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Comparative Study
. 2013 Oct 9;14(1):104.
doi: 10.1186/1465-9921-14-104.

Anxiety and depression disorders in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

Dominik Harzheim  1 , Hans Klose, Fabiola Peña Pinado, Nicola Ehlken, Christian Nagel, Christine Fischer, Ardeschir Ghofrani, Stephan Rosenkranz, Hans-Jürgen Seyfarth, Michael Halank, Eckhard Mayer, Ekkehard Grünig, Stefan Guth
Affiliations
Comparative Study

Anxiety and depression disorders in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

Dominik Harzheim et al. Respir Res. .

Abstract

Background: The objective of this prospective study was to assess the prevalence of anxiety and depression disorders and their association with quality of life (QoL), clinical parameters and survival in patients with pulmonary hypertension (PH).

Methods: We prospectively assessed 158 patients invasively diagnosed with pulmonary arterial hypertension (n = 138) and inoperable chronic thromboembolic PH (n = 20) by clinical measures including quality of life (QoL, SF-36 questionnaire), cardiopulmonary exercise testing and six minute walking distance and by questionnaires for depression (PHQ-9) and anxiety (GAD-7). According to the results of the clinical examination and the questionnaires for mental disorders (MD) patients were classified into two groups, 1) with moderate to severe MD (n = 36, 22,8%), and 2) with mild or no MD (n = 122). Patients were followed for a median of 2.7 years. Investigators of QoL, SF-36 were blinded to the clinical data.

Results: At baseline the 2 groups did not differ in their severity of PH or exercise capacity. Patients with moderate to severe MD (group 1) had a significantly lower QoL shown in all subscales of SF-36 (p < 0.002). QoL impairment significantly correlated with the severity of depression (p < 0.001) and anxiety (p < 0.05). During follow-up period 32 patients died and 3 were lost to follow-up. There was no significant difference between groups regarding survival. Only 8% of the patients with MD received psychopharmacological treatment.

Conclusion: Anxiety and depression were frequently diagnosed in our patients and significantly correlated with quality of life, but not with long term survival. Further prospective studies are needed to confirm the results.

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Figures

Figure 1
Figure 1
Quality of life in patients with no or only mild MD and moderate to severe MD. There was a significant difference between the two subgroups in relation to the SF-36 Questionnaire in all subscales (p < 0.002).
Figure 2
Figure 2
Correlation between the subscales of quality of life (SF-36; y-axis) and depression disorder (PHQ-9, x-axis). There was a significant correlation between the SF-36 subscales and depression score (p < 0.001 in all subscales). The highest correlation could be detected in the subscales vitality (r = −0.40) and mental health (r = −0.51). A linear regression line is only shown in the subscales social functioning, vitality and health (r-value >0.40), as only these showed evidence for a linear correlation.
Figure 3
Figure 3
Anxiety and depression significantly correlate in patients with PH. Generalised Anxiety disorder (GAD-7) and Depression Disorder (PHQ-9) scales of each patient were analysed by correlation analysis. Score values significantly correlated (r = 0.44, p < 0.001) between groups.
Figure 4
Figure 4
Survival amongst PH patients according to mental disorder. The two groups did not sigificantly differ in their survival (p > 0.05).
See this image and copyright information in PMC

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