SANTA ANA PUEBLO, N.M. — Peripheral vascular disease patients may be at increased risk for functional impairment in association with depression, Dr. Edward Norris said at the annual meeting of the Academy of Psychosomatic Medicine.
He and his colleagues found depressive symptoms in one-third of 66 peripheral vascular disease patients recruited for screening from the Lowering of Vascular Atherosclerotic Risk (LOVAR) study at the Lehigh Valley Hospital and Health Network in Allentown, Pa.
The depressed patients appeared to have poorer quality of life, said Dr. Norris, vice chair of research and education in the psychiatry department at Pennsylvania State University. “As you became more depressed, your quality of life was significantly worse,” he said, reviewing scores on the Medical Outcomes Short Form Survey (SF-36).
Compared with peripheral vascular disease patients who were not depressed, the 22 patients with symptoms of depression had significantly lower scores on subscales for physical functioning, physical role, emotional role, general health, vitality, social functioning, and mental health. Only bodily pain was not significantly worse in patients with depressive symptoms.
Depression is known to be associated with other forms of cardiovascular disease, but Dr. Norris said he believes this is the first study to examine the association between depression and functional status in patients with peripheral vascular disease.
The nonrandomized LOVAR study, a 5-year, prospective, cohort-controlled trial, is evaluating atherosclerosis in 513 patients, aged 39–79, with cerebral, cardiac, or peripheral vascular disease. Patients were enrolled within 6 months of a nondisabling vascular event and had at least two modifiable risk factors for myocardial infarction, stroke, or peripheral vascular disease.
Dr. Norris' group used the 21-item Beck Depression Inventory (BDI) to measure symptoms of depression in the subgroup of 66 patients with peripheral vascular disease. The 22 patients with symptoms of depression had a mean BDI score of 15.45, signaling mild to moderate depression. The other 44 patients scored a mean score of 4.34 (normal range). Patients in both groups were about 63 years old on average. Analysis of 18 risk variables, including age, marital status, employment, exercise, smoking, alcohol consumption, body mass index, and hypertension, showed no depression-related differences in demographic factors.
Myocardial infarction, stroke, transient ischemic attacks, and death occurred in about 23% of the depressed patients and in about 7% of those who were not depressed, but that trend did not achieve statistical significance. “Does depression in peripheral vascular disease affect morbidity and mortality?” he asked, calling for prospective studies of peripheral vascular disease and depression and of the effects treating depression could have on peripheral vascular disease.
Dr. Norris said in an interview that the results suggest a need to pay closer attention to peripheral vascular disease and that his group has started follow-up studies.