extended imaging follow - up of coiled aneurysms that are adequately occluded at 6  months is under debate because the yield of clinically relevant findings appears to be low [ 13 ] . although imaging follow - up with magnetic resonance angiography ( mra ) has a negligible risk of complications , a follow - up regime longer than necessary may have a negative impact on the quality of life of these patients . results from screening programs in patients with breast cancer and abdominal aortic aneurysms have indicated that potential benefits of a positive result of screening may be negated by reduced quality of life [ 4 , 5 ] . on the other hand , a previous study has shown that patients with a history of subarachnoid hemorrhage ( sah ) and neurosurgical clipping have higher hospital anxiety and depression scale scores than a reference group . anxiety seems an important factor in assessing cost effectiveness of long - term follow - up screening after neurosurgical aneurysm clipping . in a cost - effectiveness study on long - term screening after clipping of aneurysms , screening did not increase quality adjusted life years in general , but would do so if patients had a modest decreased quality of life from fear for a recurrence . the purpose of our study was to evaluate the impact on anxiety and depression of long - term ( more than 4.5  years ) mra screening in patients with a coiled intracranial aneurysm that was adequately occluded at 6  months follow - up . we assessed anxiety and depression scores directly after screening , before the results of the scan were notified to the patient ; and 3  months later , a possible short - term increase in anxiety as a result of the screening would be neutralized by 3  months . in addition , we aimed to compare anxiety and depression scores of patients with a history of sah to patients without a history of sah . in the netherlands , an ongoing multi - center study called the long term follow up study of coiled intracranial aneurysms ( lotus ) started in 2005 . in this study , the occlusion status of coiled intracranial aneurysms is evaluated with long - term mra after coiling . inclusion criteria for invitation to participate to lotus were : coiling of an intracranial aneurysm more than 4.5  years earlier with adequate aneurysm occlusion on 6  months follow - up angiography , current age under 70  years , and no contra - indication for magnetic resonance imaging ( mri ) . although the main purpose of the lotus study is assessment of the occlusion status of the coiled aneurysm , also the formation of new aneurysms and growth of additional untreated aneurysms are evaluated . participants are informed about the low risk of finding either an incompletely occluded aneurysm or a newly formed or grown aneurysm , but if found , treatment or further follow - up must be considered in view of the risk of sah . within 4  weeks after the scan , participants are informed about the scan results by telephone or at the outpatient clinic . from november 2007 to july 2009 , all participants of the lotus study were invited to fill out a questionnaire directly after the mra . the questionnaire had to be returned by mail within 4  weeks , before the mra scan results were notified to the patient . patients who responded in time received a second questionnaire by mail at least 3  months after the mra . if the second questionnaire was not returned within 2  months , patients received another copy of the second questionnaire by mail . the first part was a list of questions about patient history of sah and family history of sah . second , we used validated dutch versions of the euroqol ( eq-5d ) that contain five questions addressing mobility , usual activities , pain , self - care , and anxiety and depression , and a visual analog scale where persons can rate their overall health state ranging from 0 ( worst imaginable health state ) to 100 ( best imaginable health state ) . third was a self - developed list of screening related questions ( fig .  1 ) . in this list , patients were asked about the frequency of thoughts about the coiled aneurysm , about fear for a ( recurrent ) sah and about sleep deprivation because of worrying in relation to the aneurysm . never. for each question , the patient was asked if participation in this study caused more arousal , choosing no. patients were asked how they felt about the participation to the screening ranging from  very content to  regret. finally , patients were asked if they wanted to be screened again the next year and in 5  years . 