{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T18:16:02Z","timestamp":1778609762432,"version":"3.51.4"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Postdiagnostic anxiety and depression\u2019s impact on management and outcomes in patients with unruptured intracranial aneurysms remains underexplored. We assessed associations with treatment patterns and outcomes using a large multi-institutional database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This retrospective cohort study used TriNetX Global Collaborative Network records (2015\u20132025; &gt;130 million patients across \u2248250 health care organizations), identifying 127\u2009361 adults with unruptured intracranial aneurysms. Addressing immortal time bias, we used a 127-day landmark analysis (median time to psychiatric diagnosis), requiring event-free survival before cohort assignment. Of 119\u2009211 patients surviving to the landmark, those with anxiety\/depression diagnosed within 0 to 127 days (n=7250) were 1:1 propensity score matched to controls (n=111\u2009961), yielding 6800 per cohort. Cox proportional hazards models evaluated outcomes from a landmark.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Matched cohorts (6800 each) had balanced characteristics (all standardized mean differences &lt;0.10) and comparable follow-up (median, 1550 versus 1600 days). Anxiety\/depression was associated with higher all-cause mortality (6.3% versus 4.5%; hazard ratio [HR], 1.28 [95% CI, 1.11\u20131.48];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) and rupture (3.1% versus 2.2%; HR, 1.33 [95% CI, 1.08\u20131.64];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.007). Five-year survival was 93.7% in the anxiety\/depression cohort versus 95.5% in matched controls. Preventive treatment showed nonsignificant trends toward lower rates (odds ratio, 0.80 [95% CI, 0.62\u20131.03];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.082). Sensitivity analysis using a 365-day landmark (n=10\u2009200 per cohort) expanded eligibility by including diagnoses between days 128 and 365, and confirmed findings (mortality HR, 1.22 [95% CI, 1.08\u20131.38]; rupture HR, 1.28 [95% CI, 1.08\u20131.52]). Fine-Gray competing risk models yielded consistent results (mortality subdistribution HR, 1.27; rupture subdistribution HR, 1.31). Dose-response patterns emerged for psychiatric medication adherence: low (mortality HR, 1.50 [95% CI, 1.12\u20132.00];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.006), moderate (HR, 1.29 [95% CI, 0.98\u20131.70];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.071), and high (HR, 1.16 [95% CI, 0.89\u20131.51];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.270). E values were 1.88 for mortality and 1.99 for rupture.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Postdiagnostic anxiety and depression are associated with increased rupture risk and mortality in patients with unruptured intracranial aneurysms. Residual confounding cannot be excluded. These findings require further investigation to establish causality and suggest that an integrated psychiatric assessment may be considered in unruptured intracranial aneurysm management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.126.054546","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T10:00:12Z","timestamp":1772618412000},"page":"1208-1219","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Postdiagnostic Anxiety and Depression Increase Rupture Risk and Mortality in Unruptured Intracranial Aneurysms"],"prefix":"10.1161","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8325-2382","authenticated-orcid":true,"given":"Muhammed Amir","family":"Essibayi","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (M.A.E., A.K., D.K., N.H., D.J.A.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4256-0159","authenticated-orcid":true,"given":"Ahmed Y.","family":"Azzam","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown (A.Y.A., D.A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5208-8425","authenticated-orcid":true,"given":"Hamza Adel","family":"Salim","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, MD Anderson Medical Center, Houston, TX (H.A.S.)."},{"name":"Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, MD (H.A.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alireza","family":"Karandish","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (M.A.E., A.K., D.K., N.H., D.J.A.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4401-5127","authenticated-orcid":true,"given":"Mustafa S.","family":"Alhasan","sequence":"additional","affiliation":[{"name":"Division of Radiology, Department of Internal Medicine, College of Medicine, Taibah University, Madinah, Saudi Arabia (M.S.A.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7577-1887","authenticated-orcid":true,"given":"Dhairya A.","family":"Lakhani","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown (A.Y.A., D.A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2455-748X","authenticated-orcid":true,"given":"Huanwen","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Neurointerventional Surgery, Department of Neurosurgery, University of Maryland Medical Center, Baltimore (H.C., D.G.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6741-5970","authenticated-orcid":true,"given":"Dheeraj","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Division of Neurointerventional Surgery, Department of Neurosurgery, University of Maryland Medical Center, Baltimore (H.C., D.G.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0131-5699","authenticated-orcid":true,"given":"Adam A.","family":"Dmytriw","sequence":"additional","affiliation":[{"name":"Neuroendovascular Program, Massachusetts General Hospital &amp; Brigham and Women\u2019s Hospital, Harvard University, Boston (A.A.D.)."},{"name":"Neurointerventional &amp; Neuroanalytics Collaboration, School of Medicine, Toronto Metropolitan University, ON, Canada (A.A.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1902-9623","authenticated-orcid":true,"given":"Deepak","family":"Khatri","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (M.A.E., A.K., D.K., N.H., D.J.A.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Haranhalli","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (M.A.E., A.K., D.K., N.H., D.J.A.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5130-1378","authenticated-orcid":true,"given":"David J.","family":"Altschul","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (M.A.E., A.K., D.K., N.H., D.J.A.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2016.150"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1113260"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0229795"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(13)70263-1"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-022-01768-6"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.14.2101"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2009.09.033"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.9910"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.045393"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.71079\/aside.im.03222516"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-022-04120-w"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1080\/00273171.2011.568786"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.125.053599"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.125.050972"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2025.2020"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1214\/aos\/1176345976"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1346703"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2024.01.166"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnint.2023.1207610"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-020-02834-3"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci11101298"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1295261"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pscychresns.2008.06.006"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/720141"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.114.03300"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.21037\/qims.2016.01.06"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.038035"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2010.1084"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","unstructured":"Zimmerman K Shlobin NA Salehani A Rocque BG. 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