Anxiety, depression and fatigue may decrease long-term quality of life (QOL) for subarachnoid hemorrhage (SAH) stroke survivors
Dec 26, 08
A subarachnoid hemorrhage occurs when a blood vessel on the brains surface ruptures and bleeds into the space between the skull and brain, but not into the brain.
In a study assessing 141 men and women living in the community two to four years after a SAH stroke, researchers found health-related QOL was related to psychological symptoms, such as mood disorders, fatigue, cognitive complaints, and to personality characteristics.
Depression, anxiety and fatigue were pronounced in a significant proportion of SAH survivors studied, with a strong association to decreased QOL.
32 percent of the survivors reported anxiety;
23 percent reported depression; and
67 percent reported fatigue.
The patients discharged from the University Medical Center, Utrecht, in The Netherlands to their own homes were an average 51 years. Sixty-six percent were women.
The major point is to look beyond physical symptoms and look at psychological symptoms and personality characteristics to evaluate quality of life, said Anne Visser-Meily, M.D., Ph.D., lead author of the study and rehabilitation specialist at the Rudolph Magnus Institute of Neuroscience at University Medical Center in Utrecht. These characteristics are important in planning rehabilitation and targeting an intervention to help improve quality of life.
Researchers evaluated QOL scores using the well-established Stroke Specific Quality of Life scale. The scale has 49 items, merged into four domains reflecting physical, cognitive, emotional and social QOL. They also used other scales to help in evaluation.
Researchers found the best scores in the physical domain; the worse were in the emotional and social domains. All psychological symptoms and personality characteristics were strongly related to the total QOL score.
The study examined such personality characteristics as passive coping and neuroticism. When you analyze depression, anxiety and fatigue, you find there is a strong correlation with a passive coping style and neuroticism, Visser-Meily said. Those with a passive coping style need psychological support to encourage them to be more independent.
Cognitive function is another important determinant of QOL associated with coping style. Those who had a passive coping style and who were depressed reported more neuropsychological problems. This emphasizes the need to take personality into account as a potential vulnerability factor for decreased QOL, said Visser-Meily.
University Hospital has opened a special multidisciplinary outpatient clinic for those who have experienced SAH. In a new approach to care, nurses, physicians and psychologists are analyzing physical and (neuro) psychological symptoms and tailoring rehabilitation programs for each patient.
Co-authors are: Marloes Rhebergen, medical student; Gabriel Rinkel, M.D., Ph.D.; Martine van Zandvoort, Ph.D.; and Marcel Post, Ph.D.