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Disease Duration, Flare-ups Affect Mental Health of Non-CF Bronchiectasis Patients, Study Finds

People with non-cystic fibrosis (CF) bronchiectasis are at an increased risk for anxiety and depression, and this risk is associated with a higher rate of exacerbations (when symptoms suddenly worsen) and shorter disease duration (time since diagnosis), according to a Turkish study.

The study, which analyzed self-reported data and disease severity indices, was published in an article, “Clinical impact of depression and anxiety in patients with non-cystic fibrosis bronchiectasis,” in the journal Tuberculosis and Thorax.

According to the World Health Organization, the worldwide prevalence of depression and anxiety is about 4%.

Psychosocial factors in people with chronic respiratory symptoms may contribute to their worsened health status. The link between worse outcomes in non-CF bronchiectasis and having anxiety and depression has been reported, but existing evidence to support this is still unclear.

Therefore, a team from Turkey set out to detect depression and anxiety in patients with stable non-cystic fibrosis bronchiectasis and to evaluate its relationship with disease severity. None of the 90 participants (median age 45 years; 53 women and 37 men) had had an exacerbation for at least four weeks, as defined by deterioration in symptoms such as cough, sputum volume and/or consistency, breathlessness, exercise tolerance, and fatigue.

Patients were asked to complete the hospital anxiety and depression scale (HADS), which includes 14 questions. Those with a score of 10 or higher were considered to have anxiety, while a score of 7 or greater meant they experienced depression.

Results showed that 41% experienced depression and 30% showed anxiety. These findings are consistent with previous research that found anxiety and depression common in bronchiectasis patients.

Women had a higher rate of depression than men (55% vs. 22%), with housewives showing an even higher risk (65%). Patients with depression had shorter disease duration. In turn, anxiety was more common in those with a higher rate of exacerbations in the last year.

The researchers then investigated whether psychological status was associated with Pseudomonas aeruginosa colonization and with disease severity, as determined using by the bronchiectasis severity index (BSI) and FACED. Among the participants, 49% had moderate-to-severe disease on the BSI, and 30% had a similar status using FACED. In addition, 24% had Pseudomonas aeruginosa colonization.

While P. aeruginosa colonization is associated with increased symptom severity and more exacerbations, having the bacteria was found not to be associated with depression or anxiety risk. In addition, the proportion of patients with depression or anxiety was not impacted by disease severity.

Among the study’s limitations mentioned by the scientists were that participants were from a single clinic and that mental health status was self-reported. Another limitation is that the researchers could not determine if long-term health outcomes and clinical status are associated with psychological status.

Overall, the study reveals a relationship between mental health and disease outcome in bronchiectasis, but further studies are needed.

“To the best of our knowledge, this is the first report in terms of effect of duration of disease on depression risk,” the researchers wrote. “This may allow novel insight into our understanding of possible factors related to depression and to screen early the bronchiectatic patients for depression.”

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