title: Role of depression in outcomes of endoscopic sinus surgery.
abstract: OBJECTIVE
  To prospectively measure the prevalence and effect of symptomatic depression on chronic rhinosinusitis (CRS) patients' quality of life (QOL), disease severity, and outcomes of endoscopic sinus surgery (ESS).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Academic, tertiary care center.
  
  
  METHODS
  Seventy-six patients with CRS were enrolled prior to ESS and followed postoperatively for a mean (SD) of 13.3 (5.4) months. Lund-Mackay computed tomography score, Lund-Kennedy endoscopy score, Patient Health Questionnaire-9 (PHQ-9), 2 disease-specific QOL instruments (Rhinosinusitis Disability Index [RSDI] and Chronic Sinusitis Survey [CSS]), and 1 general QOL instrument (Medical Outcomes Study Short Form-36 [SF-36]) were measured. Differences in outcome scores were analyzed using univariate and multivariate analyses.
  
  
  RESULTS
  Only 7 (9.2%) patients reported a history of depression, but 19 (25.0%) patients scored in the range of moderate or severe depression on the PHQ-9. Mean (SD) preoperative scores were significantly worse in depressed patients on the RSDI (62.7 [18.2] vs 45.3 [16.3]; P < .001) and 7 of 8 SF-36 domains (all P ≤ .011). Patients with depression significantly improved on both disease-specific QOL instruments (mean [SD] change; RSDI: 33.5 [24.7], P = .017; CSS: 25.0 [20.9], P = .012) and 3 SF-36 domains (all P ≤ .050). Postoperative change scores were not significantly different from patients without depression on the RSDI, CSS, or SF-36. Severity of depression significantly improved postoperatively in depressed patients (preoperative PHQ-9 scores: 13.4 [2.0] vs 6.1 [4.5], P = .017).
  
  
  CONCLUSIONS
  CRS patients with depression had worse baseline QOL than other CRS patients but experienced comparable postoperative improvement in QOL after ESS. Interestingly, depression severity significantly improved after ESS.
authors.affiliation: Department of Otology and Laryngology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jamie R
authors.initials: JR
authors.lastname: Litvack
authors.forename: Jess
authors.initials: J
authors.lastname: Mace
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D004724:Endoscopy / Q000523:psychology*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011788:Quality of Life; D012220:Rhinitis / Q000523:psychology* / Q000601:surgery*; D012720:Severity of Illness Index; D012852:Sinusitis / Q000523:psychology* / Q000601:surgery*; D016896:Treatment Outcome