PH Severity Far from Sole Determinant of Patients’ Emotional Well-Being, Study Says

The emotional well-being of people with pulmonary hypertension (PH), particularly in relation to levels of anxiety and depression, may be better explained by taking into account their life circumstances and not the severity of their disease alone, a study reports.

The study, “Depression and Anxiety in Patients With Pulmonary Hypertension: The Role of Life Satisfaction and Optimism,” was published in the journal Psychosomatics.

Depression and anxiety can trouble PH patients, with studies estimating that symptoms of depression affect between 7.5 and 55% of all patients, and anxiety between 19 to 48%.

Relevant research, however, has largely been devoted to identifying disease-related factors that could explain patients’ depressive and anxiety symptoms, overlooking other psychological factors that could be contributors.

Evidence of depression and anxiety in patients with varying levels of disease severity suggesting there is no perfect link between PH and these comorbidities, and that other factors might be at play in their emotional well-being.

Researchers in Spain conducted a study to determine whether levels of life satisfaction and optimistic outlook help to explain symptoms of depression and anxiety evidenced in a group of PH patients.

Life satisfaction was defined as “global assessment of a person’s life according to [a person’s] chosen criteria” and included social relationships and activities; optimism was defined as “the extent to which people hold generalized favorable expectancies for their future.”

They recruited 64 patients (mean age 49.8,  82.8% women) who completed tests evaluating PH symptoms, functional disability, symptoms of depression and anxiety, and of life satisfaction, optimism, and quality of life. Scores of 8 or higher, considered clinically significant in a qualified test (the Hospital Anxiety and Depression Scale), were recorded for depression in almost 22% (14) of these patients, and for anxiety in almost 36% (23) of them.

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Using only measures of disease severity and functional disability, the researchers accurately predicted 50.5% of the patients identified as being depressed, and 56.5% of those with significant anxiety.

When life satisfaction and optimism were added as factors to the model, they significantly improved researchers’ ability to predict anxiety (60.9% of this patient group) and, marginally, depression. But adding these measures of emotional well-being also significantly improved the model’s ability to correctly identify patients without serious symptoms of depression or anxiety.

Researchers also found that patients had much higher levels of anxiety than depression, and that symptoms of anxiety were significantly predictive of quality of life, more so than disease severity.

“[T]hese results suggest that emotional well-being may be better explained by taking into consideration patients’ life circumstances, as these may modulate the repercussions of having pulmonary hypertension,” the researchers concluded

And they emphasized that “the higher prevalence in this sample of clinically-significant symptoms of anxiety, compared to that of depression, suggest that feelings of fear and uncertainty may require special attention among patients with pulmonary hypertension.”