Study: PAD Patients with Depression Had Worse Recovery, Women Twice as Likely to Be Depressed

New research has found that patients with peripheral artery disease (PAD) and depressive symptoms experience worse recovery, especially women, compared with counterparts who do not have depressive symptoms 1 year after receiving specialty care for PAD, according to a press release from the Journal of the American Heart Association.

PAD is the narrowing of the peripheral arteries serving the legs, stomach, arms, and head, and most commonly affects arteries in the legs, according to the press release. Further, PAD is associated with a high risk of death and illness from cardiovascular diseases and is a significant global health problem that may cause excruciating pain while walking and may affect mobility, functioning, health status, and quality of life.

Researchers followed 1243 patients treated at vascular specialty clinics in the United States, the Netherlands, and Australia who were being treated for new or recurrent symptoms of PAD. The patients included in the study were enrolled from the Patient-centered Outcomes Related to Treatment Practices in Peripheral Artery Disease Investigating Trajectories Registry.

At the beginning of the study, the researchers assessed depressive symptoms using the standard 8-item Patient Health Questionnaire, in which patients rated statements about how often they:

• have “little interest or pleasure in doing things;”
• feel “down, depressed or hopeless;”
• have “trouble sleeping;”
• feel ”tired/no energy;”
• have “poor appetite or overeat;”
• feel “bad about yourself;” or
• believe they are “moving or speaking so slowly that other people notice/or the opposite, being so fidgety or restless that they have to move around a lot more than usual.“

Disease-specific and general health status were also measured at the beginning of the study and at 3, 6, and 12 months later with standardized patient interviews. Following this, the researchers reconstructed the 1-year health status trajectory by whether or not patients reported depressive symptoms when they were diagnosed with PAD.

The analysis found that men and women with depressive symptoms had worse health status at each time point, compared with patients who did not report such symptoms.

In addition, more women than men had depressive symptoms, with 1 in 5 women with a new diagnosis or worsening symptoms of PAD having clinically relevant depressive symptoms 1 year after diagnosis. The women experienced worse health status outcomes that are partially explained by depressive symptoms, according to the press release.

“A major goal of PAD treatment is improving patients’ health status and quality of life,” said study author Qurat-Ul-Ain Jelani, MD, in the press release. “Not recognizing or treating depressive symptoms may stand in the way of realizing optimal recovery.”

Jelani added that as more value-based care options are designed for patients with PAD, integrating mental health screening and treatment pathways into chronic disease management may increase the opportunity for patients to receive more holistic care, thus improving outcomes.

The findings may not be representative of the general PAD population who may not have access to specialty care due to the study being focused on patients treated at vascular specialty clinics. In addition, the researchers acknowledged that the emphasis on depressive symptoms excludes many mental health concerns, such as anxiety or stress, and excludes unmeasured clinical factors that could contribute to depressive symptoms.

REFERENCE

PAD patients with depression had worse recovery, women twice as likely to be depressed. American Heart Association. https://newsroom.heart.org/news/pad-patients-with-depression-had-worse-recovery-women-twice-as-likely-to-be-depressed. Published August 12, 2020. Accessed August 18, 2020.