1patients response to the screening related questions at mri screening and after 3  months patients response to the screening related questions at mri screening and after 3  months the scores of the anxiety and depression question of the eq-5d questionnaire directly after screening and at 3  months follow - up was compared to reference data from 851 subjects in a sample survey from rotterdam , the netherlands , matched for gender and age . the proportion of participants reporting any problem in the anxiety and depression at baseline and at 3  months were compared to the reference group as absolute difference in proportion with 95% confidence interval ( ci ) . the mean baseline eq - vas scores were compared to 3  months with a paired sample t test . answers to the screening related questions in the likert scale were described and reduced to a nominal level  agree and  disagree to compare between baseline and follow - up measurements using  tests . anxiety and depression scores from patients with a history of a sah were compared between baseline and at 3  months and with patients without sah with fisher s exact test . responses to the screening - related questions were compared between the two groups using  and fisher s exact test . data from screen - positive patients were separately described . for the eq-5d data - analyses , all returned questionnaires at baseline and at 3  months were included . for all other comparisons of data from baseline with 3  months questionnaires , in the netherlands , an ongoing multi - center study called the long term follow up study of coiled intracranial aneurysms ( lotus ) started in 2005 . in this study , the occlusion status of coiled intracranial aneurysms is evaluated with long - term mra after coiling . inclusion criteria for invitation to participate to lotus were : coiling of an intracranial aneurysm more than 4.5  years earlier with adequate aneurysm occlusion on 6  months follow - up angiography , current age under 70  years , and no contra - indication for magnetic resonance imaging ( mri ) . although the main purpose of the lotus study is assessment of the occlusion status of the coiled aneurysm , also the formation of new aneurysms and growth of additional untreated aneurysms are evaluated . participants are informed about the low risk of finding either an incompletely occluded aneurysm or a newly formed or grown aneurysm , but if found , treatment or further follow - up must be considered in view of the risk of sah . within 4  weeks after the scan , participants are informed about the scan results by telephone or at the outpatient clinic . from november 2007 to july 2009 , all participants of the lotus study were invited to fill out a questionnaire directly after the mra . the questionnaire had to be returned by mail within 4  weeks , before the mra scan results were notified to the patient . patients who responded in time received a second questionnaire by mail at least 3  months after the mra . if the second questionnaire was not returned within 2  months , patients received another copy of the second questionnaire by mail . the questionnaire consisted of four parts . the first part was a list of questions about patient history of sah and family history of sah . second , we used validated dutch versions of the euroqol ( eq-5d ) that contain five questions addressing mobility , usual activities , pain , self - care , and anxiety and depression , and a visual analog scale where persons can rate their overall health state ranging from 0 ( worst imaginable health state ) to 100 ( best imaginable health state ) . third was a self - developed list of screening related questions ( fig .  1 ) . in this list , patients were asked about the frequency of thoughts about the coiled aneurysm , about fear for a ( recurrent ) sah and about sleep deprivation because of worrying in relation to the aneurysm . never. for each question , the patient was asked if participation in this study caused more arousal , choosing no. patients were asked how they felt about the participation to the screening ranging from  very content to  regret. finally , patients were asked if they wanted to be screened again the next year and in 5  years . 1patients response to the screening related questions at mri screening and after 3  months patients response to the screening related questions at mri screening and after 3  months the scores of the anxiety and depression question of the eq-5d questionnaire directly after screening and at 3  months follow - up was compared to reference data from 851 subjects in a sample survey from rotterdam , the netherlands , matched for gender and age . the proportion of participants reporting any problem in the anxiety and depression at baseline and at 3  months were compared to the reference group as absolute difference in proportion with 95% confidence interval ( ci ) . the mean baseline eq - vas scores were compared to 3  months with a paired sample t test . answers to the screening related questions in the likert scale were described and reduced to a nominal level  agree and  disagree to compare between baseline and follow - up measurements using  tests . anxiety and depression scores from patients with a history of a sah were compared between baseline and at 3  months and with patients without sah with fisher s exact test . responses to the screening - related questions were compared between the two groups using  and fisher s exact test . data from screen - positive patients were separately described . for the eq-5d data - analyses , all returned questionnaires at baseline and at 3  months were included . for all other comparisons of data from baseline with 3  months questionnaires , between september 2007 and june 2009 , 312 patients were invited to participate in the lotus study , and 162 patients were enrolled to undergo an mra scan more than 4.5  years after coiling of an intracranial aneurysm . reasons for patients not to participate in the lotus study are summarized in fig .  