Short communication
Depressive symptoms in relation to physical functioning in pulmonary hypertension

https://doi.org/10.1016/j.jpsychores.2008.09.014Get rights and content

Abstract

Objective

To investigate the association between depressive symptoms and physical functioning in pulmonary hypertension (PH) patients.

Methods

Fifty-two patients diagnosed with precapillary or postcapillary PH completed self-report questionnaires of depressive symptoms and physical functioning. Cardiac catheterization reports of patients were reviewed for hemodynamic variables.

Results

Physical functioning was significantly associated with depressive symptoms on bivariate analysis. On multivariate analysis, after controlling for demographic and hemodynamic variables, depressive symptoms accounted for 9% of variance in physical functioning.

Conclusion

The association of depressive symptoms with decreased physical functioning in PH patients indicates the need for longitudinal research regarding the possible effect of depression on disease outcomes in this population.

Introduction

Pulmonary hypertension (PH) is a rare disabling chronic illness of the pulmonary circulation that leads to deterioration in cardiopulmonary function and eventually to right heart failure [1]. Patients with PH experience progressive breathlessness, fatigue, weakness, chest pain, and syncope [2]. The decline in cardiac function also leads to impaired physical function and quality of life [3], [4], [5], [6], [7]. Levels of emotional distress are increased in PH patients [8], and some research indicates a relationship between distress and functional impairment in PH [6], [8]. In this study, we investigate the association between depressive symptoms and physical functioning in PH patients while controlling for illness severity. We hypothesize that patients with PH and high levels of depressive symptoms will report worse physical functioning than those with low levels of depressive symptoms.

Section snippets

Sample and procedures

The study protocol was approved by the Research Ethics Committee of the Sir Mortimer B. Davis—Jewish General Hospital. From June 2005 to October 2007, patients who were scheduled for elective cardiac catheterization for the investigation of PH were approached to participate in the study. The inclusion criteria for the study were age (18 years or older), ability to communicate in English or French, and ability to provide written informed consent. Participants received self-report questionnaires

Results

The sample consisted of 52 patients diagnosed with PH by cardiac catheterization. Table 1 presents the characteristics of the sample and compares participants with high levels of depressive symptoms (BDI scores of 17 or greater) and those with low levels of depressive symptoms (BDI scores less than 17) on physical functioning and other variables in the study.

Table 2 presents the results of the hierarchical regression. Analyses did not identify collinearity among the hemodynamic variables that

Discussion

In our study, patients had a mean physical functioning score of 32, comparable to a mean of 37 found in another study of PH patients [4], and much lower than the general population score of 82 for Canadians in this age group [17]. The mean BDI score in our sample was 11, indicating mild to moderate depressive symptoms, and 21% scored above 16 indicating moderate to severe depressive symptoms. This is consistent with previous studies in PH patients that reported a BDI score of 13 [4], the

Acknowledgments

This study was supported by funding from the Fonds de la Recherche en Santé du Québec. The investigators are supported by salary awards from the FRSQ (K.L., D.D., and D.L.) and graduate scholarship awards from the FRSQ and the Canadian Institutes of Health Research (A.P.).

References (21)

There are more references available in the full text version of this article.

Cited by (28)

  • Depression and Anxiety in Patients With Pulmonary Hypertension: The Role of Life Satisfaction and Optimism

    2018, Psychosomatics
    Citation Excerpt :

    Fourth, the sample size was relatively small, which may limit the generalizability of the findings. Given that previous studies have also suffered from this limitation,10,14,40 a close collaboration between different medical centers and/or patient associations may be necessary in this area of research. This may make it possible to access nationwide patient samples and overcome the difficulties related to sample size resulting from the extremely low prevalence of PAH and CTEPH.

  • Impact of psychological factors on the health-related quality of life of patients treated for pulmonary arterial hypertension

    2018, Journal of Psychosomatic Research
    Citation Excerpt :

    Depression symptoms can include low mood but also energy changes and psychomotor retardation. In a previous study, the poorer a patient's Physical Functioning is, the greater the level of depression [21]. This result may help explain the 6MWD described below, and especially why patients might refuse this assessment.

  • Emotional symptoms and quality of life in patients with pulmonary arterial hypertension

    2014, Journal of Heart and Lung Transplantation
    Citation Excerpt :

    Mental problems were no longer significantly associated with the PCS, although depressive symptomatology seem to explain part of the variance of the SF-36 physical sub-scales underpinning PCS, including role limitations due to physical problems, bodily pain, and general health, suggesting that emotional problems should not be overlooked as a relevant correlate of physical HRQOL. To our knowledge, one other study has used multivariable analyses to predict HRQOL,7 observing that depressive symptoms contributed to poorer physical functioning; however, the authors enrolled a mixed population of PAH patients along with those with left-sided heart disease. Given the paucity of data, especially in view of multivariable models taking disease-characteristics into consideration, further research is needed to confirm our findings.

  • Rationale for the judicious use of placebos in PAH trials

    2010, Journal of Heart and Lung Transplantation
View all citing articles on Scopus

Note: Preliminary data of the study were presented as a poster at the 65th Annual Scientific Conference of the American Psychosomatic Society, Budapest, Hungary, March 2007, and published in Psychosomatic Medicine, 2007 Meeting Abstracts, Abstract 1249, p. A-44.

View full text