Depression symptoms and lost productivity in chronic rhinosinusitis

Abstract

BackgroundChronic rhinosinusitis (CRS) is associated with significant losses of patient productivity that cost billions of dollars every year. The causative factors for decreases in productivity in patients with CRS have yet to be determined. ObjectiveTo determine which patterns of CRS symptoms drive lost productivity. MethodsProspective, cross-sectional cohort study of 107 patients with CRS. Sinonasal symptom severity was measured using the 22-item Sinonasal Outcomes Test, from which sleep, nasal, otologic or facial pain, and emotional function subdomain scores were calculated using principal component analysis. Depression risk was assessed with the 2-item Patient Health Questionnaire (PHQ-2), whereas nasal obstruction was assessed with the Nasal Obstruction Symptom Evaluation (NOSE) instrument. Lost productivity was assessed by asking participants how many days of work and/or school they missed in the last 3 months because of CRS. Associations were sought between lost productivity and CRS symptoms. ResultsA total of 107 patients were recruited. Patients missed a mean (SD) of 3.1 (12.9) days of work or school because of CRS. Lost productivity was most strongly associated with the emotional function subdomain (β = 7.48; 95% confidence interval [CI], 5.71–9.25; P < .001). Reinforcing this finding, lost productivity was associated with PHQ-2 score (β = 4.72; 95% CI, 2.62–6.83; P < .001). Lost productivity was less strongly associated with the nasal symptom subdomain score (β = 2.65; 95% CI, 0.77–4.52; P = .007), and there was no association between lost productivity and NOSE score (β = 0.01; 95% CI, −0.12 to 0.13; P = .91). ConclusionSymptoms associated with depression are most strongly associated with missed days of work or school because of CRS. Further treatment focusing on depression-associated symptoms in patients with CRS may reduce losses in productivity.