Depressive symptoms as a novel risk factor for recurrent venous thromboembolism: a longitudinal observational study in patients referred for thrombophilia investigation.
BACKGROUND
Increasing evidence suggests that psychosocial factors, including depression predict incident venous thromboembolism (VTE) against a background of genetic and acquired risk factors. The role of psychosocial factors for the risk of recurrent VTE has not previously been examined. We hypothesized that depressive symptoms in patients with prior VTE are associated with an increased risk of recurrent VTE.


METHODS
In this longitudinal observational study, we investigated 271 consecutive patients, aged 18 years or older, referred for thrombophilia investigation with an objectively diagnosed episode of VTE. Patients completed the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). During the observation period, they were contacted by phone and information on recurrent VTE, anticoagulation therapy, and thromboprophylaxis in risk situations was collected.


RESULTS
Clinically relevant depressive symptoms (HADS-D score ≥ 8) were present in 10% of patients. During a median observation period of 13 months (range 5-48), 27 (10%) patients experienced recurrent VTE. After controlling for sociodemographic and clinical factors, a 3-point increase on the HADS-D score was associated with a 44% greater risk of recurrent VTE (OR 1.44, 95% CI 1.02, 2.06). Compared to patients with lower levels of depressive symptoms (HADS-D score: range 0-2), those with higher levels (HADS-D score: range 3-16) had a 4.1-times greater risk of recurrent VTE (OR 4.07, 95% CI 1.55, 10.66).


CONCLUSIONS
The findings suggest that depressive symptoms might contribute to an increased risk of recurrent VTE independent of other prognostic factors. An increased risk might already be present at subclinical levels of depressive symptoms.
Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland; Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
Roland
R
von Känel
Department of Clinical Research, University of Bern, Bern, Switzerland.
Angelina
A
Margani
Department of Cardiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, and University of Bern, Bern Switzerland.
Stefanie
S
Stauber
Department of Clinical Research, University of Bern, Bern, Switzerland.
Fiorenza A
FA
Meyer
University Clinic of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
Franziska
F
Demarmels Biasiutti
Department of Clinical Research, University of Bern, Bern, Switzerland.
Franziska
F
Vökt
Department of Clinical Research, University of Bern, Bern, Switzerland.
Thomas
T
Wissmann
University Clinic of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.
Bernhard
B
Lämmle
Department of Clinical Research, University of Bern, Bern, Switzerland; Privatklinik für Psychiatrie und Psychotherapie, Sanatorium Kilchberg, Kilchberg, Switzerland.
Paul S
PS
Lukas
D000328:Adult; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D013557:Switzerland; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*