOL in all domains of the SIP, and changes in depression status were associated with striking parallel changes in QOL, disability, and cognitive function during the first year of recovery. CES-D scores accounted for over 60% of the explained variance in SIP total scores, whereas TICS performance accounted for no more than 6%.
Depression affects nearly half of SAH patients during the first year of recovery, and is associated with poor QOL. Systematic screening and early treatment for depression are promising strategies for improving outcome after SAH.
认知障碍被广泛认为是蛛网膜下腔出血（SAH）后残疾和失能的主要原因。抑郁对 SAH 后恢复的影响仍未得到明确界定。我们旨在确定 SAH 后抑郁的发生率，确定其发展的危险因素，并评估抑郁对发病后第一年生活质量（QOL）的影响。
我们前瞻性研究了 1996 年 7 月至 2001 年 12 月间治疗的 534 例 SAH 患者中的 216 例，这些患者具有完整的一年随访数据。使用中心流行病学研究抑郁量表（CES-D）评估抑郁状态，使用电话认知状态检查（TICS）评估认知状态，使用疾病影响量表（SIP）3 和 12 个月后评估生活质量。
发病后第一年，47%的患者出现情绪低落；26%的患者在 3 个月和 12 个月时均出现抑郁。非白种人预测早期（3 个月）和晚期（12 个月）抑郁；早期抑郁还与既往诊断的抑郁症、吸烟和脑梗死有关，而晚期抑郁与既往社会隔离和缺乏医疗保险有关。抑郁与 SIP 所有领域的 QOL 均较差有关，抑郁状况的变化与发病后第一年 QOL、残疾和认知功能的显著平行变化有关。CES-D 评分占 SIP 总分解释方差的 60%以上，而 TICS 表现仅占 6%以上。
抑郁影响 SAH 患者发病后第一年近一半的患者，与 QOL 较差有关。对抑郁进行系统筛查和早期治疗是改善 SAH 后转归的有前途的策略。
