title: Depressive symptoms, perceived social support, and prothrombotic measures in patients with venous thromboembolism.
abstract: BACKGROUND
  Psychosocial factors have been associated with both a prothrombotic state and an increased risk of venous thromboembolism (VTE). We examined the relation of depressive symptoms and social support with D-dimer, an integrative measure of enhanced coagulation activity, and several additional prothrombotic measures in patients with VTE.
  
  
  METHODS
  We studied 173 patients with a previous deep venous thrombosis and/or pulmonary embolism (mean age ± SD 45 ± 14 years, 55% men). Clinical and lab assessments took place ≥ 3 months after VTE and ≥ 1 month after discontinuation of oral anticoagulants. The patients rated depressive symptoms and social support by validated questionnaires.
  
  
  RESULTS
  After adjusting for sociodemographic and medical covariates, interactions emerged between depressive symptoms and social support for D-dimer (p=0.012) and aPTT (p=0.002). As opposed to patients with high levels of social support, those with low levels of social support showed a direct association of depressive symptoms with D-dimer (r=0.19, p=0.014) and an inverse relationship with aPTT (r=-0.14, p<0.09). Depressive symptoms were associated with levels of thrombin-antithrombin complex (r=0.19, p=0.016). Greater social support was associated with prolonged aPTT (r=0.16, p=0.046). There were no significant associations of depressive symptoms and social support with D-dimer, fibrinogen, FII:C, FV:C, FVII:C, FVIII:C, FX:C, INR, and thrombin time.
  
  
  CONCLUSIONS
  Depressive symptoms are associated with enhanced coagulation activity in patients with VTE, particularly so in those who perceive low levels of social support. Conversely, high levels of social support may contribute directly and through buffering the effect of depressive symptoms to attenuated clotting activity in VTE patients.
authors.affiliation: Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Lukas
authors.forename: Andrea
authors.initials: A
authors.lastname: Neugebauer
authors.forename: Sara
authors.initials: S
authors.lastname: Schnyder
authors.forename: Franziska Demarmels
authors.initials: FD
authors.lastname: Biasiutti
authors.forename: René
authors.initials: R
authors.lastname: Krummenacher
authors.forename: Marie-Louise Gander
authors.initials: ML
authors.lastname: Ferrari
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
mesh_terms: D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012649:Self Concept; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*