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. 2022 Apr;37(2):134-141.
doi: 10.1177/08258597211049592. Epub 2021 Nov 29.

Assessing Symptom Burden and Depression in Subjects With Chronic Respiratory Insufficiency

Heidi A Rantala  1   2 , Sirpa Leivo-Korpela  1   2 , Lauri Lehtimäki  2   3 , Juho T Lehto  2   4
Affiliations

Assessing Symptom Burden and Depression in Subjects With Chronic Respiratory Insufficiency

Heidi A Rantala et al. J Palliat Care. 2022 Apr.

Abstract

Objectives: Patients with chronic respiratory insufficiency suffer from advanced disease, but their overall symptom burden is poorly described. We evaluated the symptoms and screening of depression in subjects with chronic respiratory insufficiency by using the Edmonton symptom assessment system (ESAS). Methods: In this retrospective study, 226 subjects with chronic respiratory insufficiency answered the ESAS questionnaire measuring symptoms on a scale from 0 (no symptoms) to 10 (worst possible symptom), and the depression scale (DEPS) questionnaire, in which the cut-off point for depressive symptoms is 9. Results: The most severe symptoms measured with ESAS (median [interquartile range]) were shortness of breath 4.0 (1.0-7.0), dry mouth 3.0 (1.0-7.0), tiredness 3.0 (1.0-6.0), and pain on movement 3.0 (0.0-6.0). Subjects with a chronic obstructive pulmonary disease as a cause for chronic respiratory insufficiency had significantly higher scores for shortness of breath, dry mouth, and loss of appetite compared to others. Subjects with DEPS ≥9 reported significantly higher symptom scores in all ESAS categories than subjects with DEPS <9. The area under the receiver operating characteristic curve for ESAS depression score predicting DEPS ≥9 was 0.840 (P < .001). If the ESAS depression score was 0, there was an 89% probability of the DEPS being <9, and if the ESAS depression score was ≥4, there was an 89% probability of the DEPS being ≥9. The relation between ESAS depression score and DEPS was independent of subjects' characteristics and other ESAS items. Conclusions: Subjects with chronic respiratory insufficiency suffer from a high symptom burden due to their advanced disease. The severity of symptoms increases with depression and 4 or more points in the depression question of ESAS should lead to a closer diagnostic evaluation of depression. Symptom-centered palliative care including psychosocial aspects should be early integrated into the treatment of respiratory insufficiency.

Keywords: Edmonton symptom assessment system; chronic obstructive pulmonary disease; chronic respiratory insufficiency; depression; symptoms.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The ROC curve for the ESAS depression score to predict a DEPS score ≥9.
See this image and copyright information in PMC

References

    1. Ahmadi Z, Wysham NG, Lundstrom S, Janson C, Currow DC, Ekstrom M. End-of-life care in oxygen-dependent ILD compared with lung cancer: a national population-based study. Thorax. 2016;71(6):510-516. - PubMed
    1. Gainza-Miranda D, Sanz-Peces EM, Alonso-Babarro A, et al. Breaking barriers: prospective study of a cohort of advanced chronic obstructive pulmonary disease patients To describe their survival and End-of-life palliative care requirements. J Palliat Med. 2019;22(3):290-296. - PMC - PubMed
    1. Ryerson CJ, Arean PA, Berkeley J, et al. Depression is a common and chronic comorbidity in patients with interstitial lung disease. Respirology. 2012;17(3):525-532. - PubMed
    1. Walke LM, Byers AL, McCorkle R, Fried TR. Symptom assessment in community-dwelling older adults with advanced chronic disease. J Pain Symptom Manage. 2006;31(1):31-37. - PubMed
    1. Tsolaki V, Pastaka C, Kostikas K, et al. Noninvasive ventilation in chronic respiratory failure: effects on quality of life. Respiration. 2011;81(5):402-410. - PubMed