Depression and anxiety symptoms in Spanish adult patients with cystic fibrosis: associations with health-related quality of life☆,☆☆,☆☆☆,★,★★,★★★
Introduction
Cystic fibrosis (CF) is a genetic autosomal recessive disease which varies greatly in degrees of severity and is currently a chronic multisystemic disease with a median survival of almost 50 years and a great impact on the quality of life [1], [2]. The use of questionnaires concerning quality of life gives a perception of the severity of the disease from the patient's viewpoint. Therefore, although some parameters such as the forced expiratory volume in the first second (FEV1) or the body mass index (BMI) are useful for predictions about mortality and morbidity, they are not strongly predictive of how patients are functioning and feeling in their everyday lives [3], [4], [5].
Meta-analyses and systematic reviews have indicated that patients with chronic diseases are at increased risk of depression and anxiety [6], [7]. These psychiatric disorders are often underdiagnosed [8]. In addition, a high prevalence of these symptoms has been reported in patients with CF [9], [10], [11], [12], [13], [14], [15], [16], [17] and has been associated with a number of negative consequences and health outcomes, including worse adherence [12], [13], [14], [15], [16], [17], [18], [19], worse pulmonary function [9], [11], [14], [20], [21], increased hospitalizations and healthcare costs [16], [17], [19] and decreased health-related quality of life (HRQoL) [9], [10], [14]. In a previous study conducted by our group, the presence of depressive and anxiety symptoms was associated with a lower quality of life even when considered independently from lung function [22], [23]. The recently published results of the International Depression Epidemiological Study (TIDES) [17] on the prevalence of depression and anxiety in patients with CF and parent caregivers (which included data of Spanish patients) indicated high rates of both disorders in comparison with data reported for the general population. Using The Hospital Anxiety and Depression Scale (HADS) as a screening method, rates of depression were 5% in adolescent patients and 13% in adults. Rates of anxiety were 22% in adolescents and 32% in adults. Those found in the parent caregivers were even higher, depression in 20% of mothers and 18% of fathers and anxiety in 48% of mothers and 36% of fathers [17].
The aims of this study were to measure symptoms of depression and anxiety in a large sample of Spanish adult patients with CF and evaluate their relationship to demographics, health status and HRQoL. Symptoms of depression and anxiety were assessed in the Spanish cohort of the International Epidemiological Study [17] on Depression and Anxiety in patients with CF (TIDES).
Depression and anxiety have a great influence on quality of life in patients with CF, sometimes even more than physical variables [22], [23]. Up to now, only a few monocentric studies have evaluated the relationship between symptoms of depression/anxiety and quality of life in patients with CF. These studies had a small sample size [9], [10], [14], [23] or included patients who had Non-CF-Bronquiectasis [22]. One of the aims of our study is to assess it in a larger and more homogeneous sample. On the other hand, the TIDES is a multicentric study with a large sample size in which was evaluated the symptoms of depression and anxiety in patients with CF but not the relationship between both and quality of life, so our study is a more in-depth analysis. Therefore, nowadays, this is the largest sample of pure CF patients in which comparisons between quality of life and depression/anxiety have been made.
Section snippets
Procedure
This cross-sectional study recruited adult patients with CF at 10 representative Spanish centers. The opportunity to participate was offered to all patients at their scheduled consultation in this period of time. A total of 336 patients with CF who fulfilled the inclusion criteria agreed to participate (approximately 90%).
Study protocols were approved by local ethics committees at all CF centers. Data were collected consecutively between July 2011 and February 2012, although not all centers
Demographics
Demographic and health information for patients is presented in Table 1a. A total of 336 patients with CF agreed to participate (approximately 90% of the patients seen in that period, who fulfilled the inclusion criteria) Table 1b. The mean age of the participants was 28.1 (+/−8.2) years, and 48.2% were women. Antidepressants were being taken by 11 (3.3%), anxiolytics by 12 (3.6%) and 19 (5.7%) were undergoing psychological treatment.
For different reasons, 37 patients did not complete the
Discussion
This is a large psychological screening study conducted in Spain, with data of adult patients with CF, in the Spanish cohort of the International TIDES, although with the additional advantage of a larger sample size and also the evaluation of the effects of depression and anxiety on the HRQoL.
