title: Percutaneous transluminal angioplasty: association between depressive symptoms and diminished health status benefits.
abstract: Depressive symptoms are known to compromise health status in cardiac disease, but this relationship has not been described in peripheral artery disease (PAD). Depressive symptoms (PHQ-9) and disease-specific health status (Peripheral Artery Questionnaire, PAQ) were assessed in 242 PAD patients undergoing percutaneous transluminal angioplasty (PTA) at baseline and 1 year. Patients were classified by baseline and follow-up depression status (moderate-severe depressive symptoms = PHQ ≥ 10). Changes were categorized as no depression/improvement of depression versus persistent/worsened depression. At baseline, 20% of patients were depressed; at 1 year, 17% of patients experienced persistent/worsened depression. Although this group improved on most PAQ subscales, they improved to a significantly lesser degree than those without depressive symptoms or those who improved by 1 year (p-values < 0.05). Baseline depressive symptoms (B(per 5-point increment) = -11.9, 95% CI -15.3, -8.5, p < 0.0001) and changes in depression were independently associated with a decrease in 1-year health status (B(per 5-point increment) = -11.7, 95% CI -14.3, -9.2, p < 0.0001). In conclusion, depressive symptoms are associated with less improvement in health status 1 year after undergoing a peripheral endovascular revascularization (PER) as compared with those having no depression or whose depressive symptoms improve. Efforts to improve depression detection and treatment among patients with PAD may improve the health status outcomes of these patients.
authors.affiliation: Saint Luke's Mid America Heart and Vascular Institute, Kansas City, MO 64111, USA. k.g.e.smolderen@gmail.com
authors.forename: Kim G
authors.initials: KG
authors.lastname: Smolderen
authors.forename: David M
authors.initials: DM
authors.lastname: Safley
authors.forename: John A
authors.initials: JA
authors.lastname: House
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Steven P
authors.initials: SP
authors.lastname: Marso
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008923:Missouri; D017060:Patient Satisfaction; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012919:Social Behavior; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome