Depressed Mood Modulates Impact of Chronic Rhinosinusitis Symptoms on Quality of Life

Abstract

It is unknown how severity of depressed mood affects the well-recognized relationship between chronic rhinosinusitis (CRS) symptom burden and decreased general health-related quality of life (QOL). The objective of this study was to determine whether depressed mood would affect the relationship between CRS symptom burden and decreased general health-related QOL. For this cross-sectional study, 610 participants with CRS were prospectively recruited. CRS symptom burden was measured with the 22-item Sino-Nasal Outcome Test (SNOT-22). General health-related QOL was measured with the EuroQol 5-dimensional health utility value (EQ-5D HUV) and visual analog scale (EQ-5D VAS). Depressed mood was measured using the Patient Health Questionnaire-2 (PHQ-2). Participants were stratified as having well-controlled CRS symptoms (SNOT-22 < 35) and poorly controlled CRS symptoms (SNOT-22 ≥ 35). Good general health-related QOL was determined as EQ-5D HUV ≥ 0.9 or EQ-5D VAS ≥ 80, in contrast to low general health-related QOL. In participants with well-controlled CRS symptoms, both SNOT-22 and PHQ-2 were significantly and negatively associated with good general health-related QOL (P < .020 in all cases using multivariable regression). In participants with poorly controlled CRS symptoms, the PHQ-2 was significantly and negatively associated with good general health-related QOL using the EQ-5D HUV (adjusted odds ratio [OR]= 0.37, 95% confidence interval [CI]: 0.22-0.62, P < .001) or the EQ-5D VAS (adjusted OR= 0.74, 95% CI: 0.57-0.96, P= .024). In contrast, SNOT-22 was not associated with general health-related QOL in these patients. Depressed mood modulates the association between CRS symptom burden and general health-related QOL. Our results suggest a threshold of CRS symptom burden or control, beyond which depressed mood-not CRS symptom burden-drives the association with general health-related QOL.