Psychosocial outcome following subarachnoid haemorrhage: An under-researched problem

Abstract

The high mortality rate associated with spontaneous subarachnoid haemorrhage (Hop et al, 1997) has meant that for a long time research on subarachnoid haemorrhage has focused on gross morbidity and survival time. However, improving survival over the last few decades (Nieuwkamp et al, 2009) has meant that it is now important to also examine subarachnoid haemorrhage patients' psychosocial outcome. This has been measured by asking patients to report on their health-related quality of life (HRQoL). Research that has looked into the effects on HRQoL of subarachnoid haemorrhage has found significant reductions compared to both normative levels and that reported by persons after other illnesses (e.g. Deane et al, 1996; Hackett and Anderson, 2000). Despite their importance in explaining more fundamental aspects of outcome after subarachnoid haemorrhage, classical predictors–such as patient age, sex, clinical severity, bleed severity, physical and cognitive disability–have not been found to help explain the reduction in subarachnoid haemorrhage HRQoL. This article will examine why traditional predictors are of little use in explaining subarachnoid haemorrhage patients' HRQoL. The evidence on alternative explanative factors is discussed. The evidence suggests that there are indications that the secondary consequences of subarachnoid haemorrhage in the form of post-traumatic stress disorder (Noble et al, 2008) and hormonal dysfunction (Kreitschmann-Andermahr et al, 2007) may better account for the reduced HRQoL after subarachnoid haemorrhage.