Postdiagnostic Anxiety and Depression Increase Rupture Risk and Mortality in Unruptured Intracranial Aneurysms

BACKGROUND: Postdiagnostic anxiety and depression’s impact on management and outcomes in patients with unruptured intracranial aneurysms remains underexplored. We assessed associations with treatment patterns and outcomes using a large multi-institutional database. METHODS: This retrospective cohort study used TriNetX Global Collaborative Network records (2015–2025; >130 million patients across ≈250 health care organizations), identifying 127 361 adults with unruptured intracranial aneurysms. Addressing immortal time bias, we used a 127-day landmark analysis (median time to psychiatric diagnosis), requiring event-free survival before cohort assignment. Of 119 211 patients surviving to the landmark, those with anxiety/depression diagnosed within 0 to 127 days (n=7250) were 1:1 propensity score matched to controls (n=111 961), yielding 6800 per cohort. Cox proportional hazards models evaluated outcomes from a landmark. RESULTS: Matched cohorts (6800 each) had balanced characteristics (all standardized mean differences