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Wu J, Sun H, Ma J. Causal association between depression and intracranial aneurysms: a bidirectional two-sample Mendelian randomization study. Front Neurol 2024; 15:1346703. [PMID: 38419712 PMCID: PMC10899323 DOI: 10.3389/fneur.2024.1346703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Background Although observational studies have suggested a bidirectional relation between depression and intracranial aneurysms (IAs), their causal relations remain unclear. Thus we aimed to assess the causal association between depression and IAs. Methods We conducted a bidirectional two-sample Mendelian randomization (MR) study using summary-level data from publicly available genome-wide association studies of depression (n = 500,199), IAs (n = 79,429), unruptured intracranial aneurysm (uIA) (n = 74,004), and subarachnoid hemorrhage (SAH) (n = 77,074). MR analyses included the inverse-variance weighted (IVW) method as the primary analytic, plus weighted-median, simple mode, weighted mode, MR-Egger, and MR PRESSO. Results Genetically predicted depression was strongly positively related to IAs (odds ratio [OR] = 1.69, 95% confidence interval [CI] 1.19-2.39, p = 0.003), uIA (OR = 1.96, 95% CI 1.06-3.64, p = 0.032), and SAH (OR = 1.73, 95% CI 1.14-2.61, p = 0.009). Reverse MR analyses showed that while genetically predicted uIA was positively related to depression (OR = 1.02, 95% CI 1.00-1.05, p = 0.044), no causal relations were observed for either IAs or SAH for depression. Conclusion Our findings provide evidence of a causal effect of depression on IAs, uIA, and SAH. For the reverse MR analyses, we found a causal impact of uIA on depression, but no causal influence of either IAs or SAH for depression.
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Affiliation(s)
- Jujiang Wu
- Neurointensive Care Unit, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Hao Sun
- Neurointensive Care Unit, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Junqiang Ma
- Neurointensive Care Unit, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Population Medicine, Shantou University Medical College, Shantou, China
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Peng K, Li Y, Adegboro AA, Wanggou S, Li X. Mood swings are causally associated with intracranial aneurysm subarachnoid hemorrhage: A Mendelian randomization study. Brain Behav 2023; 13:e3233. [PMID: 37632147 PMCID: PMC10636415 DOI: 10.1002/brb3.3233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/05/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Mood swings have been observed in patients with intracranial aneurysm (IA), but it is still unknown whether mood swings can affect IA. AIM To explore the causal association between mood swings or experiencing mood swings and IA through a two-sample Mendelian randomization (MR) study. METHODS Summary-level statistics of mood swings, experiencing mood swings, IA, aneurysm-associated subarachnoid hemorrhage (aSAH), and non-ruptured IA (uIA) were collected from the genome-wide association study. Two-sample MR and various sensitivity analyses were employed to explore the causal association between mood swings or experiencing mood swings and IA, or aSAH, or uIA. The inverse-variance weighted method was used as the primary method. RESULTS Genetically determined mood swings (odds ratio [OR] = 5.23, 95% confidence interval (95%CI): 1.65-16.64, p = .005) and experiencing mood swings (OR = 2.50, 95%CI: 1.37-4.57, p = .003) were causally associated with an increased risk of IA. Mood swings (OR = 5.67, 95%CI: 1.40-23.04, p = .015) and experiencing mood swings were causally associated with the risk of aSAH (OR = 2.91, 95%CI: 1.47-5.75, p = .002). Neither mood swings (OR = 1.95, 95%CI: .31-12.29, p = .478) nor experiencing mood swings (OR = 1.20, 95%CI: .48-3.03, p = .693) were associated with uIA. CONCLUSIONS Mood swings and experiencing mood swings increased the risk of IA and aSAH incidence. These results suggest that alleviating mood swings may reduce IA rupture incidence and aSAH incidence.
