Diagnosis and Management of Depression in CRS: A Knowledge, Attitudes and Practices Survey

Abstract

Introduction Comorbid major depressive disorder (MDD) is present in up to 25% of chronic rhinosinusitis (CRS) cases and provides prognostic information for patients undergoing endoscopic sinus surgery (ESS). Clinical visits offer an opportunity to identify at-risk patients. Objective The purpose of the present study is to evaluate practice patterns among members of the American Rhinologic Society (ARS) in screening for/diagnosing MDD. Methods A 21-question survey was distributed to 1,206 members of the ARS from May 26, 2018 to June 12, 2018. The impact of demographic factors, including hospital setting, fellowship status, and experience were assessed through chi-squared analysis. Results A total of 80 members of the ARS completed the survey, yielding a response rate of 7%. Half of the respondents worked in academic settings and 43% had completed a rhinology fellowship. Twenty percent of the participants felt comfortable diagnosing or managing MDD, while only 10% of participants screened for MDD in patients with CRS. Respondents cited a lack of training (76%) and unfamiliarity with diagnostic criteria (76%) as barriers to the routine assessment of MDD. Most respondents (95%) considered comorbid psychiatric illness to negatively impact outcomes following ESS. Fellowship-trained respondents were significantly more likely to implement screening tools in their practice (p = 0.05), and believe in the negative impact of MDD on postoperative outcomes (p = 0.007), cost of care (p = 0.04) and quality of life (p = 0.047). Conclusion Amongst ARS members, 95% of the respondents consider comorbid MDD to negatively impact patient outcomes following ESS. Regardless, a large proportion of surgeons neither screen nor feel comfortable diagnosing MDD.

The Impact of Gender on Long‐Term Quality of Life After Sinus Surgery for Chronic Rhinosinusitis

“…55,56 Based on clinical experience, many rhinologists report that comorbid depression negatively impacts patient outcomes following ESS. 57 However, it is important to note that although patients with depression start with greater quality of life impairments before surgery and finish with greater impairments after surgery, they experience comparable improvement in SNOT-22 scores as patients without a depression diagnosis. 58,59 Moreover, CRS patients with depression had a statistically significant improvement in the severity of their depression following ESS.…”

“…Interestingly, high scores on the SNOT‐22 subdomains (sleep and emotional) predict depression and anxiety with relatively high sensitivity and specificity 55,56 . Based on clinical experience, many rhinologists report that comorbid depression negatively impacts patient outcomes following ESS 57 . However, it is important to note that although patients with depression start with greater quality of life impairments before surgery and finish with greater impairments after surgery, they experience comparable improvement in SNOT‐22 scores as patients without a depression diagnosis 58,59 .…”

Physician views of artificial intelligence in otolaryngology and rhinology: A mixed methods study

“…The survey was e‐mailed twice in 2021 to members of the American Rhinologic Society (ARS), a subspecialty of Otolaryngology‐Head and Neck Surgery consisting of fellowship trained and general Otolaryngologists with specific interests in Rhinology. Prior surveys have examined varied topics informing specialty needs, best practices, and future educational objectives, with a response rate of 7%–12% 12–15 . Responses were anonymous.…”

“…Prior surveys have examined varied topics informing specialty needs, best practices, and future educational objectives, with a response rate of 7%–12%. 12 , 13 , 14 , 15 Responses were anonymous.…”