Influence of Depression on Return to Work after Subarachnoid Hemorrhage
Depression occurs in about 30% of subjects with subarachnoid hemorrhage (SAH) and is associated with impaired quality of life (QoL). However, the influence of depression on return to work (RTW) after SAH is not known. We prospectively studied a consecutive series of 121 SAH subjects, working premorbidly, who completed a Center for Epidemiological Studies-Depression Scale (CES-D) at 3 months post-SAH (63% women, mean age = 47 years). Depression was defined as a score ≥ 16 on the CES-D, and work status as working vs. not working. Potential predictors of post-SAH depression and RTW were screened with univariate tests and included: basic demographics, pre- and post-SAH psychiatric status, and acute physiologic parameters of SAH. Variables deemed significant in the univariate models (p<.05) were entered into a forward, stepwise binary logistic model with 3-month work status as the dependent measure. In our population, premorbid lifetime diagnosis or treatment for depression was present in 17% of the subjects (20/121), but rose to 40% (48/121) at 3 months post-SAH (M3). Only 42% (51/121) reported that they had resumed their pre-morbid work status either at the same level (36/121) or at a decreased level (15/121). For non-depressed subjects, half (38/73) were able to return to work, however, only 27% (13/48) of the depressed subjects were able to return (p<.008). Significant univariate predictors of RTW were: education (p<.007), race (p<.044), admission Hunt Hess grade (p<.006), and cerebral edema (p<.001). The final multivariate model for the prediction of return to work identified 3 risk factors: cerebral edema (OR=9.4, 95% CI 2.51–35.46, p<.001), lower education (OR=1.1, 95% CI 1.02–1.29, p<.025), and depression at M3 (OR=2.4, 95% CI 1.01–5.73, p<.048). Overall, depression occurred in about 40% of subjects when assessed 3 months after SAH. The association of depression with work status remains significant, even after controlling for factors that contribute to occupational disability, including lower education and cerebral edema. Early diagnosis and treatment of acute edema and delayed depression in these patients may lead to significant improvement in employment rates after SAH.