Abstract
Introduction: Late stage PAD, or critical limb ischemia, is a devastating diagnosis where patients deal with pain, non-healing wounds, high rates of major amputation, and increased cardiovascular event risk. Previously, we have demonstrated that depression and perceived stress are prevalent in early-stage PAD and associated with adverse health status and mortality risk, but it is unclear what the mental health burden is in patients with late stage disease. Methods: In the ongoing 11-center SCOPE-CLI registry, patients with a new diagnosis of CLI (Rutherford 4-6) were enrolled and underwent assessments with the 8-item Patient Health Questionnaire (PHQ-8, range 0-24, score ≥10 denoting positive screen, scores 10-14 moderate, 15-19 moderately-severe, and 20-24 severe depressive symptoms) and the 4-item Perceived Stress Scale (PSS-4, range 0-15, scores ≥6 exceed normative population scores). Results: Between 01/2020 and 06/2022, we enrolled 184 patients with mean ages of 67.5±10.4 years, 20.1% were black, and 70.1% was male. A total of 22.3%, 71.7%, and 6.0% had Rutherford 4, 5, and 6, respectively. A total of 31.8% had a positive depression screen (mean 7.4±6.2), with rates being equally high across Rutherford categories. Somatic symptoms (sleep, appetite, fatigue) were prominent along with cognitive symptoms (loss of interest, feeling hopeless). A total of 6.3% presented with severe depressive symptoms. Perceived stress levels were high (mean 4.8±3.5) with 41.0% exceeding the normative scores and highest stress rates observed amongst those with Rutherford 5-6 observed (37.8-43.4%). ( Figure ). Conclusions: As clinically relevant depressive symptoms and perceived stress are very common experiences in patients navigating a CLI diagnosis, integrated pathways that include behavioral evaluation and treatment in concert with CLI treatment goals are urgently indicated.
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