title: Depressive symptoms and lower extremity functioning in men and women with peripheral arterial disease.
abstract: OBJECTIVE
  Factors associated with impaired functioning in patients with lower extremity peripheral arterial disease (PAD) are not fully understood. The purpose of this study was to determine the relationship between depressive symptoms and objective measures of lower extremity functioning in persons with PAD.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Four hundred twenty-three men and women with PAD identified from 3 Chicago area medical centers.
  
  
  RESULTS
  PAD was defined as ankle brachial index (ABI) <0.90. The Geriatric Depression Scale short form (GDS-S) (0-15 scale, 15 = worst) was completed by all participants. A clinically significant number of depressive symptoms was defined as a GDS-S score >or=6. Six-minute walk distance and usual-and fast-pace walking velocity were determined for all participants. A GDS-S score >or=6 was present in 21.7% of participants with PAD. Adjusting for age, increasing numbers of depressive symptoms were associated with an increasing prevalence of leg pain on exertion and rest (P =.004). Adjusting for age, sex, race, ABI, number of comorbidities, current smoking, and antidepressant medications, increasing numbers of depressive symptoms were associated with shorter 6-minute walk distance (P <.001), slower usual-pace walking velocity (P =.005), and slower fast-pace walking velocity (P =.005). These relationships were attenuated slightly after additional adjustment for presence versus absence of leg pain on exertion and rest and severity of exertional leg symptoms.
  
  
  CONCLUSIONS
  Among men and women with PAD, the prevalence of a clinically significant number of depressive symptoms is high. Greater numbers of depressive symptoms are associated with greater impairment in lower extremity functioning. Further study is needed to determine whether identifying and treating depressive symptoms in PAD is associated with improved lower extremity functioning.
authors.affiliation: Department of Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA. mdm608@northwestern.edu
authors.forename: Mary McGrae
authors.initials: MM
authors.lastname: McDermott
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.forename: William H
authors.initials: WH
authors.lastname: Pearce
authors.forename: Cheeling
authors.initials: C
authors.lastname: Chan
authors.forename: Joseph
authors.initials: J
authors.lastname: Schneider
authors.forename: Leena
authors.initials: L
authors.lastname: Sharma
authors.forename: Lloyd M
authors.initials: LM
authors.lastname: Taylor
authors.forename: Adnan
authors.initials: A
authors.lastname: Arseven
authors.forename: Maureen
authors.initials: M
authors.lastname: Quann
authors.forename: Lillian
authors.initials: L
authors.lastname: Celic
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D010807:Physical Endurance; D011446:Prospective Studies; D016138:Walking