Unhealthy Behaviors, Thoughts Can Cause Depression or Anxiety

Study into factors beyond those related to PH affecting patients' well-being

Somi Igbene, PhD avatar

by Somi Igbene, PhD |

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Unhealthy changes in cognition, like a focus on worries, can lead to anxiety in people with pulmonary hypertension(PH), while those in behavior, like social avoidance, may cause depression, according to a U.K. study.

Greater dyspnea, or shortness of breath, was also a contributing factor when paired with these cognitive or behavioral tendencies.

Findings, drawn from patient questionnaires, are “consistent with research suggesting disease‐related factors do not fully explain anxiety and depression in people with PH,” the researchers wrote, and support “the importance of psychological interventions” being among the care given.

The study, “Cognitive and behavioural processes predict anxiety and depression in patients with pulmonary hypertension,” was published in the journal Pulmonary Circulation.

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High levels of depression and anxiety seen in 77 patients in study

Depression and anxiety are reported by researchers to affect a substantial proportion of PH patients, with appropriate support given to a minority of them. Little is known about what causes and what makes these patients more vulnerable to mood and anxiety disorders, the scientists noted.

Much of the research on risk factors for depression and anxiety with has focused on disease-related and life measures, such as PH functional class and a person’s age and finances. Subjective factors, those capturing psychological well-being or distress, are given less attention.

Researchers working at academic sites in Nottingham and Sheffield investigated how anxiety and depression might correlate with psychological processes like dyspnea and cognitive and behavioral processes.

Their study involved 77 patients (93.5% female, mean age 47.8, 58.4% white) with different forms and functional classes of PH, recruited globally.

These people answered questions concerning their demographics and clinical factors like PH type or years since diagnosis, and specific questionnaires for dyspnea and health-related quality of life. They also completed two common questionnaires of anxiety and depression in PH patients: the Generalized Anxiety Disorder‐7 (GAD‐7) and the Patient Health Questionnaire‐9 (PHQ‐9).

The majority of participants (57%) reported having either type II or III functional class symptoms, and most had either idiopathic (no known cause) PH or chronic thromboembolic pulmonary hypertension (CTEPH).

Based on GAD‐7 and PHQ-9 responses, more than 70% scored above the clinical cut-off for anxiety and 63% for depression.

Demographics were not significantly associated with anxiety or depression scores, but functional class and PH type significantly correlated with depression and health-related quality of life.

Shortness of breath, as well as cognitive and behavioral tendencies, significantly associated with anxiety and depression. More helpful behaviors aligned with fewer difficulties.

A statistical analysis showed that cognitive factors and shortness of breath significantly predicted anxiety, whereas shortness of breath and behavioral factors predicted depression.

“Combined with the finding that behavioral processes were a significant predictor of depression (but not anxiety), whereas cognitive factors predicted anxiety (but not depression), it may be that low mood in people with PH is more linked with the limiting impact of the condition in terms of reduced physical health and fatigue, loss, isolation, and restricted daily activity,” the researchers wrote.

They suggest different therapeutic approaches to address these risks. For depression, “strategies focusing on education, improving motivation, pacing to help break activities up, build stamina and promote a balance between rest and activity” may be of help. For anxiety, they recommend interventions that tackle “rumination, thinking biases and worry.”

Such approaches “for anxiety and depression should be delivered alongside treatments focusing on PH-driven symptoms such as breathing difficulties and vice versa, recognising people with dyspnea are likely to also report difficulties with mood,” the researchers added.

“Our findings contribute to the small but growing evidence demonstrating the importance of psychological interventions, in particular, CBT [cognitive behavioral therapy], recognizing the need to tailor treatments taking into considering the nature of emotional difficulties and how they interact with PH,” the team concluded.

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