2 . 2flowchart showing patient selection for the lotus study and the present sub - study flowchart showing patient selection for the lotus study and the present sub - study of 162 invited patients , 120 ( 74% ) returned the completed questionnaire in time , and 42 patients did not want to fill out the questionnaire or were too late returning it . the second questionnaire was sent at least 3  months after the mri scan to the 120 patients that completed the first one and was returned by 100 ( 83% ) patients mean 8.3  months ( range 2.9 - 20.4  months ) after the mri scan . of 120 included patients , 82 were female ( 68% ) . mean age was 55  years ( median 56 , range 23 - 70  years ) . of 120 patients , 106 ( 88% ) had a ruptured aneurysm that was coiled and 14 ( 12% ) were coiled for an unruptured aneurysm . fourteen patients ( 12% ) had a family history of intracranial aneurysms . in the baseline questionnaire , 56 of 120 patients ( 47% ; 95% ci 38 - 56% ) reported to have any problem with anxiety or depression ; and at 3  months , this was reported by 42 of 100 patients ( 42% , 95% ci 32 - 52% ; fig .  3 table 1 ) . if the analysis is restricted to the subset of 100 patients who completed the questionnaires at both assessments , the proportions of patients with any problem with anxiety or depression were 44% ( 95% ci 34 - 54% ) at time of mra and 42% ( 95% ci 32 - 52% ) 3  months after mra ( difference 2% ; 95%ci of difference 1 to 4% ) this indicates that anxiety or depression was not significantly increased directly after screening compared to 3-months follow - up ( p  =  0.89 ) . however , compared to the 19% ( 95% ci 16 - 22% ) in the general dutch population and adjusted for gender and age , patients reported 38% ( 95% ci : 9 - 67% ) more often to have any problem with anxiety or depression in the baseline questionnaire and 27% ( 95% ci 4 - 50% ) more often at 3  months ( fig .  4 ) . .  4patients reporting to have  any problem with anxiety or depression in the eq-5d questionnaire at mri screening and after 3  months compared to dutch general population norms patients response to  are you anxious or depressed ? question at mri screening and after 3  months patients reporting to have  any problem with anxiety or depression in the eq-5d questionnaire at mri screening and after 3  months compared to dutch general population norms overall health in 100 patients that completed both questionnaires was rated mean 75 points out of 100 ( median 79.5 , range 4 - 100 ) . at 3  months , this was with 72.1 points ( median 75 , range 10 - 100 ) , which was significantly lower ( p  =  0.03 ) ( table 1 ) . answers to screening - related questions at baseline and at 3  months are shown in fig .  1 . at time of mra , 14 of 99 patients ( 14% ) indicated to think regularly or most of the time of the coiled aneurysm ; and at 3  months , this was 16 of 100 ( 16% ) . to the question  did participation in this study increase frequency of these thoughts? , 26 of 93 ( 28% ) of patients confirmed at baseline and seven of 100 ( 7% ) at 3  months ; three of these seven patients had a recurrent or new aneurysm . of 99 patients , 91 ( 92% ) responded not to be afraid of a ( recurrent ) sah and 85 of 96 patients ( 91% ) felt that participation in the study did not increase this fear . at 3  months , of the two patients reporting increased fear for a sah at 3  months , in one patient an aneurysm recurrence was found . of 98 patients , 89 ( 91% ) indicated not to sleeping disturbances because of worries of their state of health and participation on screening did not alter this in 91 of 100 patients ( 91% ) . at 3  months , nine patients reported to sleep better and two to sleep worse after screening . in these two patients , an aneurysm recurrence was found . at 3  months , 89 of 100 participants ( 89% ) were content or very content with participation on the screening ; no patients regretted participation . seventy - nine participants ( 79% ) were interested in a yearly screening and 89 ( 89% ) in screening every 5  years . of 100 patients who completed both questionnaires , 88 had a history of sah and 12 had not . forty - one of 88 sah patients ( 47% ) had any problem with anxiety or depression at baseline ; and at 3  months , this was reported by 37 patients ( 42% ) , ( p  =  0.50 ) . three of 12 ( 25% ) non - sah patients had any problem with anxiety of depression at the time of mra , a non - significantly lower proportion compared to sah patients ( p  =  0.16 ) . at 3  months , five of 12 ( 42% ) non - sah patients reported to have any problem with anxiety or depression ; this increase was not significant ( p  =  0.67 ) . of 82 sah patients that responded , 25 ( 30% ) reported an increase in frequency of thoughts about the coiled aneurysm due to screening compared to one of 11 responding non - sah patients ( 9% ) . however , at 3  months , this difference was no longer present with six of 88 sah patients ( 7% ) and one of 11 responding non - sah patients ( 9% ) reporting an increase in thoughts due to screening . screening caused more fear for a recurrent sah at baseline in sah patients ( nine of 84 respondents , 11% ) compared to no non - sah patients ( 0% ) ; but at 3  months , this difference was no longer present . to the question about disturbed sleep because of worries about health , sah patients and non - sah patients responded comparable . in eight of 100 patients who completed both questionnaires , four patients needed additional treatment for a recurrence or de novo aneurysm , three patients had small aneurysm recurrences for which extended follow - up was recommended , and one patient had a small recurrence that needed no further follow - up . at 3  months , three of eight ( 38% ) screen - positive patients reported  any problem with anxiety , compared to 39 of 92 ( 42% ) screen negatives . two screen - positive patients scored more anxiety or depression at 3  months than at baseline . between september 2007 and june 2009 , 312 patients were invited to participate in the lotus study , and 162 patients were enrolled to undergo an mra scan more than 4.5  years after coiling of an intracranial aneurysm . reasons for patients not to participate in the lotus study are summarized in fig .  2 . 2flowchart showing patient selection for the lotus study and the present sub - study flowchart showing patient selection for the lotus study and the present sub - study of 162 invited patients , 120 ( 74% ) returned the completed questionnaire in time , and 42 patients did not want to fill out the questionnaire or were too late returning it . the second questionnaire was sent at least 3  months after the mri scan to the 120 patients that completed the first one and was returned by 100 ( 83% ) patients mean 8.3  months ( range 2.9 - 20.4  months ) after the mri scan . of 120 included patients , 82 were female ( 68% ) . mean age was 55  years ( median 56 , range 23 - 70  years ) . of 120 patients , 106 ( 88% ) had a ruptured aneurysm that was coiled and 14 ( 12% ) were coiled for an unruptured aneurysm . in the baseline questionnaire , 56 of 120 patients ( 47% ; 95% ci 38 - 56% ) reported to have any problem with anxiety or depression ; and at 3  months , this was reported by 42 of 100 patients ( 42% , 95% ci 32 - 52% ; fig .  3 table 1 ) . if the analysis is restricted to the subset of 100 patients who completed the questionnaires at both assessments , the proportions of patients with any problem with anxiety or depression were 44% ( 95% ci 34 - 54% ) at time of mra and 42% ( 95% ci 32 - 52% ) 3  months after mra ( difference 2% ; 95%ci of difference 1 to 4% ) this indicates that anxiety or depression was not significantly increased directly after screening compared to 3-months follow - up ( p  =  0.89 ) . however , compared to the 19% ( 95% ci 16 - 22% ) in the general dutch population and adjusted for gender and age , patients reported 38% ( 95% ci : 9 - 67% ) more often to have any problem with anxiety or depression in the baseline questionnaire and 27% ( 95% ci 4 - 50% ) more often at 3  months ( fig .  4 ) . .  4patients reporting to have  any problem with anxiety or depression in the eq-5d questionnaire at mri screening and after 3  months compared to dutch general population norms patients response to  are you anxious or depressed ? any problem with anxiety or depression in the eq-5d questionnaire at mri screening and after 3  months compared to dutch general population norms overall health in 100 patients that completed both questionnaires was rated mean 75 points out of 100 ( median 79.5 , range 4 - 100 ) . at 3  months , this was with 72.1 points ( median 75 , range 10 - 100 ) , which was significantly lower ( p  =  0.03 ) ( table 1 ) . answers to screening - related questions at baseline and at 3  months are shown in fig .  1 . at time of mra , 14 of 99 patients ( 14% ) indicated to think regularly or most of the time of the coiled aneurysm ; and at 3  months , this was 16 of 100 ( 16% ) . to the question  did participation in this study increase frequency of these thoughts? , 26 of 93 ( 28% ) of patients confirmed at baseline and seven of 100 ( 7% ) at 3  months ; three of these seven patients had a recurrent or new aneurysm . of 99 patients , 91 ( 92% ) responded not to be afraid of a ( recurrent ) sah and 85 of 96 patients ( 91% ) felt that participation in the study did not increase this fear . at 3  months , of the two patients reporting increased fear for a sah at 3  months , in one patient an aneurysm recurrence was found . of 98 patients , 89 ( 91% ) indicated not to sleeping disturbances because of worries of their state of health and participation on screening did not alter this in 91 of 100 patients ( 91% ) . at 3  months , nine patients reported to sleep better and two to sleep worse after screening . in these two patients , an aneurysm recurrence was found . at 3  months , 89 of 100 participants ( 89% ) were content or very content with participation on the screening ; no patients regretted participation . seventy - nine participants ( 79% ) were interested in a yearly screening