Even if these are not true prevalence rates because not all the people participated, the sample seems to be representative of the population with CF in Spain because a large proportion of the Spanish CF
Conflicts of interest
None of the authors has any conflict of interest to disclose.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Statement of authorship
Quittner A, Olveira C, and Olveira G: contributed to the conception and design of the study; Olveira C, and Olveira G contributed to the acquisition, analysis and interpretation of the data; and statistical analysis and drafting of the manuscript. Both authors (Olveira C and Olveira G) are the guarantors of the paper, taking responsibility for the integrity of the work as a whole from inception to published article. Sole A, Girón RM, Quintana-Gallego E, Mondejar P, Baranda F, Alvarez A, Prados
Acknowledgments
This study was supported in part by a grant “Pablo Motos” 2010 of Cystic Fibrosis Research.
References (45)
- et al.
Validity and reliability of the St George's respiratory questionnaire in adults with cystic fibrosis
Arch Bronconeumol
(2007) - et al.
Validation of the Spanish version of the revised cystic fibrosis quality of life questionnaire in adolescents and adults (CFQR 14 + Spain)
Arch Bronconeumol
(2010) - et al.
Depression, chronic diseases, anddecrements in health: results from the world health surveys
Lancet
(2007) - et al.
The association of depression and anxiety with medical symptom burden in patients with chronic medical illness
Gen Hosp Psychiatry
(2007) - et al.
The association between depression, lung function, and health-related quality of life among adults with cystic fibrosis
Chest
(2007) - et al.
Quality of life in patients with cystic fibrosis: association with anxiety and depression
J Cyst Fibros
(2008) - et al.
Prevalence of symptoms of anxiety and depression in German patients with cystic fibrosis
Chest
(2010) - et al.
Screening for depression in a single CF centre
J Cyst Fibros
(2013) - et al.
Pulmonary medication adherence andhealthcare utilization in cystic fibrosis
Chest
(2014) - et al.
TIDES-UK Group. depression and anxiety in adolescents and adults with cystic fibrosis in the UK: a cross-sectional study
J CystFibros
(2014)
A validation study of the hospital anxiety and depression scale in a Spanish population
Gen Hosp Psychiatry
Development and validation of the cystic fibrosis questionnaire in the United States: a health-related quality-of-life measure for cystic fibrosis
Chest
Anxiety disorders and comorbid medical illness
Gen Hosp Psychiatry
Grupo ESEMeD-España. prevalencia de los trastornos mentales y factores asociados: resultados del estudio ESEMeD-España
Med Clin (Barc)
Comorbidity of major depressive episodes and chronic physical conditions in Spain, a country with low prevalence of depression
Gen Hosp Psychiatry
Mental–Physical comorbidity in an ethnically diverse population
SocSci Med
Mediterranean diet is associated on symptoms of depression and anxiety in patients with bronchiectasis
Gen Hosp Psychiatry
Surprisingly high prevalence of anxiety and depression in chronic breathing disorders
Chest
The psychosocial and psychiatric side of cystic fibrosis in adolescents and adults
J Cyst Fibros
Impact of socioeconomic status, race, and ethnicity on quality of life in patients with cystic fibrosis
Chest
Longevity of patients with cystic fibrosis in 2000 to 2010 and beyond: survival analysis of the Cystic Fibrosis Foundation Patient Registry
Ann Intern Med
A contemporary survival analysis of individuals with cystic fibrosis: a cohort study
EurRespir J
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2022, Journal of Cystic FibrosisCitation Excerpt :Those with CFRD have the additional burden of making clinical judgments about the required insulin dose [75]. Psychological difficulties in people with CF are prevalent [76] and depression is associated with poorer survival [77] and quality of life [78,79]. For those with CFRD the treatment burden is increased with greater decrements across patient-reported HRQoL domains; most notably, social and emotional functioning, body image, respiratory symptoms and treatment issues [80].
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Associations Between Religious/Spiritual Coping and Depression Among Adults with Cystic Fibrosis: A 12-Month Longitudinal Study
2021, Journal of Religion and Health
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Conflicts of Interest: None of the authors has any conflict of interest to disclose.
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Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Study protocols were approved by local ethics committees at all CF centers.
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Informed Consent: Informed consent was obtained from all individual participants included in the study.
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Patients' Data Protection: The authors declare that they have followed the protocols of their work center on the publication of patient data.
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Statement of Authorship: Quittner A, Olveira C, and Olveira G: contributed to the conception and design of the study; Olveira C, and Olveira G contributed to the acquisition, analysis and interpretation of the data; and statistical analysis and drafting of the manuscript. Both authors (Olveira C and Olveira G) are the guarantor of the paper, taking responsibility for the integrity of the work as a whole from inception to published article. Sole A, Girón RM, Quintana-Gallego E, Mondejar P, Baranda F, Alvarez A, Prados C, Rodríguez-González J, Herrero-Labarga I contributed to data acquisition and critical revision of the manuscript.