Factors associated with development of depression in adult patients with brain arteriovenous malformations

Abstract

Objective

Cerebrovascular diseases are often associated with the development of depression, but few studies have assessed this association with brain arteriovenous malformations (bAVMs). We aim to explore the association of brain arteriovenous malformation(bAVM) with new onset depression at follow-up.

Methods

We performed a retrospective cohort study on adult bAVMs patients using an institutional bAVM database. Patients with hereditary hemorrhagic telangiectasia(HHT), incomplete data or a confirmed diagnosis of depression before their bAVM diagnosis were excluded. The outcome of interest was diagnosis of depression at follow-up. Self-reported depression without an established diagnosis were not counted. Patient demographics, socioeconomic status, clinical and bAVM characteristics were analyzed in a multivariable logistic regression against the outcome variable.

Results

Among 752 adult bAVM patients with complete data, 660 (87.8 %) had no depression at the time of their bAVM diagnosis and were included as the final cohort. There were 250(37.9 %) ruptured bAVMs. Mean follow-up time was 9.60 years, during which 187(28.3 %) had a new diagnosis of depression. Multivariable analysis found that white race(OR=1.75,CI=[1.21,2.57],p = 0.004), female(OR=1.49,CI=[1.04,2.14],p = 0.031), ADI quantile 2(OR=1.85,CI=[1.21,2.85],p = 0.005) and quantile 3(OR=2.05,CI=[1.22,3.42],p = 0.006), occipital lobe involvement(OR=1.66,CI=[1.05,2.60],p = 0.028), follow-up mRS≥ 2(OR=1.69,CI=[1.14,2.52],p = 0.010), bAVM obliteration (OR=1.46,CI=[1.02,2.11],p = 0.040), and follow-up seizures(OR=1.70,CI=[1.14,2.55],p = 0.009) were significant factors associated with new-onset diagnosis of depression at follow-up.

Conclusion

We characterized the probability of new-onset depression at follow-up in patients with bAVMs. More than 25 % of patients developed depression in this study. White female, suboptimal socioeconomic status, occipital lobe, poor outcome, follow-up seizures, and definitive management with bAVM obliteration was associated with depression. Identification of these features may provide guidance in early preventive measures.