Depression, anxiety and psychological distress in patients with pulmonary hypertension: a mixed-methods study

Abstract

IntroductionPulmonary hypertension (PH) is a chronic and progressive disease. While prognoses have improved, PH patients still experience side effects and activity restrictions. Accordingly, the key questions asked by this study are ‘How many PH patients have depression/anxiety symptoms?’ and ‘Is there a difference in the symptoms and distress factors between pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH) patients, and how are they experiencing distress?’MethodsA mixed-methods study was conducted to collect and analyse quantitative and qualitative data. We administered questionnaires (Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder-7) and then conducted interviews with participants who reported moderate to severe depressive symptoms (PHQ-9 ≥10).ResultsSeventy-four participants were enrolled in the study, 25 with idiopathic PAH and 49 with CTEPH. Their average age was 55.2 years (PAH 42.7 years, CTEPH 61.5 years). Overall, 44.6% of participants had mild or more severe depressive symptoms (PHQ-9 ≥5) and 17.6% had moderate or more severe depressive symptoms (PHQ-9 ≥10). PAH patients had particularly high depressive symptoms (PHQ-9 ≥5: PAH 64.0%, CTEPH 34.7%; PHQ-9 ≥10: PAH 24%, CTEPH 14.3%). We extracted four common themes from the qualitative interview data on participants’ experience of psychological distress: ‘Loss of myself,’ ‘Isolation from my surroundings,’ ‘Hassle associated with oxygen therapy,’ and ‘Fear of illness progression/deterioration.’ One theme— ‘Suffering from side effects’—was extracted only for PAH patients, while another—‘Rumination on illness due to breathlessness’—was extracted only for CTEPH patients.Discussion and conclusionThe study found that PH patients are prone to depression. The identification of factors and themes that influence the psychological distress of PH patients is important information that can be used to improve the support for the physical and mental health of these patients. Interventions for these distress may contribute to improving the mental status of PH patients.

Anxiety and Depression in Patients With Pulmonary Arterial Hypertension in Northwest China: A Cross-Sectional Study

“…In contrast, the anxiety was less prevalent than depression in the present study with prevalence of 17.55%, which was similar to the finding from Japan (10). One study found that patients who had long been diagnosed and followed in a reference center have a lower frequency of psychological disorders than those who had recently been diagnosed with PAH (25).…”

“…These may be because of the poor prognosis, significant side effects, and activity limitations of patients diagnosed of PAH that may expose patients to higher stressors, leading to the development of depression and anxiety (21). High levels of such status can adversely affect health outcomes (22), increase the chance of unhealthy behaviors (23), cause adverse events to occur more frequently (11), and reduce quality of life (10). However, there was a lack of psychological support for PAH patients with depression in the present population, who have not received any type of intervention, and similar observations have been made in the study of Harzheim et al (24).…”

“…In other countries, PAH patients showed a high mental health burden. For example, a study in Japan reported 64% of candidates had depression and 28% had anxiety (10). A study in Beijing, China, found 66.3% of samples had depression and anxiety (11), while 38.2% of PAH patients reported these symptoms in Germany (12).…”

“…A study in Beijing, China, found 66.3% of samples had depression and anxiety (11), while 38.2% of PAH patients reported these symptoms in Germany (12). Some studies also have suggested that patients' anxiety and depression symptoms may further lead to deterioration of physical function (11,13), poor cardiac function (14), poor prognosis (11), worsening quality of life, and increased health-related costs (10).…”

Prevalence, Risk Factors and Intervention for Depression and Anxiety in Pulmonary Hypertension: A Systematic Review and Meta-analysis

“…Furthermore, two recently published studies corroborate the findings of this review. Takita et al ( 45 ) performed a mixed-methods study, involving both quantitative and qualitative methods, and found PH patients to be more vulnerable to depression and psychological distress. Olsson et al ( 46 ) similarly concluded psychological disorders, including major depression and panic disorder, to be prevalent in PAH patients and these disorders may contribute greatly to the patients' reduced quality of life.…”