Advertisement

Depression and anxiety up to two years after acute pulmonary embolism: Prevalence and predictors

  • Simone Fischer
    Correspondence
    Corresponding author at: IBE, LMU München, c/o Epidemiology, Medical Faculty, University of Augsburg, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
    Affiliations
    Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany

    Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU München, Munich, Germany
    Search for articles by this author
  • Christine Meisinger
    Affiliations
    Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
    Search for articles by this author
  • Jakob Linseisen
    Affiliations
    Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany

    Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU München, Munich, Germany
    Search for articles by this author
  • Thomas M. Berghaus
    Affiliations
    Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
    Search for articles by this author
  • Inge Kirchberger
    Affiliations
    Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany

    Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU München, Munich, Germany
    Search for articles by this author
Published:December 24, 2022DOI:https://doi.org/10.1016/j.thromres.2022.12.013

      Highlights

      • One in five patients suffers from depression or anxiety after pulmonary embolism.
      • Association of risk stratification and depression decreases over time.
      • Persistent dyspnoea is associated with emotional harm 2 years after the acute event.
      • Careful monitoring the mental health of patients with pulmonary embolism is needed.

      Abstract

      Introduction

      Pulmonary embolism (PE) is an acute life-threatening event. Besides known physical long-term consequences such as persistent dyspnoea or reduced physical performance, less attention is given to the emotional experience.

      Methods

      We used data from patients with PE of the ‘Lungenembolie Augsburg (LEA)’ cohort study at University Hospital Augsburg. Baseline characteristics were collected during hospital stay and participants received postal questionnaires 3, 6, 12, and 24 months after their PE event. Mental problems were assessed by the Hospital Anxiety and Depression Scale (HADS). Differences in baseline characteristics in patients with or without depression or anxiety at 3 months were tested. Linear mixed models were built to explore long-term effects.

      Results

      About one-in-five of the 297 patients suffered from depressive or anxiety symptoms after PE. Patients with depressiveness 3 months after PE were found to be significantly older, had a higher simplified pulmonary embolism severity index (sPESI), higher education level, more frequently previous depression, lower oxygen saturation, and a longer hospital stay. Linear mixed models revealed significant associations of age, history of depression and sPESI with HADS depression score, and symptoms of dyspnoea with HADS anxiety score after PE. While the association with sPESI decreased over time, persistent dyspnoea and limitations in daily life showed constant associations over the two-year time period for both, depression and anxiety.

      Conclusions

      The findings highlight depression and anxiety to be common in patients with PE and reveal possible predictors. Careful monitoring the mental health of patients with PE is needed for early detection and intervention.

      Abbreviations:

