title: Lower-leg symptoms in peripheral arterial disease are associated with anxiety, depression, and anhedonia.
abstract: Patients with peripheral arterial disease (PAD) report diverse clinical manifestations that are not always consistent with classic intermittent claudication. We examined the degree to which atypical exertional leg symptoms, intermittent claudication, and exertional leg symptoms that begin at rest were associated with mood states such as anxiety, depressive symptoms, and anhedonia (i.e. lack of positive affect). A cohort of consecutive PAD patients (n = 628) from the Erasmus Medical Center, Rotterdam, The Netherlands, completed the Hospital Anxiety and Depression Scale and the San Diego Claudication questionnaire. The ankle-brachial index and clinical factors were assessed in all patients at baseline. Anxiety was present in 29%, depressive symptoms in 30%, and anhedonia in 28% of patients. Pain at rest was independently associated with anxiety, depressive symptoms, and anhedonia (ORs between 2.5 and 4.0, p </= 0.001), while there was no relationship between intermittent claudication and mood states. Patients with atypical leg symptoms had a twofold risk of anxiety (OR = 1.9, 95% CI 1.1-3.5, p < 0.05). Adjusting for sex, age, ankle-brachial index, cardiovascular history, time since ankle-brachial index screening, clinical factors, and medication use, both pain at rest (OR = 3.4, 95% CI 1.6-7.0, p = 0.001) and atypical leg symptoms (OR = 2.3, 95% CI 1.1-4.9, p < 0.05) were associated with comorbid mood problems. In conclusion, PAD patients with atypical leg symptoms or pain at rest reported more impaired mood than patients without those symptoms. These patients should be monitored closely in clinical practice, as previous research in cardiovascular patients has shown that mood disorders and sub-threshold symptoms predict poor prognosis.
authors.affiliation: CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University.
authors.forename: Kim G
authors.initials: KG
authors.lastname: Smolderen
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Inge I
authors.initials: II
authors.lastname: de Liefde
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000339:Affect; D001007:Anxiety / Q000150:complications*; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology* / Q000523:psychology; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010147:Pain Measurement; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires