Influence of Depression and Anxiety on Health-Related Quality of Life While Awaiting Lung Transplant

Abstract

Severe lung disease may have significant effects on mental health, which may be exacerbated by the stress of awaiting lung transplantation (LTx). However, the prevalence of depression and anxiety symptoms in LTx candidates and the effects of these disorders on health-related quality of life (HRQL) has not been well described. We sought to describe the prevalence of depression and anxiety in patients on the LTx waiting list, and associations between depression or anxiety symptoms and HRQL. The Frailty and Sarcopenia in Organ Transplantation study (FROST) is a prospective single-center cohort study of 240 adults listed for solid organ transplantation. Of 70 subjects on the LTx list, we evaluated the 65 with complete data. Prior to transplant, these patients completed the Patient Health Questionnaire (PHQ-9) to screen for depression, the Generalized Anxiety Disorder scale (GAD-7) to screen for anxiety, and the 12-item short form health survey (SF12) to evaluate HRQL using physical and mental component summary scores (PCS & MCS). Using multiple linear regression adjusted for age, gender, and diagnosis, we identified whether depression or anxiety was associated with the SF12 MCS or PCS. 50% of participants were female, with an average age of 59 (SD 13.3). The most common diagnoses were interstitial lung disease (46%), and chronic obstructive pulmonary disease (38%). Average PHQ9 score was 7.2 corresponding to mild depression. 69% of patients had some degree of depression of whom 22% had moderate to severe depression (score ≥ 10). Average GAD7 score was 4.2 corresponding to no anxiety and 6.2% of patients had moderate to severe anxiety. Patients with depression had a lower mean SF12 MCS than those without depression (46 vs. 55, p = 0.001), but there was no significant difference between PCS scores. Patients with anxiety had a lower MCS (43, SD=7 vs. 53, SD=9, p = 0.005), and PCS (30, SD=5 vs. 34, SD=6, p = 0.03) than those without anxiety. A substantial proportion of LTx candidates in this cohort had depression, but the prevalence of anxiety was lower. Both were associated with significant reductions in mental HRQL. Anxiety was also associated with a reduction in physical HRQL. Screening and treatment for depression and anxiety may represent an opportunity to improve HRQL in lung transplant candidates.