Long-term quality of life and depressive symptoms among survivors of poor-grade aneurysmal subarachnoid hemorrhage.

Introduction: Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality and poor functional outcomes. Despite improved survival with advances in neurocritical care, long-term quality of life (QOL) and psychological sequelae remain insufficiently characterized. Research question: What is the long-term quality of life among survivors of poor-grade aSAH and how is it associated with functional and psychological outcomes? Material and methods: We retrospectively analyzed patients with poor-grade aSAH (WFNS IV-V) treated between 2013 and 2023. Survivors underwent long-term follow-up assessment using the Stroke-Specific Quality of Life scale (SS-QOL), SF-12 Physical Component Summary (PCS), and Patient Health Questionnaire (PHQ-9). SS-QOL >147 was used as descriptive threshold. Results: Of 339 patients with poor-grade aSAH, 47.8% died. Among survivors, 15.9% were lost to follow-up. Among eligible survivors, 35.8% did not participate, resulting in 79 included patients (23.3% of the original cohort; median follow-up of 4.36 years. Among participants, 88.6% had SS-QOL >147. SS-QOL correlated positively with SF-12 PCS (ρ = 0.49, p < 0.001) and negatively with PHQ-9 (ρ = -0.67, p < 0.001). In multivariable analysis, PHQ-9 was the only variable associated with SS-QOL. Higher depressive symptom burden was associated with lower scores across all SS-QOL domains. Discussion and conclusion: Among selected survivors of poor-grade aSAH, favorable QOL was observed despite severe initial disease. Depressive symptom burden was strongly associated with overall QOL, and inversely associated with all SS-QOL domains. However, mortality, loss to follow-up, and non-participation represent sources of selection bias and may result in overestimation of QOL.