Long-term anxiety in spontaneous intracerebral hemorrhage survivors

Although anxiety is common in several neurological conditions, it has been poorly investigated after spontaneous intracerebral hemorrhage (ICH).

In consecutive ICH survivors, we assessed the long-term prevalence of anxiety and its clinical and radiological determinants.

Using the Hospital Anxiety and Depression Scale (HADS), we evaluated ICH survivors enrolled in the prospective, single-center Prognosis of Intracerebral Hemorrhage (PITCH) study. The prevalence of anxiety (defined as a HADS-anxiety subscale score >7) was evaluated at three time points (1-2, 3-5, and 6-8 years after ICH), along with neurological symptoms severity, functional disability, and cognitive impairment scores. Clinical and radiological characteristics associated with anxiety were evaluated in univariate and multivariable models.

Of 560 patients with spontaneous ICH, 255 were alive 1 year later, 179 of whom completed the HADS questionnaire and were included in the study. Thirty-one patients (17%; 95% confidence interval (CI) = 12-23) had anxiety 1-2 years, 38 (27%; 95% CI = 19-34) 3-5 years, and 18 (21%; 95% CI = 12-30) 6-8 years after ICH. In patients with anxiety, the prevalence of associated depressive symptoms was 48% 1-2 years, 61% 3-5 years, and 56% 6-8 years after ICH. Among clinical and radiological baseline characteristics, only lobar ICH location was significantly associated with anxiety 1-2 years after ICH (odds ratio = 2.8; 95% CI = 1.2-6.5). Anxiety was not associated with concomitant neurological symptoms severity, functional disability, or cognitive impairment.

Anxiety is frequent in ICH survivors, often in association with depressive symptoms, even many years after the index event.