Abstract
Objective: Mental health may affect the quality of life (QoL) in patients with pulmonary arterial hypertension (PAH). However, mental disorders have not been systematically assessed in these patients. We examined the prevalence of mental disorders using structured interviews and determined their impact on QoL in patients with PAH.Methods: This study included 217 patients with PAH from two German referral centers. Psychiatric disorders were assessed using the structured clinical interview for DSM-V. QoL was assessed using the WHO Quality of Life questionnaire (short form). The diagnostic value of the Hospital Anxiety and Depression Scale was evaluated by receiver operating characteristic curve analysis.Results: More than one third of the patients had psychological disorders with current or past adjustment disorder (38.2%), current major depressive disorder (23.0%), and panic disorder (15.2%) being the most prevalent mental illnesses. About half of the patients with a history of adjustment disorder developed at least one other mental illness. The presence of mental disorders had a profound impact on QoL. The Hospital Anxiety and Depression Scale ruled out panic disorder and depression disorder with negative predictive values of almost 90%.Conclusion: Mental disorders, in particular adjustment disorder, major depression, and panic disorder, are common in patients with PAH and contribute to impaired QoL in these patients. The Hospital Anxiety and Depression Scale may be used as a screening tool for the most common mental health disorders. Future studies need to address interventional strategies targeting mental disorders in patients with PAH.
Highlights
Pulmonary arterial hypertension (PAH) is a rare debilitating and life-threatening disease characterized by progressive pulmonary vascular remodeling and consecutive right-sided heart failure [1]
The consequences of receiving a PAH diagnosis are immense as the patients have to deal with their physical limitations and with uncertainties about their future; the potential inability to continue working with all its financial, familial, and social consequences; the outlook of not being able to become pregnant or to raise children; the need for continued medical check-ups including invasive procedures; and the burden, complexities, and side effects of medical therapies including the possible need for lung transplantation
Patients with mental disorders were younger, more likely to receive combination therapies for PAH, had a higher diffusion capacity of the lung for carbon monoxide, and were more likely to smoke than patients without mental disorders (Table 1)
Summary
Pulmonary arterial hypertension (PAH) is a rare debilitating and life-threatening disease characterized by progressive pulmonary vascular remodeling and consecutive right-sided heart failure [1]. Receiving the diagnosis of PAH is frequently associated with conflicting emotions as patients may be relieved that an explanation for their symptoms has been found while realizing at the same time that they suffer from a severe, permanent, and potentially lethal disease, which will affect and change the rest of their lives. The consequences of receiving a PAH diagnosis are immense as the patients have to deal with their physical limitations and with uncertainties about their future; the potential inability to continue working with all its financial, familial, and social consequences; the outlook of not being able to become pregnant or to raise children; the need for continued medical check-ups including invasive procedures; and the burden, complexities, and side effects of medical therapies including the possible need for lung transplantation. To the best of our knowledge, all previous studies assessing mental disorders in patients with PAH have used self-rating questionnaires rather than structured expert faceto-face interviews, which are considered the gold standard of psychiatric assessment
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