and 89 ( 89% ) in screening every 5  years . of 100 patients who completed both questionnaires , 88 had a history of sah and 12 had not . forty - one of 88 sah patients ( 47% ) had any problem with anxiety or depression at baseline ; and at 3  months , this was reported by 37 patients ( 42% ) , ( p  =  0.50 ) . three of 12 ( 25% ) non - sah patients had any problem with anxiety of depression at the time of mra , a non - significantly lower proportion compared to sah patients ( p  =  0.16 ) . at 3  months , five of 12 ( 42% ) non - sah patients reported to have any problem with anxiety or depression ; this increase was not significant ( p  =  0.67 ) . of 82 sah patients that responded , 25 ( 30% ) reported an increase in frequency of thoughts about the coiled aneurysm due to screening compared to one of 11 responding non - sah patients ( 9% ) . however , at 3  months , this difference was no longer present with six of 88 sah patients ( 7% ) and one of 11 responding non - sah patients ( 9% ) reporting an increase in thoughts due to screening . screening caused more fear for a recurrent sah at baseline in sah patients ( nine of 84 respondents , 11% ) compared to no non - sah patients ( 0% ) ; but at 3  months , this difference was no longer present . to the question about disturbed sleep because of worries about health , sah patients and non - sah patients responded comparable . in eight of 100 patients who completed both questionnaires , a new finding was present on mri . four patients needed additional treatment for a recurrence or de novo aneurysm , three patients had small aneurysm recurrences for which extended follow - up was recommended , and one patient had a small recurrence that needed no further follow - up . at 3  months , three of eight ( 38% ) screen - positive patients reported  any problem with anxiety , compared to 39 of 92 ( 42% ) screen negatives . two screen - positive patients scored more anxiety or depression at 3  months than at baseline . in this study , we found that patients with a coiled intracranial aneurysm that were screened with mri more than 4.5  years after coiling are more anxious or depressed at the time of screening and 3  months thereafter compared to dutch general population norms . half of the patients reported to have a problem with anxiety or depression at the time of screening . however , a quarter of the patients indicated that screening caused more frequent thinking about the coiled aneurysm and one in ten reported to be more afraid for recurrent sah , even before results of screening were communicated . three months after screening , one in seven patients reported that screening had decreased thoughts of their coiled aneurysm and one in five was less afraid of a recurrent sah . table  1patient characteristics , eq-5d anxiety / depression scores and vas scores of participants compared to dutch general population norms.baseline ( n  =  120)follow - up ( n  =  100)reference group ( n  =  851)screen - positives at follow - up ( n  =  8)number of men38 ( 32%)33 ( 33%)384 ( 45%)1 ( 13%)mean age ( median , range)55 ( 56 , 23 - 70)55 ( 57 , 23 - 70)56 ( 57 , 46 - 63)number with anxiety or depression56 ( 47%)42 ( 42%)161 ( 19%)3 ( 38%)mean vas75.072.180.359.0reference group from essink - bot et al .   published in health economics in 1993number of participants reporting to have  any problem with anxiety or depression in the dutch eq-5d questionnairevas from the eq-5d questionnaire with scores from 0 to 100 , with a score of 0 being the worst and 100 the best imaginable health statepatient age is reported per decade ; 13%  =  18 - 29  years , 19%  =  30 - 39  years , 13%  =  40 - 49  years , 12%  =  50 - 59  years , 16%  =  60 - 69  years , 17%  =  70 - 79  years , 10%  =  80 + years patient characteristics , eq-5d anxiety / depression scores and vas scores of participants compared to dutch general population norms . published in health economics in 1993 number of participants reporting to have  any problem with anxiety or depression in the dutch eq-5d questionnaire vas from the eq-5d questionnaire with scores from 0 to 100 , with a score of 0 being the worst and 100 the best imaginable health state patient age is reported per decade ; 13%  =  18 - 29  years , 19%  =  30 - 39  years , 13%  =  40 - 49  years , 12%  =  50 - 59  years , 16%  =  60 - 69  years , 17%  =  70 - 79  years , 10%  =  80 + years the eq-5d questionnaire we used is a rough tool and can not assess a moderate temporary increase in anxiety or depression caused by screening in our population . however , our study does rule out a major impact of long - term follow - up screening on quality of life and in particular on anxiety or depression . our screening - related questions are not validated , but may imply subjective feelings of temporary increased fear in participants . a negative screening result , although positive news for the patient , did not substantially decrease anxiety or depression , but provided a subjective feeling of relieve in most participants and no patients regretted participation . surprisingly , a screen - positive result did not influence quality of life , nor did it cause a subjective