Anxiety and depression after pregnancy-related cerebral venous sinus thrombosis: associations with functional disability at discharge.

BACKGROUND

Cerebral venous sinus thrombosis (CVST) during pregnancy and the puerperium is a rare but potentially life-threatening condition. While neurological and functional outcomes have been increasingly studied, the burden of anxiety and depression after CVST in pregnant and postpartum women remains poorly characterized.

METHODS

We conducted a retrospective cohort study of pregnant and postpartum women diagnosed with CVST at a tertiary referral center. Anxiety and depression were assessed at 3 months after CVST using the Hamilton Anxiety Rating Scale (HAMA) and the 24-item Hamilton Depression Rating Scale (HAMD-24). Functional outcome was evaluated using the modified Rankin Scale (mRS) at discharge. Associations between functional disability and affective symptoms were examined using linear regression models treating HAMA, HAMD-24, and mRS as continuous variables, with minimal and full adjustment for clinically relevant covariates and overlapping comorbidities, stratified by perinatal phase (antepartum vs. postpartum) with a formal mRS × phase interaction test, and supported by heteroscedasticity-consistent (HC3) robust standard errors, regression diagnostics, and rank-based Spearman correlation analyses as assumption-free sensitivity analyses.

RESULTS

Among 115 eligible patients (43 antepartum-onset, 72 postpartum-onset), symptoms of anxiety and depression were common at 3 months after CVST. The mean HAMA score was 14.9 (SD 12.0), and the mean HAMD-24 score was 15.9 (SD 12.3). Moderate-to-severe anxiety and depression were observed in 43.2 and 37.8% of patients, respectively. A worse functional outcome at discharge was strongly associated with higher anxiety and depression scores. In fully adjusted models, each one-point increase in mRS was associated with an 8.4-point increase in HAMA (95% CI 7.0-9.7) and a 7.3-point increase in HAMD-24 (95% CI 5.8-8.7, both p < 0.001). The dose-response relationship was directionally consistent across antepartum and postpartum subgroups (interaction p = 0.075 for HAMA, 0.897 for HAMD-24), and was confirmed by Spearman correlations (ρ = 0.75 for HAMA, 0.68 for HAMD-24; both p < 0.001).

INTERPRETATION: Anxiety and depression are highly prevalent following pregnancy- and puerperium-related CVST and are closely linked to functional disability at discharge. Early functional outcome may serve as a pragmatic marker to identify patients at high risk of affective disorders, highlighting the need for integrated neurological and mental health follow-up in this vulnerable population.