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

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

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

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

    Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU München, Munich, Germany
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Published:December 24, 2022DOI:


      • 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.



      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.


      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.


      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.


      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.


      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)


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