feeling of increased fear for sah in most patients . compared to patients without a history of sah , patients with a history of sah are more anxious at the time of long - term follow - up screening . in a comparable long - term follow - up screening study of patients with a ruptured aneurysm that was surgically clipped , first , we only invited participants of our multi - center long - term follow - up study after coiling ( lotus ) to fill out the questionnaires . we did not invite the patients who declined screening , either out of lack of interest or out of fear for the screening or its results . if fear of screening would be a major reason to decline screening , our study is likely to underestimate the true anxiety scores in patients long - term after coiling . however , the goal of this study was to assess impact on mood and anxiety of patients that participate in a long - term follow - up screening ; hence , non - participants are not exposed to this additional burden . second , although the same questionnaires were filled out at the time of mri and 3  months later in order to pick up a possible temporary increase in anxiety induced by the screening , our study lacks a true baseline measurement and we have no solid proof that temporarily increased anxiety will have resided within 3  months . third , although this is the largest study to assess anxiety in this specific patient group to date , our sample size was too small to compare different subgroups , for example patients with and without familial intracranial aneurysms and screen - positives and screen - negatives . in our comparison of patients with or without a history of sah , we encountered large confidence intervals because of the small sample of patients without a history of sah . anxiety is a very important factor in assessing cost - effectiveness of long - term follow - up screening after neurosurgical aneurysm clipping . to our knowledge , our study is the first to assess psychosocial impact of long - term mra screening in patients with a history of intracranial aneurysm coiling . screening did not temporarily increase anxiety , nor did a negative screening result give a substantial decrease in anxiety . aneurysms that are coiled with adequate occlusion at 6  months follow - up are likely to remain sufficiently occluded at long - term follow - up . in addition , the frequency of new aneurysm formation and enlargement of untreated aneurysms in this patient population appears to be low . clinical relevance of long - term screening of patients with adequately occluded coiled aneurysms is doubtful , emphasized by our study results that patients with a coiled intracranial aneurysm are more anxious compared to a reference group . patients with a history of aneurysm coiling and especially patients with a history of sah and coiling are more anxious or depressed compared to a dutch general population group . long - term follow - up screening does not induce a major increase in anxiety or depression temporarily , and a negative screening outcome does not give a substantial decrease in the patients feelings of anxiety or depression . the decision to subject patients with a coiled intracranial aneurysm to long - term follow - up should be made considering clinical relevance only , and follow - up is not recommended for the sole purpose of reassuring the patient .
introductionmagnetic resonance angiography ( mra ) screening for recurrence of a coiled intracranial aneurysm and formation of new aneurysms long - term after coiling may induce anxiety and depression . in coiled patients 
 , we evaluated effects on mood and level of anxiety from long - term follow - up mra in comparison to general population norms.methodsof 162 patients participating in a long - term ( > 4.5  years ) mra follow - up after coiling , 120 completed the eq-5d questionnaire , a visual analog health scale and a self - developed screening related questionnaire at the time of mra . 
 three months later , the same questionnaires were completed by 100 of these 120 patients . 
 results were compared to general population norms adjusted for gender and age.resultsany problem with anxiety or depression was reported in 56 of 120 patients ( 47% ; 95%ci3856% ) at baseline and 42 of 100 patients ( 42% ; 95%ci3252% ) at 3  months , equally for screen - positives and -negatives . 
 compared to the reference population , participants scored 38% ( 95%ci967% ) and 27% ( 95%ci450% ) more often any problem with anxiety or depression . 
 three months after screening , 21% ( 20 of 92 ) of screen - negatives and 13% ( one of eight ) of screen - positives reported to be less afraid of subarachnoid hemorrhage ( sah ) compared to before screening . 
 one of eight screen - positives reported increased fear of sah.conclusionspatients with coiled intracranial aneurysms participating in long - term mra screening reported significantly more often to be anxious or depressed than a reference group . 
 screening did not significantly increase anxiety or depression temporarily . 
 however , subjectively , patients did report an increase in anxiety caused by screening , which decreased after 3  months .