Mental Health Disorders Impair Quality of Life for CTEPH Patients

Somi Igbene PhD avatar

by Somi Igbene PhD |

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Nearly a third of individuals with chronic thromboembolic pulmonary hypertension (CTEPH) live with mental health disorders that impair their overall quality of life, a study in Germany has found.

The significant impact of panic disorder, major depression, and other mental disorders on life quality suggests that adequate screening tools are needed for people with CTEPH.

The study, “Prevalence of mental disorders in patients with chronic thromboembolic pulmonary hypertension,” was published in the journal Frontiers in Psychiatry.

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CTEPH is a rare type of pulmonary hypertension (PH) caused by blood clots in the lungs that obstruct and increase blood pressure in lung arteries. It is associated with shortness of breath, reduced ability to exercise, and other symptoms that affect quality of life and increase the risk of psychological disorders.

Although previous studies have investigated depression and anxiety rates in individuals with CTEPH, many have assessed them using self-rating questionnaires instead of more reliable, structured, and validated clinical surveys.

In the new study, a team of scientists investigated depression and anxiety rates in individuals with CTEPH using structured clinical interviews and evaluated the correlation between these psychological disorders and life quality. They also compared the rates of depression and anxiety in individuals with CTEPH, pulmonary arterial hypertension (PAH) patients, and the general German population.

The scientists recruited participants from two large German PH referral centers, Hannover Medical school and University of Giessen and Marburg. All participants underwent medical assessments and completed questionnaires about their age, weight, height, body mass index (a measure of body fat), and lifestyle, including smoking habits, alcohol intake, and participation in sports. Their psychological health was assessed using the hospital anxiety and depression scale (HADS), and quality of life was measured using the short version of the World Health Organization quality of life form — WHOQOL-BREF.

A total of 107 adults (51% women) with a mean age of 69 years participated in the study. Of the group, 31.8% had a mental disorder, 8.4% had panic disorder or a specific phobia (irrational and persistent fear of an object, a situation, or an activity), and 6.5% had major depressive disorder.

The prevalence of major depressive disorder was significantly lower in CTEPH compared to PAH patients, but similar to the general population. In addition, panic disorder was significantly more common in CTEPH than in the general population.

Using the HADS scale, a score of at least 11 points was required to detect major depressive and panic disorders. At this cut-off value, it could accurately detect 57.1% of participants who had these disorders and a nearly 90% specificity in detecting those without such conditions. However, the researchers said these cut-off values are higher than values seen in other studies and suggest that patients be assessed by psychologists to determine if they truly have depressive and panic disorders.

“The comparably high cut-off value for depression in this study is not in line with previously used cut-off values in general medical patients … or adults with congenital heart disease,” the team wrote. “To further examine whether patients with CTEPH who meet the cut-off values in HADS truly suffer from mental disorders, streamlined access to psychological evaluation and counselling is needed.”

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However, HADS may still be a useful tool for cardiologists and pneumologists to detect early panic or major depressive disorder, the investigators noted.

Within the CTEPH group, participants with any type of psychological disorder had a lower psychological and physical quality of life than those who did not experience these disorders. Exercise frequency and alcohol intake affected quality of life with regular participation in sports and infrequent alcohol intake associated with a higher psychological quality of life.

“In summary, one-third of the patients with CTEPH in our cohort [group] had a current mental disorder, similar to what has been reported in the general population or patients with PAH,” the investigators wrote. “The presence of any mental disorder had a major negative impact on overall and psychological [quality of life]. Moreover, the HADS was identified as a possible screening tool for the identification of possibly present panic disorder and major depressive disorder in patients with CTEPH.”

Assessing mental disorders before the diagnosis of CTEPH is needed, the researchers added, as well as more research to develop treatment strategies for affected patients.