      BMI (body mass index), CRQ (Chronic Respiratory Disease Questionnaire), HADS (Hospital Anxiety and Depression Scale), IQR (interquartile range), LEA (Lungenembolie Augsburg study), LRT (likelihood ratio test), sPESI (simplified pulmonary embolism severity index), PE (pulmonary embolism), PEmb-QoL (Pulmonary Embolism Quality of Life), VTE (venous thromboembolism)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Thrombosis Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Konstantinides S.V.
        • Meyer G.
        • Becattini C.
        • Bueno H.
        • Geersing G.-J.
        • Harjola V.-P.
        • Huisman M.V.
        • Humbert M.
        • Jennings C.S.
        • Jiménez D.
        • Kucher N.
        • Lang I.M.
        • Lankeit M.
        • Lorusso R.
        • Mazzolai L.
        • Meneveau N.
        • Ní Áinle F.
        • Prandoni P.
        • Pruszczyk P.
        • Righini M.
        • Torbicki A.
        • van Belle E.
        • Zamorano J.L.
        ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).
        Eur. Heart J. 2019; 41: 543-603https://doi.org/10.1093/eurheartj/ehz405
        • Klok F.A.
        • van der Hulle T.
        • den Exter P.L.
        • Lankeit M.
        • Huisman M.V.
        • Konstantinides S.
        The post-PE syndrome: a new concept for chronic complications of pulmonary embolism.
        Blood Rev. 2014; 28: 221-226https://doi.org/10.1016/j.blre.2014.07.003
        • Tran A.
        • Redley M.
        • de Wit K.
        The psychological impact of pulmonary embolism: a mixed-methods study.
        Res. Pract. Thromb. Haemost. 2021; 5: 301-307https://doi.org/10.1002/rth2.12484
        • Noble S.
        • Lewis R.
        • Whithers J.
        • Lewis S.
        • Bennett P.
        Long-term psychological consequences of symptomatic pulmonary embolism: a qualitative study.
        BMJ Open. 2014; 4e004561https://doi.org/10.1136/bmjopen-2013-004561
        • Rolving N.
        • Brocki B.C.
        • Andreasen J.
        Coping with everyday life and physical activity in the aftermath of an acute pulmonary embolism: a qualitative study exploring patients' perceptions and coping strategies.
        Thromb. Res. 2019; 182: 185-191https://doi.org/10.1016/j.thromres.2019.06.007
        • Kirchberger I.
        • Ruile S.
        • Linseisen J.
        • Haberl S.
        • Meisinger C.
        • Berghaus T.M.
        The lived experience with pulmonary embolism: a qualitative study using focus groups.
        Respir. Med. 2020; 167105978https://doi.org/10.1016/j.rmed.2020.105978
        • Etchegary H.
        • Wilson B.
        • Brehaut J.
        • Lott A.
        • Langlois N.
        • Wells P.S.
        Psychosocial aspects of venous thromboembolic disease: an exploratory study.
        Thromb. Res. 2008; 122: 491-500https://doi.org/10.1016/j.thromres.2007.12.001
        • Hunter R.
        • Lewis S.
        • Noble S.
        • Rance J.
        • Bennett P.D.
        “Post-thrombotic panic syndrome”: a thematic analysis of the experience of venous thromboembolism.
        Br. J. Health Psychol. 2017; 22: 8-25https://doi.org/10.1111/bjhp.12213
        • Danielsbacka J.S.
        • Rostberg L.
        • Olsén M.F.
        • Mannerkorpi K.
        “Whole life changed” - experiences of how symptoms derived from acute pulmonary embolism affects life. A qualitative interview study.
        Thromb. Res. 2021; 205: 56-62https://doi.org/10.1016/j.thromres.2021.07.004
        • Bennett P.
        • Patterson K.
        • Noble S.
        Predicting post-traumatic stress and health anxiety following a venous thrombotic embolism.
        J. Health Psychol. 2016; 21: 863-871https://doi.org/10.1177/1359105314540965
        • Højen A.A.
        • Sørensen E.E.
        • Dreyer P.S.
        • Søgaard M.
        • Larsen T.B.
        Long-term mental wellbeing of adolescents and young adults diagnosed with venous thromboembolism: results from a multistage mixed methods study.
        J. Thromb. Haemost. 2017; 15: 2333-2343https://doi.org/10.1111/jth.13873
        • Liu C.
        • Li X.
        • Chen H.
        • Cui J.
        • Niu L.
        • He Y.
        • Tian X.
