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Anxiety and Depression in Patients With Pulmonary Hypertension

From the Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Medical Center, Heidelberg, Germany (B.L., K.G., C.U., W.H.); the Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana (B.L., K.K.); and the Department of Cardiology, Angiology, and Pulmonology, University of Heidelberg, Medical Center, Heidelberg, Germany (E.G., M.M.B.).

Address correspondence and reprint requests to Bernd Löwe, MD, PhD, Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Medical Center, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany. E-mail: bernd.loewe{at}med.uni-heidelberg.de

OBJECTIVE: This is the first study that investigates the prevalence and actual treatment of anxiety, depression, and other mental disorders in patients with pulmonary hypertension (PH). The prevalence of mental disorders in patients with PH was compared with parallel groups of primary care patients and patients with inflammatory rheumatic diseases, and the relationship between functional status and prevalence of mental disorders was determined.

METHODS: The patient group with PH (70.1% female; mean age, 47.8 ± 12.7 years) and the two comparison groups, which were matched by age and sex, consisted of 164 patients each. Patients completed self-administered instruments, including the Patient Health Questionnaire for the diagnosis of mental disorders. New York Heart Association (NYHA) functional class was assessed in all patients with PH.

RESULTS: Thirty-five percent of the patients with PH suffered from mental disorders, with the most common being major depressive disorder (15.9%) and panic disorder (10.4%). Both panic disorder and panic attacks were significantly more prevalent in patients with PH than in either patients with inflammatory rheumatic diseases or primary care patients. The prevalence of mental disorders in patients with PH increased significantly with functional impairment, from 17.7% (NYHA class I) to 61.9% (NYHA class IV). Only 24.1% of the patients with PH with mental disorders were receiving psychopharmacological or psychotherapeutic treatment.

CONCLUSIONS: Anxiety and depression are frequent in patients with PH and increase as the severity of disease progresses. Given the fact that safe and efficacious treatments of mental disorders are available, greater importance should be attached to the diagnosis and treatment of these conditions in patients with PH.

Key Words: pulmonary hypertension, • depressive disorders, • anxiety disorders, • panic, • diagnosis, • prevalence.

Abbreviations: PH = pulmonary hypertension;; IRD = inflammatory rheumatic disease;; PC = primary care;; PHQ = Patient Health Questionnaire;; NYHA = New York Heart Association;; OR = odds ratio;; CI = confidence interval.

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