The impact of mental health on chronic rhinosinusitis symptom scores

Abstract

We aimed to assess whether anxiety and depression influence a patient's subjective symptom scores in chronic rhinosinusitis (CRS). Fifty-seven consecutive patients referred with CRS were asked to complete Sinonasal Outcome Test-22 (SNOT22) and Hospital Anxiety and Depression Score (HADS) questionnaires. Spearman's rank correlation was used to test association between SNOT22 and HADS. Linear regression was used to simultaneously analyse SNOT, HADS, patient age and gender. Mean anxiety score was 7.9 (range 0-19) with 32 % scoring over 11 (A score of ≥ 11 for either anxiety or depression is suggestive). Mean depression score was 5.0 (range 0-17), with 11 % scoring over 11. Five patients scored over 11 for both domains in the HADS questionnaire. Total SNOT22 and both anxiety (Spearman's ρ = 0.48, p = 0.0002) and depression scores (ρ = 0.44, p = 0.0007) revealed a strong association. We also identified a very strong association between psychological symptoms (questions 11-20) in SNOT22 and anxiety (ρ = 0.60, p = 0.0001) and depression scores (ρ = 0.341, p = 0.002). However, there was no association between nose-specific symptoms in SNOT22 and anxiety score in HADS (ρ = 0.18, p = 0.1775), but there was a strong association between nose-specific symptoms of SNOT22 and depression score in HADS (ρ = 0.32, p = 0.02). There is a strong association between total SNOT 22 and HADS score, but this appears to be due to the impact on generic quality of life items rather than disease-specific symptoms. This supports inclusion of global items in the SNOT22, but also use of two separate subscales when interpreting data.