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Affiliation(s)
- Kang Peng
- Department of NeurosurgeryXiangya HospitalCentral South UniversityChangshaHunanChina
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor ResearchXiangya HospitalCentral South UniversityChangshaChina
| | - Yanwen Li
- Department of NeurosurgeryXiangya HospitalCentral South UniversityChangshaHunanChina
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor ResearchXiangya HospitalCentral South UniversityChangshaChina
| | - Abraham Ayodeji Adegboro
- Department of NeurosurgeryXiangya HospitalCentral South UniversityChangshaHunanChina
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor ResearchXiangya HospitalCentral South UniversityChangshaChina
| | - Siyi Wanggou
- Department of NeurosurgeryXiangya HospitalCentral South UniversityChangshaHunanChina
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor ResearchXiangya HospitalCentral South UniversityChangshaChina
| | - Xuejun Li
- Department of NeurosurgeryXiangya HospitalCentral South UniversityChangshaHunanChina
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor ResearchXiangya HospitalCentral South UniversityChangshaChina
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Mensing LA, van Tuijl RJ, Greving JP, Velthuis BK, van der Schaaf IC, Wermer MJH, Verbaan D, Vandertop WP, Zuithoff NPA, Rinkel GJE, Ruigrok YM. Aneurysm Prevalence and Quality of Life During Screening in Relatives of Patients With Unruptured Intracranial Aneurysms: A Prospective Study. Neurology 2023; 101:e904-e912. [PMID: 37414571 PMCID: PMC10501091 DOI: 10.1212/wnl.0000000000207475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/17/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Screening for unruptured intracranial aneurysms (UIAs) is effective for first-degree relatives (FDRs) of patients with aneurysmal subarachnoid hemorrhage (aSAH). Whether screening is also effective for FDRs of patients with UIA is unknown. We determined the yield of screening in such FDRs, assessed rupture risk and treatment decisions of aneurysms that were found, identified potential high-risk subgroups, and studied the effects of screening on quality of life (QoL). METHODS In this prospective cohort study, we included FDRs, aged 20-70 years, of patients with UIA without a family history of aSAH who visited the Neurology outpatient clinic in 1 of 3 participating tertiary referral centers in the Netherlands. FDRs were screened for UIA with magnetic resonance angiography between 2017 and 2021. We determined UIA prevalence and developed a prediction model for UIA risk at screening using multivariable logistic regression. QoL was evaluated with questionnaires 6 times during the first year after screening and assessed with a linear mixed-effects model. RESULTS We detected 24 UIAs in 23 of 461 screened FDRs, resulting in a 5.0% prevalence (95% CI 3.2-7.4). The median aneurysm size was 3 mm (interquartile range [IQR] 2-4 mm), and the median 5-year rupture risk assessed with the PHASES score was 0.7% (IQR 0.4%-0.9%). All UIAs received follow-up imaging, and none were treated preventively. After a median follow-up of 24 months (IQR 13-38 months), no UIA had changed. Predicted UIA risk at screening ranged between 2.3% and 14.7% with the highest risk in FDRs who smoke and have excessive alcohol consumption (c-statistic: 0.76; 95% CI 0.65-0.88). At all survey moments, health-related QoL and emotional functioning were comparable with those in a reference group from the general population. One FDR with a positive screening result expressed regret about screening. DISCUSSION Based on the current data, we do not advise screening FDRs of patients with UIA because all identified UIAs had a low rupture risk. We observed no negative effect of screening on QoL. A longer follow-up should determine the risk of aneurysm growth requiring preventive treatment.
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Affiliation(s)
- Liselore A Mensing
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands.
