title: Post-traumatic stress disorder and depression in survivors of thrombotic thrombocytopenic purpura.
abstract: BACKGROUND
  Survivors of thrombotic thrombocytopenic purpura (TTP) have high rates of chronic morbidities including neurocognitive complications and depression. There is limited information regarding the psychological consequences of TTP. We conducted this cross sectional study to estimate the prevalence of symptoms of PTSD and depression in survivors of TTP.
  
  
  METHODS
  An online survey tool comprising demographic and clinical information and two validated self-administered questionnaires, the PTSD checklist for DSM-5 (PCL-5) and Beck Depression Inventory-II (BDI-II), was distributed to individuals with TTP. Multivariable regression was used to identify clinical and demographic associations of depression and PTSD.
  
  
  RESULTS
  A total of 236 individuals completed either the BDI II or PCL-5 and were included in the analysis. Median age was 44years and 87.3% were female. Median time from diagnosis was 80months. BDI-II scores >13 indicating at least mild depressive symptoms were present in 80.8% individuals (15.8%, 28.2%, and 36.8% with mild, moderate and severe symptoms, respectively) and 35.1% had a positive screen for PTSD (PCL-5 score≥38). A previous diagnosis of depression [OR 3.65 (95% CI 1.26-10.57); p=0.017] and unemployment attributed to TTP [OR 5.86 (95% CI 1.26-27.09); p=0.024] were associated with depression. Younger age (p=0.017), a pre-existing anxiety disorder [OR 3.57 (95% CI 1.76-7.25), p<0.001], and unemployment attributable to TTP [OR 6.42 (95% CI 2.75-415.00), p<0.001] were associated with PTSD.
  
  
  CONCLUSIONS
  We report a high prevalence of PTSD and depression in TTP survivors. These results are concerning and indicate a need for further investigation to better define this association and its consequences.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Shruti
authors.initials: S
authors.lastname: Chaturvedi
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Olalekan
authors.initials: O
authors.lastname: Oluwole
authors.affiliation: Division of Hematology, Department of Medicine, Ohio State University, Columbus, OH, United States.
authors.forename: Spero
authors.initials: S
authors.lastname: Cataland
authors.affiliation: Department of Cellular and Molecular Medicine, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, United States; Hematologic Oncology and Blood Disorders, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, United States. Electronic address: mccraek@ccf.org.
authors.forename: Keith R
authors.initials: KR
authors.lastname: McCrae
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications*; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology*; D011795:Surveys and Questionnaires; D017741:Survivors; D014478:Unemployment
keywords: Depression; Post-traumatic stress disorder; Quality of life; Survivorship; Thrombotic thrombocytopenic purpura