The Role of Psychological Distress on Health-Related Quality of Life, Fatigue, and Pain in Adults With Pulmonary Hypertension

Abstract

While anxiety and depression are commonly reported in pulmonary hypertension (PH), limited evidence exists on how these conditions interact with the pathophysiological symptoms of PH. Fatigue and, to a lesser degree, pain are key symptoms of PH; however, they have rarely been examined as separate experiences associated with PH. Using a cross-sectional research design, 68 adults with PH recruited from global Pulmonary Hypertensions Associations completed a series of self-report measures assessing fatigue, pain self-efficacy, anxiety, depression, and health-related quality of life (HRQoL). Aiming to understand the nuances of PH symptomatology, we first looked at responses on individual items from fatigue and pain measures, respectively. Then, to examine relationships between self-reported symptoms, we tested potential pathways from fatigue and pain to HRQoL through depression and anxiety. All symptoms were correlated, suggesting individuals with greater anxiety and depression also experienced more fatigue, and lower pain self-efficacy and HRQoL. Parallel mediation analyses showed that fatigue and pain had a direct effect on HRQoL, as well as an indirect effect via anxiety and depression. Explorative serial mediation models suggested the indirect path from fatigue to HRQoL was significant when depression was ordered first followed by anxiety; whereas for pain self-efficacy, the path was significant when anxiety was followed by depression. Results add to the evidence demonstrating the high co-occurrence of mental health difficulties in PH and the important role they play in pathophysiological symptomatology. Analyses support providing holistic care for this clinical group to help identify various therapeutic targets suggestive of predicting HRQoL.

Keywords: anxiety; depression; mental health; psychology; pulmonary arterial hypertension.

Figure 1

Parallel mediation models showing unstandardised estimates with bootstrapped 95% confidence intervals (and standardised estimates in brackets) for fatigue (Model 1) or pain‐self efficacy (Model 2) on lower HRQoL (health‐related quality of life) through anxiety or depression. *p < 0.05, **p < 0.01, ***p < 0.001.