Prevalence and Determinants of Depression and Anxiety in Patients With Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension

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Abstract
Background: Depression and anxiety screening has not been adequately examined in patients with pulmonary hypertension (PH). We assessed depression and anxiety prevalence and their determinants in pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH).Methods and Results: This cross-sectional study included 234 patients with PH (age 57 [42–68] years; 75% female; PAH/CTEPH/other: 103/126/5). Overall, 24% and 26% of patients had depression (Hospital Anxiety and Depression Scale [HADS]-depression score ≥8) and anxiety (HADS-anxiety score ≥8) respectively. Depression and anxiety prevalence was 18% and 19% in PAH and 27% and 30% in CTEPH, respectively. Among patients with PAH, depression was significantly associated with higher mean right atrial pressure (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.03–1.32; P=0.013), higher pulmonary vascular resistance (OR 1.08; 95% CI 1.01–1.16; P=0.034), lower arterial oxygen saturation (OR 0.89; 95% CI 0.80–0.98; P=0.021), pulmonary artery oxygen saturation (OR 0.93; 95% CI 0.87–0.99; P=0.020), and reduced use of phosphodiesterase-5 inhibitor (OR 0.30; 95% CI 0.11–0.86; P=0.025). In CTEPH, depression was significantly associated with the presence of a psychiatric disorder (OR 4.71; 95% CI 1.24–17.90; P=0.023). Anxiety was not significantly associated with any of the aforementioned parameters in PAH and CTEPH.Conclusions: Predicting depression and anxiety based on disease severity and hemodynamics was challenging, making individual assessments and approaches crucial.

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