        Depression, anxiety and influencing factors in patients with acute pulmonary embolism.
        Chin. Med. J. 2011; 124: 2438https://doi.org/10.3760/cma.j.issn.0366-6999.2011.16.007
        • Feehan M.
        • Walsh M.
        • van Duker H.
        • Godin J.
        • Munger M.A.
        • Fleming R.
        • Johnson S.A.
        • Morrison M.A.
        • DeAngelis M.M.
        • Witt D.M.
        Prevalence and correlates of bleeding and emotional harms in a national US sample of patients with venous thromboembolism: a cross-sectional structural equation model.
        Thromb. Res. 2018; 172: 181-187https://doi.org/10.1016/j.thromres.2018.05.025
        • Tzeng N.-S.
        • Chung C.-H.
        • Chang S.-Y.
        • Yeh C.-B.
        • Lu R.-B.
        • Chang H.-A.
        • Kao Y.-C.
        • Chou Y.-C.
        • Yeh H.-W.
        • Chien W.-C.
        Risk of psychiatric disorders in pulmonary embolism: a nationwide cohort study, Journal of investigative medicine: the official publication of the American Federation for Clinical Research. 67. 2019: 977-986https://doi.org/10.1136/jim-2018-000910
        • Erickson R.M.
        • Feehan M.
        • Munger M.A.
        • Tak C.
        • Witt D.M.
        Understanding factors associated with quality of life in patients with venous thromboembolism.
        Thromb. Haemost. 2019; 119: 1869-1876https://doi.org/10.1055/s-0039-1696717
        • Meisinger C.
        • Linseisen J.
        • Kirchberger I.
        • von Scheidt W.
        • Berghaus T.M.
        Long-term outcomes in patients with acute pulmonary embolism after in-hospital treatment: study protocol of the prospective Lungenembolie Augsburg Studie (LEA study).
        BMJ Open. 2019; 9e031411https://doi.org/10.1136/bmjopen-2019-031411
        • Bjelland I.
        • Dahl A.A.
        • Haug T.T.
        • Neckelmann D.
        The validity of the Hospital Anxiety and Depression Scale: an updated literature review.
        J. Psychosom. Res. 2002; 52: 69-77https://doi.org/10.1016/S0022-3999(01)00296-3
        • Herrmann C.
        International experiences with the Hospital Anxiety and Depression Scale-a review of validation data and clinical results.
        J. Psychosom. Res. 1997; 42: 17-41https://doi.org/10.1016/S0022-3999(96)00216-4
        • Frey P.M.
        • Méan M.
        • Limacher A.
        • Leiss W.
        • Schwab N.
        • Rochat M.
        • Aujesky D.
        Quality of life after pulmonary embolism: prospective validation of the German version of the PEmb-QoL questionnaire.
        Thromb. Res. 2015; 135: 1087-1092https://doi.org/10.1016/j.thromres.2015.03.031
        • Puhan M.A.
        • Behnke M.
        • Frey M.
        • Grueter T.
        • Brandli O.
        • Lichtenschopf A.
        • Guyatt G.H.
        • Schunemann H.J.
        Self-administration and interviewer-administration of the German Chronic Respiratory Questionnaire: instrument development and assessment of validity and reliability in two randomised studies.
        Health Qual. Life Outcomes. 2004; 2: 1https://doi.org/10.1186/1477-7525-2-1
        • Righini M.
        • Roy P.-M.
        • Meyer G.
        • Verschuren F.
        • Aujesky D.
        • Le Gal G.
        The Simplified Pulmonary Embolism Severity Index (PESI): validation of a clinical prognostic model for pulmonary embolism.
        J. Thromb. Haemost. 2011; 9: 2115-2117https://doi.org/10.1111/j.1538-7836.2011.04469.x
        • Textor J.
        • van der Zander B.
        • Gilthorpe M.S.
        • Liskiewicz M.
        • Ellison G.T.
        Robust causal inference using directed acyclic graphs: the R package ‘dagitty’.
        Int. J. Epidemiol. 2016; 45: 1887-1894https://doi.org/10.1093/ije/dyw341
        • R Core Team
        R: A Language And Environment for Statistical Computing.
        R Foundation for Statistical Computing, Vienna, Austria2021
        • Valerio L.
        • Barco S.
        • Jankowski M.
        • Rosenkranz S.
        • Lankeit M.
        • Held M.
        • Gerhardt F.
        • Bruch L.
        • Ewert R.
        • Faehling M.
        • Freise J.
        • Ghofrani H.-A.
        • Grünig E.
        • Halank M.
        • Hoeper M.M.
        • Klok F.A.
        • Leuchte H.H.
