The Psychological Footprint of Unruptured Intracranial Aneurysm Discovery
- 1Yale University School of Medicine
Abstract
BackgroundUnruptured intracranial aneurysms (UIAs) are increasingly identified incidentally, and management balances rupture risk against treatment risk. UIA diagnosis has been linked to psychological distress, but psychotropic medication initiation after UIA discovery has not been compared across the full UIA management spectrum.
MethodsWe conducted a retrospective cohort study using IBM MarketScan claims (CCAE, MDCD, and MDCR; 2009-2023) among adults with a UIA diagnosis, continuous enrollment for 365 days before and after the index date, and no SAH/rupture on or before the index date. We compared the prevalence of 6 mental-health diagnoses before versus after UIA discovery and used adjusted logistic regression to examine psychotropic medication initiation within 365 days by management strategy (untreated observation as the reference).
ResultsAmong 54,945 patients (untreated, 78.5%; endovascular, 11.3%; clipping, 3.0%; other/uncertain, 7.2%), prevalence of every mental-health diagnosis was higher after UIA discovery, most for depression (+4.6 percentage points) and anxiety (+4.5 points). Medication initiation was most common for benzodiazepines (8.7%). Endovascular treatment was associated with higher adjusted odds of benzodiazepine (aOR, 1.21), SSRI (aOR, 1.20), and sedative-hypnotic (aOR, 1.25) initiation.Surgical clipping demonstrated the broadest association, with higher odds across 5 of 6 classes, including benzodiazepines (aOR, 1.71) and sedative-hypnotics (aOR, 1.86). Benzodiazepines had the lowest 1-year persistence (10.5%) despite being the most commonly initiated class. Findings were consistent across sensitivity analyses, with the exception of the increase in panic disorder, which was no longer observed after applying a 30-day post-index lag.
ConclusionsMental-health diagnoses and psychotropic medication initiation increased after UIA discovery, and medication initiation was most pronounced among patients treated with surgical clipping. These findings support psychological assessment as part of aneurysm management regardless of strategy.
Related
- Experiences of being diagnosed with unruptured intracranial aneurysm in a population-based health survey: A qualitative interview study.
- Associations of genetically predicted Helicobacter pylori antibodies with aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysm: A two-sample mendelian randomization study.
- Quantifying procedural burden during stent-assisted coil embolization for unruptured intracranial aneurysms: development of the aneurysm endovascular procedural complexity score and internal validation of a multivariable complication model
- Clinical Outcomes After Clopidogrel Versus Prasugrel Use in Endovascular Treatment of Unruptured Intracranial Aneurysms: A Propensity-Matched TriNetX Analysis
- Intraoperative intra-aneurysmal pressure monitoring to individualize flow diverter therapy and optimize coil use in unruptured intracranial aneurysms
BibTeX
@misc{renedo2026psychological,
title = {{The Psychological Footprint of Unruptured Intracranial Aneurysm Discovery}},
author = {D. Renedo and H. Chen and K. N. Sheth and D. Gandhi and A. Malhotra and C. C. Matouk},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.25.26361377},
url = {https://www.medrxiv.org/content/10.64898/2026.08.25.26361377v1},
note = {CC BY-ND},
}
RIS
TY - UNPB
TI - The Psychological Footprint of Unruptured Intracranial Aneurysm Discovery
AU - D. Renedo
AU - H. Chen
AU - K. N. Sheth
AU - D. Gandhi
AU - A. Malhotra
AU - C. C. Matouk
PY - 2026
DA - 2026/08/25
PB - medRxiv
DO - 10.64898/2026.08.25.26361377
UR - https://www.medrxiv.org/content/10.64898/2026.08.25.26361377v1
AB - BackgroundUnruptured intracranial aneurysms (UIAs) are increasingly identified incidentally, and management balances rupture risk against treatment risk. UIA diagnosis has been linked to psychological distress, but psychotropic medication initiation after UIA discovery has not been compared across the full UIA management spectrum. MethodsWe conducted a retrospective cohort study using IBM MarketScan claims (CCAE, MDCD, and MDCR; 2009-2023) among adults with a UIA diagnosis, continuous enrollment for 365 days before and after the index date, and no SAH/rupture on or before the index date. We compared the prevalence of 6 mental-health diagnoses before versus after UIA discovery and used adjusted logistic regression to examine psychotropic medication initiation within 365 days by management strategy (untreated observation as the reference). ResultsAmong 54,945 patients (untreated, 78.5%; endovascular, 11.3%; clipping, 3.0%; other/uncertain, 7.2%), prevalence of every mental-health diagnosis was higher after UIA discovery, most for depression (+4.6 percentage points) and anxiety (+4.5 points). Medication initiation was most common for benzodiazepines (8.7%). Endovascular treatment was associated with higher adjusted odds of benzodiazepine (aOR, 1.21), SSRI (aOR, 1.20), and sedative-hypnotic (aOR, 1.25) initiation.Surgical clipping demonstrated the broadest association, with higher odds across 5 of 6 classes, including benzodiazepines (aOR, 1.71) and sedative-hypnotics (aOR, 1.86). Benzodiazepines had the lowest 1-year persistence (10.5%) despite being the most commonly initiated class. Findings were consistent across sensitivity analyses, with the exception of the increase in panic disorder, which was no longer observed after applying a 30-day post-index lag. ConclusionsMental-health diagnoses and psychotropic medication initiation increased after UIA discovery, and medication initiation was most pronounced among patients treated with surgical clipping. These findings support psychological assessment as part of aneurysm management regardless of strategy.
ER -