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. 2022 Mar 2:13:821466.
doi: 10.3389/fpsyt.2022.821466. eCollection 2022.

Prevalence of Mental Disorders in Patients With Chronic Thromboembolic Pulmonary Hypertension

Madelaine-Rachel Dering  1 , Nicole Lepsy  1 , Jan Fuge  2 , Tanja Meltendorf  2 , Marius M Hoeper  2 , Ivo Heitland  1 , Jan C Kamp  2 , Da-Hee Park  2 , Manuel J Richter  3 , Henning Gall  3 , Hossein A Ghofrani  3   4 , Dietmar Ellermeier  5 , Hans-Dieter Kulla  6 , Kai G Kahl  1 , Karen M Olsson  1   2
Affiliations

Prevalence of Mental Disorders in Patients With Chronic Thromboembolic Pulmonary Hypertension

Madelaine-Rachel Dering et al. Front Psychiatry. .

Abstract

Objective: Pulmonary hypertension (PH) is a chronic and progressive pulmonary vascular disease resulting in symptoms such as shortness of breath and fatigue and leading to death from right heart failure if not adequately treated. Chronic thromboembolic pulmonary hypertension (CTEPH) is a subgroup of PH characterized by obstruction or occlusion of pulmonary arteries by post-embolic fibrotic material. To date, few studies examined symptoms of depression and anxiety in patients with CTEPH, showing depression levels as high as 37.5%. However, none of the former studies used structured expert interviews.

Methods: Mental disorders were diagnosed using the Structured Clinical Interview for DSM-5 (SCID). The prevalence of mental disorders in patients with CTEPH were compared to the prevalence in patients with pulmonary arterial hypertension (PAH) and the general German population. Quality of life (QoL) was measured with World Health Organization (WHO) Quality of Life questionnaire (short form). Factors associated with QoL were analyzed with linear regression and the diagnostic value of the Hospital Anxiety and Depression Scale (HADS) was evaluated using receiver operating characteristics (ROC) curve analysis.

Results: Hundred and seven patients with CTEPH were included. Almost one-third of the patients (31.8%) had current psychological disorders. Panic disorder (8.4%), specific phobia (8.4%), and major depressive disorder (6.5%) were the most prevalent mental illnesses. The prevalence of panic disorders was higher in CTEPH compared to the German population while major depressive disorder was fewer in CTEPH compared to PAH. The presence of mental disorders had a major impact on QoL. Hospital Anxiety and Depression Scale discriminated depression and panic disorder reliably.

Conclusion: Mental disorders are common in patients with CTEPH and associated with an impaired QoL. The HADS may be a useful screening tool for panic and depression disorders in patients with CTEPH. Further research on therapeutic strategies targeting mental disorders in patients with CTEPH is needed.

Keywords: CTEPH; chronic thromboembolic pulmonary hypertension; depression disorder; mental disorder; panic disorder; pulmonary hypertension; quality of life.

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Conflict of interest statement

MH has received honoraria for lectures and/or consultations from Acceleron, Actelion, Bayer, GSK, Janssen, MSD, and Pfizer, all outside the present study. D-HP has received honoraria for lectures and/or consultations from Janssen. HG has received personal fees from Actelion, personal fees from AstraZeneca, personal fees from Bayer, personal fees from BMS, personal fees from GSK, personal fees from Janssen-Cilag, personal fees from Lilly, personal fees from MSD, personal fees from Novartis, personal fees from OMT, personal fees from Pfizer, personal fees from United Therapeutics, outside the submitted work. HAG has received fees from Actelion, Bayer, Gilead, GSK, MSD, Pfizer, and United Therapeutics, outside the present work. KK has received honoraria for consultations and/or lectures from Eli Lilly, Janssen, Lundbeck, Neuraxpharm, Otsuka, Pfizer, Servier, Schwabe, Takeda, and Trommsdorff/Ferrer, Alexion, and CannaXan advisory board. KO has received honoraria for lectures and/or consultations from Acceleron, Actelion, Bayer, GSK, Janssen, MSD, United Therapeutics and Pfizer, all outside the present study. H-DK was employed by Pulmonale Hypertonie eV. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patient inclusion.
Figure 2
Figure 2
Receiver operating characteristic (ROC) curves of the Hospital Anxiety and Depression Scale (HADS) for the detection of panic disorder (A) and depression (B).
See this image and copyright information in PMC

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