Influence of Personality, Resilience and Life Conditions on Depression and Anxiety in 104 Patients Having Survived Acute Autoimmune Thrombotic Thrombocytopenic Purpura

Abstract

Autoimmune thrombotic thrombocytopenic purpura (iTTP) is a life-threatening, relapsing disease in which an acquired deficiency of the enzyme ADAMTS13 leads to generalised microvascular thrombosis. Survivors have a high prevalence of depression and impaired cognitive function. The aim of this study was to determine whether life circumstances and personality have an influence on the development and severity of depression and anxiety in iTTP patients and how they impact the quality of life. With validated questionnaires, we examined the prevalence of depression and anxiety symptoms in 104 iTTP patients, as well as parameters of subjective cognitive deficits, quality of life, attitude to life and resilience. iTTP patients had significantly more depressive symptoms (p < 0.001), a tendency to have anxiety disorders (p = 0.035) and a significantly worse cognitive performance (p = 0.008) compared to the controls. Sex, age, physical activity and partnership status had no significant influence on depression, whereas the number of comorbidities did. Lower scores of resilience, attitude to life and quality of life were reported by patients compared to controls. iTTP patients had a high prevalence of depression and anxiety, as well as a more negative attitude to life and low resilience. Resilience correlated negatively with the severity of the depression. Furthermore, quality of life and cognitive performance were significantly reduced.

Keywords: depression; quality of life; resilience; thrombotic thrombocytopenic purpura.

Figure 1

Patient recruitment and response rates in two surveys of the cohort of autoimmune thrombotic thrombocytopenic purpura (iTTP) patients from Mainz. A total of 147 eligible iTTP patients in remission were invited to fill in the various questionnaires used in two surveys each (2015 and 2016). * Between the first and second survey five patients were lost to follow-up. Questionnaires concerned: depression (PHQ-9), anxiety (GAD-7), attitude of life (LOT-R), resilience (RS-11), quality of life (QLQ-C30) and cognitive disturbance (FLei).

Figure 2

Results of the depression (PHQ-9), anxiety disorder (GAD-7) and cognitive performance (FLei score) questionnaires from the iTTP patients in two surveys (2015 and 2016) and the healthy controls (median, box 25th and 75th percentiles, whiskers 2.5th and 97.5th percentiles, ●, ▪, ▲ denote outliers above 97.5th percentiles or below 2.5th percentiles outliers). (a) PHQ-9: For the first survey (n = 88), the median evaluated score was 5 (IQR 2–10), for the second survey (n = 81), the median score was 7 (IQR 2.5–12.5), and for the healthy controls, the median score was 3 (IQR 1–6). (b) GAD-7: For the first survey (n = 87), the median evaluated score was 4 (IQR 1–8), for the second survey (n = 80), the median score was 5 (IQR 1–8.75), and for the healthy controls (n = 131), the median score was 2 (IQR 1–5). (c) FLei: For the first survey (n = 85), the median evaluated score was 28.0 (IQR 14–60.5), for the second survey (n = 81), the median score was 34.0 (IQR 17–68), and for the healthy controls (n = 130), the median score was 22.0 (IQR 13.75–34.25).

Figure 3

Results of the resilience (RS-11), attitude to life (LOT-R) and quality of life (QLQ-C30) questionnaires from the autoimmune thrombotic thrombocytopenic purpura (iTTP) patients in two surveys (2015 and 2016) and the healthy controls (median, box 25th and 75th percentiles, whiskers 2.5th and 97.5th percentiles, ●, ▪, ▲ outliers above the 97.5th percentiles or below the 2.5th percentiles). (a) RS-11: For the survey in 2015, the median evaluated score was 60 (IQR 49.5–68.5), for the survey in 2016, the score was 55 (IQR 45–66), and for healthy controls, the score was 64 (IQR 56–69). (b) LOT-R: In the optimism score, the patients showed significantly worse results than the control group in both rounds (2015 survey p = 0.011, 2016 survey p = 0.006). Within the pessimism score, no large differences between the patients and controls could be detected (2015 survey p = 0.49, 2016 survey p = 0.63). In the first round, no significant difference (p = 0.088) between the patients and controls was found in the total score, but in the second round, a significant difference (p = 0.009) between the patients and controls was found. (c) QLQ-C30: In the “global health”, “physical function” and “cognitive function” scores, the patients had significantly worse results than the control group in both rounds (2015 and 2016 surveys p < 0.0001).

Figure 4

Correlation of the PHQ-9 score (depressive symptoms) with the resilience score. The correlation of the degree of depression (PHQ-9) with resilience (RS-11) was analysed for 102 iTTP patients (r_s = −0.588, p < 0.0001) (every iTTP patient was analysed only once, the first evaluation of those that participated in both surveys was considered). The horizontal line indicates the cut-off for major depression (PHQ-9 score ≥10).