Post-traumatic stress following aneurysmal and angiography-negative subarachnoid hemorrhage: Impact on participation

Background: A subarachnoid hemorrhage (SAH) is a severe type of stroke, associated with post-traumatic stress in patients with an aneurysmal SAH (aSAH). So far, it is unknown whether post-traumatic stress is also present after angiography-negative SAH (anSAH). This study investigates the prevalence and temporal progression of post-traumatic stress symptoms after both aSAH and anSAH, along with their impact on long-term participation in various aspects of life (work, leisure and social relationships).
Methods: Patients diagnosed with either aSAH or anSAH were recruited at the University Medical Center Groningen between February 2019 and February 2024. Neuropsychological assessments were conducted 6 months post-SAH (T1), 1 year post-SAH (T2) and 2 years post-SAH (T3). Post-traumatic stress was evaluated using the Impact of Events Scale (IES). Participation was assessed using the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P).
Results: A total of 88 patients (aSAH: n= 61, anSAH: n=27) were included. At T1, 22.9% of aSAH patients and 33.3% of anSAH patients showed clinically significant scores (>26) on the IES. No significant difference was found between the two patient groups (U= 861, p= .639). IES scores after aSAH did not vary significantly across time points (X2= 11.474, p= .003). While IES scores decreased between T1 and T2 for anSAH patients, this decrease did not continue between T2 and T3. Higher post-traumatic stress levels correlated with increased restrictions in work, leisure, and social relationships at all timepoints post-anSAH and only at 2 years post-aSAH.
Conclusion: The assessment of post-traumatic stress in patients with aSAH and anSAH is crucial as it seems to be an important factor influencing their ability to participate in various life domains. Post-traumatic stress may be a target for treatment to facilitate recovery and enhance participation after SAH.