Depression, Depressive Symptoms Can Derail Peripheral Artery Disease Treatment

Kim Smolderen, PhD

Insight from a recent study performed by investigators at the Yale University School of Medicine is detailing the impact depressive symptoms can have on management of peripheral artery disease.

Results of the study, which assessed data of patients from the US, Europe, and Australia, indicate depressive symptoms were associated with worse disease-specific health status recovery path and also revealed the burden of depressive symptoms appeared to be greater among women with peripheral artery disease than men.

"This is the first study to document how depressive symptoms may complicate PAD recovery even among patients receiving specialty care," said lead investigator Kim G. Smolderen, PhD, a clinical health psychologist and co-director of the Vascular Medicine Outcomes Research Program in the internal medicine department at Yale New Haven Hospital, Yale University School of Medicine, in a statement.

In an effort to further study the effects of various factors on treatment practices in peripheral artery disease, investigators designed the current study using data of patients from the Patient-Centered Outcomes Related to Treatment Practices in Peripheral Artery Disease Investigating Trajectories (PORTRAIT) registry. From the registry, investigators identified a cohort of 1243 patients treated at vascular specialty clinics in the US, the Netherlands, and Australia being treated for new or recurrent symptoms of PAD for inclusion in their study.

From the registry, investigators obtained information related to assessments of depressive symptoms at baseline and 3 months according to the 8-Item Patient Health Questionnaire (PHQ-8), which indicates clinically relevant depressive symptoms if patients achieved a score of 10 or more. Additionally, all patients included in the analysis had disease-specific and genetic health status assessed via Peripheral Artery Questionnaire and EQ-5D Visual Analogue Scale at baseline and 3, 6, and 12 months.

For the purpose of the analysis, investigators an adjusted general linear model for repeated measures was constructed for baseline and 3-, 6-, and 1-month health status outcomes according to depressive symptoms at baseline.

The mean age of the study cohort was 67.6±9.4 years, 38% were women, 52.6% had new-onset PAD symptoms, and 87% had follow-up data through 12 months. In total, 16% (n=199) of patients had moderate-severe depressive symptoms at baseline—investigators pointed out the rates of depressive symptoms were higher among women than in men (21.1% vs 12.9%; P <.001). Overall, mean PHQ-8 scores were 4.2±4.8 in men and 5.6±5.3 in women.

In adjusted models, investigators found patients with depressive symptoms had worse health status at each of the aforementioned time points when compared against those without depressive symptoms. Investigators pointed out similar results were observed for EQ-5D Visual Analogue Scale scores and magnitude in 1-year change in health status scores did not differ by sex.

Additionally, investigators noted depressive symptoms accounted for 19% of the association between sex differences in 1-year Peripheral Artery Questionnaire summary scores.

"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,” added Qurat-Ul-Ain Jelani, MD, an interventional cardiologist in training at Yale University School of Medicine, in the aforementioned statement. “A multidisciplinary approach that includes mental health supports for patients with PAD would be beneficial."

This study, “Relationship Between Depressive Symptoms and Health Status in Peripheral Artery Disease: Role of Sex Differences,” was published in the Journal of the American Heart Association.