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Prevalence of Psychological Issues among Patients with Pulmonary Hypertension

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Conference: 2014 International PHA Conference and Scientific Sessions

Release Date: 06.22.2014

Presentation Type: Abstracts

File Download: 2014 Conference Abstract - Tania Von Visger

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Patients with pulmonary hypertension (PH) have a high prevalence of depression and anxiety compared to the general patient population. Depression and anxiety have been shown to adversely impact adherence to medical regimens in chronically ill patients. Management of PH may entail complex medical and pharmacological modalities which require a high level of mental focus, support, and commitment. The primary aim of this study is to assess the prevalence of depression and anxiety among patients with PH. The second aim is to explore the use of pharmacological treatment for depression and anxiety in PH patients.

Background: Patients with pulmonary hypertension (PH) have a high prevalence of depression and anxiety compared to the general patient population. Depression and anxiety have been shown to adversely impact adherence to medical regimens in chronically ill patients.  Management of PH may entail complex medical and pharmacological modalities which require a high level of mental focus, support, and commitment.  The primary aim of this study is to assess the prevalence of depression and anxiety among patients with PH.  The second aim is to explore the use of pharmacological treatment for depression and anxiety in PH patients. 

Methods: A sample of 115 patients from a Pulmonary Clinic with a confirmed PH diagnosis completed questionnaires evaluating psychosocial concerns. Patients’ psychotropic medication use was obtained from medical chart review. The Patient Health Questionnaire (PHQ) was used to assess the prevalence of depression, anxiety and several other psychiatric conditions. This study was conducted from July 2011 to July 2013 subsequent to the Institutional Review Board approval.  

Results: Twenty-nine percent of patients reported experiencing at least one type of psychological disorder.  Approximately 41% of patients were prescribed at least one psychotropic medication (selective serotonin reuptake inhibitors, benzodiazepines, and/or antipsychotics).  Table one indicates that of those being treated with medications for depression, 6.4% endorsed feeling of hopelessness and 27.7% still met criteria for major depression.  About 8.5% had depressive symptoms that did not meet full criteria for major depression, 2.1% had panic disorder, and 19.1% had an anxiety disorder (met criteria for generalized anxiety disorder).

Table 1. Proportion of patients with PH who endorsed psychological distress
PHQ Hopelessness* Major Depressive Disorder "Other" Depressive Disorder Panic Disorder "Other" Anxiety Disorder  
     
  N (%) N (%) N (%) N (%) N (%)    
   
Total (n = 115) 8 (7) 16 (13.9) 12 (10.4) 9 (8.1) 13 (11.6)          
On psychotropic medication (n = 47) 3 (6.4) 13 (27.7) 4 (8.5) 1 (2.1) 9 (19.1)          
Not on psychotropic medication (n = 68) 5 (7.4) 3 (4.4) 8 (11.8) 8 (11.8) 4 (5.9)          

*Patient endorsed “thoughts that you would be better off dead or of hurting yourself in some way” at least several days in the past two weeks

Conclusions: In this study, about one-fourth of patients with PH reported experiencing clinical levels of psychological distress which can directly impact effective self-management of their disease. More than half of PH patients who reported depression and anxiety symptoms were already receiving psychotropic medication, possibly suggesting that they are undertreated. This study highlights the importance of routine psychological assessment, treatment referral, and treatment surveillance for PH patients.

Type: Clinical Science