NEUROSURGERY VOLUME 63 | NUMBER 6 | DECEMBER 2008 | 1095 CLINICAL STUDIES Adam J. Noble, B.Sc. Department of Psychology, Durham University, Stockton-on-Tees, England Stefanie Baisch Department of Psychology, Durham University, Stockton-on-Tees, England A. David Mendelow, Ph.D. Department of Neurosurgery, Newcastle General Hospital, Newcastle, England Lizanne Allen, Ph.D. Department of Neuropsychology, James Cook University, Middlesbrough, England Philip Kane, M.D. Department of Neurosurgery, James Cook University, Middlesbrough, England Thomas Schenk, Ph.D. Department of Psychology, Durham University, Stockton-on-Tees, England Reprint requests: Thomas Schenk, Ph.D., Wolfson Research Institute, Durham University, Queen’s Campus, Stockton-on-Tees, England TS17 6BH. Email: thomas.schenk@durham.ac.uk Received, February 16, 2008. Accepted, May 15, 2008. O utcome research on subarachnoid hem- orrhage (SAH) is confronted with a par- adox. Conventional clinical measures, which focus on the disability level of the disor- der, such as the Glasgow Outcome Scale (24), suggest that most SAH survivors can expect a moderate to good outcome with little disability (7, 21). In contrast, handicap-oriented measures report that SAH patients show significantly reduced social participation and quality of life (QoL) in both the short and long term (27, 55). Neither physical nor cognitive impairments, on average, seem severe enough to explain the QoL reduction (39, 40). Instead, we need to look beyond classic neurological SAH sequelae to find an explanation. Two candidates are post- traumatic stress disorder (PTSD) and fatigue. PTSD, characterized by intrusive recollec- tions of the trauma, active avoidance of stimuli associated with the trauma, and persistently increased arousal (e.g., sleep disturbance, hyper- vigilance, and an exaggerated startle response), POSTTRAUMATIC STRESS DISORDER EXPLAINS REDUCED QUALITY OF LIFE IN SUBARACHNOID HEMORRHAGE P ATIENTS IN BOTH THE SHORT AND LONG TERM OBJECTIVE: A subarachnoid hemorrhage reduces patients’ quality of life (QoL) in both the short and long term. Neurological problems alone cannot explain this reduction. We examined whether posttraumatic stress disorder (PTSD) and fatigue provide an expla- nation. METHODS: We prospectively studied a representative sample of 105 subarachnoid hemorrhage patients. Patients were examined at approximately 3 and 13 months post- ictus. Examinations included assessments of PTSD, fatigue, sleep, cognitive and phys- ical outcomes, and QoL. Patients’ coping skills were also assessed. Regression analy- ses identified predictors for QoL and PTSD. RESULTS: Thirty-seven percent met the diagnostic criteria for PTSD at both assessment points. This is a fourfold increase compared with the rate of PTSD in the general pop- ulation. Fatigue in patients was also consistently elevated, higher, in fact, than the noto- riously high fatigue level reported for cancer patients undergoing chemotherapy. PTSD was the best predictor for mental QoL, the domain most persistently impaired. It also helped predict physical QoL. Moreover, PTSD was linked to increased sleep problems and may, therefore, have led to fatigue in both the acute and later stages of recovery. To establish the cause of PTSD, a logistic regression was performed. This showed that mal- adaptive coping was the best predictor of PTSD. CONCLUSION: PTSD explains why some subarachnoid hemorrhage patients, despite relatively good clinical outcomes, continue to experience a reduced QoL. Given that maladaptive coping skills seem the main cause of PTSD, teaching patients better cop- ing skills early on might prevent PTSD and QoL reduction. KEY WORDS: Fatigue, Outcome, Posttraumatic stress disorder, Quality of life, Subarachnoid hemorrhage Neurosurgery 63:1095–1105, 2008 DOI: 10.1227/01.NEU.0000327580.91345.78 www.neurosurgery-online.com ABBREVIATIONS: FIM-MS, Functional Independence Measure motor score; MFSI-SF, Multidimensional Fatigue Symptom Inventory–Short Form; PSQI, Pittsburgh Sleep Quality Index; PTSD, posttraumatic stress disorder; QoL, quality of life; SAH, subarachnoid hemorrhage; SF-36, Short Form-36; WFNS, World Federation of Neurological Societies