title: Psychiatric distress amplifies symptoms after surgery for chronic rhinosinusitis.
abstract: BACKGROUND
  Psychiatric disorders are associated with increased symptom burden when combined with chronic medical conditions. However, there are no reports of how psychiatric distress influences outcomes with surgical treatment for chronic rhinosinusitis (CRS). We hypothesized that subjects with psychiatric distress (somatization, anxiety, and depression) would report more severe long-term sinus symptoms and worse quality of life (QOL) than subjects without psychiatric distress.
  
  
  METHODS
  This is a community-based, prospective, observational cohort study of patients diagnosed with CRS presenting for surgery. Patients were interviewed before surgery; CT scans were reviewed, and questionnaires were completed about sinusitis-related symptoms (SNOT-16), general health status and QOL (SF-36), and psychiatric distress (BSI and PHQ). Outcomes were also assessed 1, 3, 6, and 12 months postoperatively.
  
  
  RESULTS
  Ninety-five patients had complete records for analysis. Psychiatric distress was prevalent, with 31% screening positive for somatization, 17% positive for anxiety, and 25% positive for depressive disorders. Subjects with somatization had significantly worse SNOT-16 scores at each time point compared with those without somatization ( P < 0.05). Subjects with depression reported more severe symptoms at 6 and 12 months after surgery than those without depression ( P < 0.05). The presence of somatization preoperatively was also independently associated with worse symptom severity 12-months after surgery, even after adjusting for prior sinus surgery, CT stage, Charlson Index, and deviated septum. In addition, subjects with psychiatric distress reported significantly worse SF-36 physical and mental component summary scores 12-months after surgery than subjects without psychiatric distress.
  
  
  CONCLUSIONS
  Psychiatric distress is associated with worse reported sinus symptoms and lower QOL throughout surgical management of chronic rhinosinusitis. Despite this, subjects with psychiatric distress report a similar degree of improvement in sinus symptoms after surgery compared with those without distress.
  
  
  CONCLUSIONS
  Psychiatric distress should be considered in patients with persistent symptoms after surgery. Psychiatric distress should also be considered in efforts to design a chronic sinusitis staging system.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle 98195, USA. gedavis@u.washington.edu
authors.forename: Greg E
authors.initials: GE
authors.lastname: Davis
authors.forename: Bevan
authors.initials: B
authors.lastname: Yueh
authors.forename: Edward
authors.initials: E
authors.lastname: Walker
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Koepsell
authors.forename: Ernest A
authors.initials: EA
authors.lastname: Weymuller
mesh_terms: D001008:Anxiety Disorders / Q000150:complications; D002908:Chronic Disease; D003866:Depressive Disorder / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012220:Rhinitis / Q000523:psychology* / Q000601:surgery*; D012720:Severity of Illness Index; D012852:Sinusitis / Q000523:psychology* / Q000601:surgery*; D013001:Somatoform Disorders / Q000150:complications; D016896:Treatment Outcome