30% of PAH Patients Experience Depression or Anxiety, Study Shows

Thirty percent of pulmonary arterial hypertension (PAH) patients experience depression or anxiety, according to a study that looked at patients’ psychological disorders, feelings of stress, and social support.

The study, “Quality of life and psychological symptoms in patients with pulmonary hypertension,” was published in the journal Heart & Lung.

PAH is a rare, progressive lung disease that has a major impact on patients’ daily lives. Depression and anxiety disorders can make it worse. Some studies have shown that up to 50% of patients have symptoms of depression.

The amount of time it takes for many people to be diagnosed with PAH and the time it takes for them to adjust to their condition may stoke depression and anxiety.

On average, it takes 2.8 years for a person who starts to experience PAH symptoms to get a definitive diagnosis.

While doctors are trying to diagnose their condition, patients and their families can experience anger, frustration and uncertainty. Just after the diagnosis, anxiety and fear can appear, particularly because patients have little knowledge about the disease. Once patients accept that they have PAH, and must learn to live with it, their main concerns are coping with uncertainty and dealing with treatment.

To learn more about how PAH patients’ psychological health and quality of life changes after their diagnosis, researchers studied 108 of them during their treatment visits at a university medical center in the Midwest between 2011 and 2013.

The length of time between patients’ diagnosis and their visits ranged between one and 95 months. Eighty-two percent were receiving an oral medication for their condition. Twenty-seven percent were receiving an injection or IV medication, and 16% were on combination therapies.

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Seventy-seven percent of the patients were women. Most were white, and their disease was PAH Class II or III according to the New York Heart Association functional classification.

Researchers asked patients to fill out questionnaires on their psychological health, quality of life, perceived stress levels and perceived social support.

Thirty percent reported symptoms of depression or anxiety. Sixteen percent reported symptoms of major depression and 9% symptoms of other depressive disorders. Symptoms of panic disorder affected 8%, and symptoms of other anxiety disorders 4%

The study showed that the percentage of patients with a major depressive disorder was higher than in the general population but similar to that reported in patients with chronic diseases such as diabetes, a cardiovascular heart condition or a kidney disorder.

Patients deemed their social support to be “less than adequate,” felt that their stress levels were relatively high, and reported that their quality of life was at a “moderate level.”

Those who had been diagnosed longer expressed the most satisfaction with their level of social support. This may be because over time patients become accustomed to asking for support and become satisfied with the level they receive from healthcare professionals or others.

Researchers also found a correlation between time from diagnosis and higher levels of perceived patient stress. This suggested that as their disease advances, patients feel more stress. One reason this makes sense is that as PAH worsens, patients much deal with a more complex disease management regimen.

Taken together, the results highlighted the importance of assessing PAH patients’ mental health and  providing them with specialized psychological support.

“The high proportion of participants reporting depressive symptoms in this study underscores the importance of a holistic approach to routine care and management of patients with PAH to detect, treat, and monitor for symptoms of depression that may hinder optimal outcomes of PAH care,” the researchers wrote.

“The multiple medications that need to be taken, combined with fatigue, dyspnea [shortness of breath], and other bothersome symptoms associated with PAH, may adversely impact treatment adherence [sticking to treatment],” they wrote. “When applicable, PAH clinicians [doctors] should refer patients to a mental health professional, with ongoing evaluation of clinical outcomes.”