Sleep

Investigation of psychological and sleep states in patients with Intracerebral hemorrhage and analysis of influencing Factors: A Single-Center Case-Control study.

TL;DR

Psychological issues in ICH patients, though prevalent, declined over time, affected by patient characteristics (physical function, socioeconomic status), caregiver dynamics, and multidimensional psychological interactions.

Key Findings

The prevalence of moderate-to-severe anxiety and depression in ICH patients gradually declined over one year post-discharge.

  • 524 ICH patients were enrolled in this single-center case-control study.
  • Assessments were conducted at hospital admission and at 1, 3, 6, and 12 months after onset.
  • Multiple questionnaires were used to assess disease and psychological status at each time point.
  • The decline in anxiety and depression prevalence was progressive throughout the rehabilitation period.

Sleep quality in ICH patients fluctuated over the rehabilitation period, peaking (worsening) at 1 month and 6 months post-discharge.

  • Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI).
  • Unlike anxiety and depression, sleep quality did not follow a simple declining trend but showed bimodal worsening.
  • HAMD (Hamilton Depression Scale) and Barthel Index scores were identified as influencing factors for sleep quality.
  • Sleep quality assessments were conducted at the same five time points as psychological assessments.

Multivariate analysis identified multiple risk factors for psychological disorders in ICH patients, spanning individual, socioeconomic, and caregiver-related domains.

  • Risk factors with OR > 1 (increasing risk) included hypertension, lower family income, and prolonged daily caregiving hours.
  • Risk factors with OR < 1 (protective or inversely associated) included male gender, low muscle strength, lack of exercise, and unemployment.
  • Caregiver-related risk factors included caregivers' limited disease knowledge and low caregiver enthusiasm (OR < 1).
  • Both patient-specific and family/social factors were independently associated with psychological outcomes.

Anxiety and depression were strongly correlated with each other at 1 month post-discharge.

  • The correlation coefficient between anxiety and depression at 1 month post-discharge was r = 0.730.
  • Psychological scores exhibited intercorrelations across multiple dimensions.
  • This strong correlation suggests co-occurrence of anxiety and depression early in the rehabilitation period.

Admission Somatic Symptom Scale (SSS) scores significantly predicted anxiety in ICH patients.

  • SSS scores at admission were identified as a significant predictor of anxiety through multivariate analysis.
  • Depression was linked to PSQI (Pittsburgh Sleep Quality Index), SSS, and Barthel Index scores.
  • The Barthel Index, a measure of functional independence, was associated with both depression and sleep quality outcomes.
  • These associations highlight the interplay between somatic symptoms, functional status, and psychological outcomes.

Caregiver characteristics, including disease knowledge and enthusiasm, were associated with psychological outcomes in ICH patients.

  • Data regarding rehabilitation support provided by caregivers or family members were collected alongside patient data.
  • Caregivers' limited disease knowledge was identified as a risk factor for worse psychological outcomes.
  • Low caregiver enthusiasm was also identified as a risk factor (OR < 1 in multivariate analysis).
  • Prolonged daily caregiving hours were associated with increased risk (OR > 1), suggesting caregiver burden may negatively impact patient outcomes.

What This Means

This research followed 524 patients recovering from intracerebral hemorrhage (bleeding in the brain) over 12 months to track how their mental health and sleep changed during recovery. The study measured anxiety, depression, and sleep quality at five different time points: at hospital admission and then at 1, 3, 6, and 12 months after the stroke. The researchers found that anxiety and depression were common after ICH but gradually became less severe over the year of follow-up. Sleep problems, however, were more unpredictable, getting worse at 1 month and again at 6 months before improving. The study identified a wide range of factors that influenced how patients fared psychologically. Physical factors like muscle weakness and lack of exercise played a role, as did social and economic factors like unemployment and lower family income. Interestingly, the knowledge and enthusiasm of family caregivers also mattered — patients whose caregivers knew more about the disease and were more engaged tended to have better outcomes. Anxiety and depression were closely linked to each other, especially at 1 month after discharge, and depression was also connected to poor sleep quality and reduced ability to perform daily activities independently. This research suggests that caring for ICH patients requires attention beyond the physical injury itself. Because psychological recovery is shaped by the patient's physical condition, their financial and social circumstances, and the quality of care provided at home, a comprehensive approach that supports both patients and their caregivers may lead to better mental health outcomes during rehabilitation. The findings point to a need for early screening for anxiety, depression, and sleep problems, as well as programs that educate and support family caregivers throughout the recovery process.

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Citation

He Y, Xia C, Zhao X, Xiao L, Luo Q. (2026). Investigation of psychological and sleep states in patients with Intracerebral hemorrhage and analysis of influencing Factors: A Single-Center Case-Control study.. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. https://doi.org/10.1016/j.jocn.2026.111870