| | - Rick J van Tuijl
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Jacoba P Greving
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Birgitta K Velthuis
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Irene C van der Schaaf
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Marieke J H Wermer
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Dagmar Verbaan
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - W Peter Vandertop
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Nicolaas P A Zuithoff
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Gabriël J E Rinkel
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
| | - Ynte M Ruigrok
- From the UMC Utrecht Brain Center (L.A.M., G.J.E.R., Y.M.R.), Department of Neurology and Neurosurgery, Department of Radiology (R.J.v.T., B.K.V., I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (J.P.G., N.P.A.Z.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), University Medical Center Leiden; and Department of Neurosurgery (D.V., W.P.V.), Amsterdam University Medical Center, the Netherlands
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Cooke DL, Shen H, Duvvuri M, Thompson D, Neylan T, Wolfe W, Hetts S, Ovbiagele B, Whooley M, Cohen B. Association of select psychiatric disorders with incident brain aneurysm and subarachnoid hemorrhage among veterans. Front Integr Neurosci 2023; 17:1207610. [PMID: 37600234 PMCID: PMC10433370 DOI: 10.3389/fnint.2023.1207610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Background Brain aneurysms represent a significant cause of hemorrhagic stroke. Prior research has demonstrated links between stress and stroke, including brain aneurysms. We aimed to determine relationships between select psychiatric disorders and aneurysms and aneurysmal SAH. Methods We performed retrospective, case-control study of a National Veterans Affairs population with two experimental groups (aneurysm-only and aneurysmal SAH) and 10-fold controls per group matched by age, date, and clinical data source. The studied the presence of 4 psychiatric disorders: Posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and other mood disorders. Our main outcomes Unadjusted and multivariable adjusted ORs of PTSD, MDD, GAD, and mood disorders within aneurysm-only and aSAH groups. Results In 6,320,789 US Veterans who were enrolled for at least 5 years in Medicare and/or the Veterans Health Administration, we identified 35,094 cases of aneurysm without SAH and 5,749 cases of aneurysm with SAH between 1/2005 and 12/2019. In analyses adjusted for sex, hypertension, and tobacco use, patients with aneurysm were more likely than matched controls to have a history of PTSD (OR 1.48), MDD (OR 1.33), GAD (OR 1.26), and other mood disorders (OR 1.34) (all p-values < 0.0001). Similarly, patients with aSAH were more likely than controls to have a history of PTSD (OR 1.35), MDD (OR 1.38), GAD (OR 1.18), and other mood disorders (OR 1.30) (all p-values < 0.0001). Conclusion The study, the largest of its kind, further suggests links between psychiatric disorders and stroke. This is important as patients with aneurysms are not routinely screened for such psychiatric risk factors. Additional research on this topic could lead to novel strategies to improve stroke prevention.
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Affiliation(s)
- Daniel L. Cooke
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Hui Shen
- San Francisco Veterans Affairs Medical Center, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Madhavi Duvvuri
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Daniel Thompson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Thomas Neylan
- Department of Psychiatry, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States
| | - William Wolfe
- Department of Psychiatry, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States
| | - Steven Hetts
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce Ovbiagele
- Department of Neurology, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States
| | - Mary Whooley
- Department of Medicine, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States
| | - Beth Cohen
- Department of Medicine, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States
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A meta-analysis on the prevalence of anxiety and depression in patients with unruptured intracranial aneurysms: exposing critical treatment gaps. Neurosurg Rev 2022; 45:2077-2085. [PMID: 35290550 DOI: 10.1007/s10143-022-01768-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
Unruptured intracranial aneurysms (UIAs) are a significant cause of anxiety and depression. Though the annual rupture rate is relatively low, ensuing mortality and morbidity may be high. Most published studies have focused on functional outcomes; however, limited studies have explored and reported on psychiatric outcomes, which are equally important. We aimed to review existing data on anxiety and depression in patients with UIAs. We systematically searched the databases of Pubmed, Cochrane, Scopus, EBSCOHOST, and ClinicalTrials.gov for studies that reported on anxiety and depression in patients with UIAs. Where available, we also reported data on aneurysm characteristics, treatment modalities, and functional outcomes of these populations. We performed a meta-analysis of proportions by random-effects modeling to compute the prevalence of anxiety and depression in patients with UIAs. Eighteen studies reporting a total of 1413 patients with UIAs were included in the systematic review. The mean age was 57.8 (range 27-79); 64% of whom were female. Random-effect modeling analysis showed an overall estimated prevalence of 28% [95% CI: 0.17-0.42] for anxiety and 21% [95% CI: 0.13-0.33] for depression among patients with UIAs. No significant difference was found in the prevalence of these conditions between treated vs untreated aneurysms. Our review highlights the heterogeneity of data from existing studies and the lack of standardized methodologies in determining psychiatric outcomes in patients with UIAs. It was also limited by the small sample sizes and patient counseling bias in the included studies. Larger, well-designed epidemiologic studies on patients with UIA should include more representative samples, assess for predictors of psychological outcomes, and explore the most optimal psychiatric assessment tools.
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