Depression after aneurysmal subarachnoid hemorrhage: development of a screening tool and discharge user interface

Abstract

Background: A method for identification of chronic depression after aneurysmal subarachnoid hemorrhage (aSAH), risk stratification, and counseling is needed. This study aimed to develop a scoring system for post-aSAH depression and a user interface to supplement discharge counseling for patients. Methods: Based on a published prediction model for posttreatment depression risk among aSAH patients, a scale was developed using the beta coefficients of the final predictive model. The 5-point scale was based on 4 characteristics: tobacco use (2 points), chronic obstructive pulmonary disease (1 point), diabetes (1 point), and nonsaccular aneurysm type (1 point). A score of 1 was defined as low risk, a score of 2 or 3 was defined as medium risk, and a score of 4 or 5 was defined as high risk. The scale was then validated in a cohort of 514 patients treated at a single center. An interactive application was developed. Results: The rate of posttreatment depression among aSAH patients was 29.6% (152 of 514). The low-risk group had a nonsignificant increase in depression risk (relative risk [RR] [95% CI] = 0.89 [0.59–1.33], p = 0.71) compared with those with a score of 0. Significant increases in depression risk were found in the medium-risk (RR [95% CI] = 1.78 [1.34–2.37], p < 0.001) and high-risk (RR [95% CI] = 2.29 [1.28–4.09], p < 0.001) groups. Conclusions: A substantial percentage of patients in our cohort experienced major depressive disorder symptoms after aSAH treatment. An easy-to-use prediction and risk stratification tool for posttreatment depression among aSAH patients is available.