Anxiety after subarachnoid hemorrhage: A systematic review and meta-analysis

Abstract

Background: Anxiety is a common and debilitating illness accompanying many neurological disorders including non-traumatic subarachnoid hemorrhage (SAH). Objectives: The aim of this systematic review was to identify and critically appraise all published studies that have reported the frequency, severity, and time course of anxiety after SAH, the factors associated with its development and the impact of anxiety on patients’ quality of life. Methods: The PubMed EMBASE, PsycINFO and Ovid Nursing databases were searched for studies published in English that recruited at least 40 patients aged 18 or over who were diagnosed with anxiety after SAH. Results: Twenty-nine studies covering 4,104 patients met the inclusion criteria. The frequency of anxiety ranged from 0% to 61.7%, with a weighted proportion of 31.2%. Anxiety remained prevalent several years after the index SAH. Anxiety after SAH was associated with education level, social support, and coping style. Comorbid cognitive impairment, fatigue, and depression also increased the risk of anxiety. Rupture of posterior circulation aneurysms may also be related to anxiety. Anxiety reduces the work capacity, participation in leisure and social activities, and quality of life of patients after SAH. Conclusions: Anxiety is common after SAH. Further research is needed to clarify its time course and identify the neurochemical factors and brain circuits associated with the development of post-SAH anxiety. Randomized controlled treatment trials targeting SAH-related anxiety are warranted.

Keywords

• Subarachnoid hemorrhage
• Anxiety
• Systematic review
• Meta-analysis