        • Mayer E.
        • Meyer F.J.
        • Neurohr C.
        • Opitz C.
        • Schmidt K.-H.
        • Seyfarth H.-J.
        • Trudzinski F.
        • Wachter R.
        • Wilkens H.
        • Wild P.S.
        • Konstantinides S.V.
        Quality of life 3 and 12 months following acute pulmonary embolism: analysis from a prospective multicenter cohort study.
        Chest. 2021; 159: 2428-2438https://doi.org/10.1016/j.chest.2021.01.071
        • Chuang L.-H.
        • Gumbs P.
        • van Hout B.
        • Agnelli G.
        • Kroep S.
        • Monreal M.
        • Bauersachs R.
        • Willich S.N.
        • Gitt A.
        • Mismetti P.
        • Cohen A.
        • Jimenez D.
        Health-related quality of life and mortality in patients with pulmonary embolism: a prospective cohort study in seven European countries.
        Qual. Life Res. Int. J. Qual. Life Asp. Treat. Care Rehab. 2019; 28: 2111-2124https://doi.org/10.1007/s11136-019-02175-z
        • Robinson R.G.
        • Jorge R.E.
        Post-stroke depression: a review.
        Am. J. Psychiatry. 2016; 173: 221-231https://doi.org/10.1176/appi.ajp.2015.15030363
        • Jørgensen T.S.H.
        • Wium-Andersen I.K.
        • Wium-Andersen M.K.
        • Jørgensen M.B.
        • Prescott E.
        • Maartensson S.
        • Kragh-Andersen P.
        • Osler M.
        Incidence of depression after stroke, and associated risk factors and mortality outcomes, in a large cohort of Danish patients.
        JAMA Psychiatry. 2016; 73: 1032-1040https://doi.org/10.1001/jamapsychiatry.2016.1932
        • Towfighi A.
        • Ovbiagele B.
        • El Husseini N.
        • Hackett M.L.
        • Jorge R.E.
        • Kissela B.M.
        • Mitchell P.H.
        • Skolarus L.E.
        • Whooley M.A.
        • Williams L.S.
        Poststroke depression: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2017; 48: e30-e43https://doi.org/10.1161/STR.0000000000000113
        • Thayabaranathan T.
        • Andrew N.E.
        • Kilkenny M.F.
        • Stolwyk R.
        • Thrift A.G.
        • Grimley R.
        • Johnston T.
        • Sundararajan V.
        • Lannin N.A.
        • Cadilhac D.A.
        Factors influencing self-reported anxiety or depression following stroke or TIA using linked registry and hospital data.
        Qual. Life Res. 2018; 27: 3145-3155https://doi.org/10.1007/s11136-018-1960-y
        • Doi-Kanno M.
        • Fukahori H.
        Predictors of depression in patients diagnosed with myocardial infarction after undergoing percutaneous coronary intervention: a literature review.
        J. Med. Dent. Sci. 2016; 63: 37-43https://doi.org/10.11480/jmds.630301
        • Murphy B.
        • Le Grande M.
        • Alvarenga M.
        • Worcester M.
        • Jackson A.
        Anxiety and depression after a cardiac event: prevalence and predictors.
        Front. Psychol. 2019; 10: 3010https://doi.org/10.3389/fpsyg.2019.03010
        • Keller K.
        • Tesche C.
        • Gerhold-Ay A.
        • Nickels S.
        • Klok F.A.
        • Rappold L.
        • Hasenfuß G.
        • Dellas C.
        • Konstantinides S.V.
        • Lankeit M.
        Quality of life and functional limitations after pulmonary embolism and its prognostic relevance.
        J. Thromb. Haemost. 2019; 17: 1923-1934https://doi.org/10.1111/jth.14589
        • Hunter R.
        • Noble S.
        • Lewis S.
        • Bennett P.
        Long-term psychosocial impact of venous thromboembolism: a qualitative study in the community.
        BMJ Open. 2019; 9e024805https://doi.org/10.1136/bmjopen-2018-024805
        • Keddington K.S.
        • Jones A.E.
        • Feehan M.
        • Witt D.M.
        Development of a brief screening instrument for emotional distress associated with thromboembolism.
        Thromb.Update. 2020; 1100015https://doi.org/10.1016/j.tru.2020.100015
        • Kowal C.
        • Peyre H.
        • Amad A.
        • Pelissolo A.
        • Leboyer M.
        • Schürhoff F.
        • Pignon B.
        Psychotic, mood, and anxiety disorders and venous thromboembolism: a systematic review and meta-analysis.
        Psychosom. Med. 2020; 82: 838-849https://doi.org/10.1097/PSY.0000000000000863