Chest
Volume 138, Issue 4, October 2010, Pages 929-936
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Original Research
Cystic Fibrosis
Prevalence of Symptoms of Anxiety and Depression in German Patients With Cystic Fibrosis

https://doi.org/10.1378/chest.09-2940Get rights and content

Background

Chronic illness is a significant risk factor for the development of internalizing psychopathology; however, evidence for the prevalence of these symptoms in patients with cystic fibrosis (CF) is limited. We investigated the prevalence of symptoms of anxiety and depression in German-speaking patients with CF and the association of these symptoms to physical health status.

Methods

A representative sample of German patients with CF (N = 670; age range, 12-64 years; 52.7% men) completed the Hospital Anxiety and Depression Scale. Their medical data were taken from the German CF registry. Data on the study sample were compared with data on a control group from the German general population.

Results

Elevated anxiety scores were found in 20.6% of the patients with CF, and 9.6% reported high levels of symptoms of depression. Adult patients with CF reported more elevated symptoms of anxiety than healthy control subjects, whereas no age group of patients was more or less depressed than the general population. Younger patients reported fewer symptoms of anxiety and depression than older patients, and women reported more symptoms of anxiety than men. Recent hemoptysis/pneumothorax and recent diagnosis of diabetes were associated with anxiety, whereas impaired lung function and transplant listing status were associated with depression.

Conclusions

Anxiety in particular is an important issue for a large proportion of patients with CF. The risk of depression increased with greater impairment in pulmonary function. Annual screening of symptoms of anxiety and depression as well as appropriate referrals for those in the clinically elevated range are recommended.

Section snippets

Procedures

Staff members at 31 German and one Austrian (Innsbruck) CF centers attempted to screen all patients aged 12 years through adulthood. The study protocol was approved by the Ethics Committee at the University Ulm and the local institutional review boards of the participating CF centers. After completion of informed consent/assent, the Hospital Anxiety and Depression Scale (HADS) and the additional questionnaires assessing sociodemographic and medical variables were administered by a staff member

Study Sample

A total of 670 patients with CF (aged 12-64 years, Mean = 23.1 years, 52.7% male) were enrolled, which was approximately 50% of all eligible patients at the participating sites. Table 1 shows the sample characteristics of patients in the study group and the nonparticipants aged 12 and older across all German CF centers (n = 2,629), the latter including also those patients who were not eligible for the study because they were treated in centers that did not participate in TIDES. No significant

Discussion

To our knowledge, this is the first large, representative, multicenter epidemiologic study of anxiety and depression in adolescent and adult patients with CF. The main findings indicated that symptoms of anxiety are more prevalent in adult German patients with CF compared with peers in the community, whereas in no age group were patients more or less depressed than the general population, unless their lung function was severely impaired. Impairments in lung function were associated with more

Acknowledgments

Author contributions: Dr Goldbeck: designed the study in collaboration with The International Depression/anxiety Epidemiological Study (TIDES) group, was responsible for data collection and analyses, and contributed to the writing of the manuscript.

Dr Besier: was responsible for data collection and analyses, and contributed to the writing of the manuscript.

Dr Hinz: contributed data about the control subjects and contributed to the writing of the manuscript.

Dr Singer: contributed data about the

References (41)

  • R Bussing et al.

    Prevalence of anxiety disorders in a clinic-based sample of pediatric asthma patients

    Psychosomatics

    (1996)
  • T Besier et al.

    Life satisfaction of adolescents and adults with cystic fibrosis: impact of partnership and gender

    J Cyst Fibros

    (2009)
  • L Goldbeck et al.

    Monitoring quality of life in outpatients with cystic fibrosis: feasibility and longitudinal results

    J Cyst Fibros

    (2007)
  • JM Somers et al.

    Prevalence and incidence studies of anxiety disorders: a systematic review of the literature

    Can J Psychiatry

    (2006)
  • F Jacobi et al.

    Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS)

    Psychol Med

    (2004)
  • RC Kessler et al.

    Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey

    Arch Gen Psychiatry

    (1994)
  • WM Compton et al.

    Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991-1992 and 2001-2002

    Am J Psychiatry

    (2006)
  • HU Wittchen et al.

    Prevalence, recognition and management of depression in primary care in Germany: the Depression 2000 study

    Human Psychopharmacol

    (2002)
  • SA Riolo et al.

    Prevalence of depression by race/ethnicity: findings from the National Health and Nutrition Examination Survey III

    Am J Public Health

    (2005)
  • World Health Organization. http://www.who.int/mental_health/management/depression/definition/en/. Accessed December 8,...
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      Prior literature addressing this question has produced mixed results. Several national studies of patients with CF reported that those with impaired lung function had more symptoms of depression [9,11,14,20,21]. In contrast, the International TIDES [17] and others [10,13] found minimal associations with lung function.

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    Funding/Support: The study was supported by a financial grant from the Mukoviszidose Institut gGmbH, the research and development arm of the German Cystic Fibrosis Association Mukoviszidose e.V.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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