characterize the association of depression with selected clinical variables in patients with ..... Australia and New Zealand and the Irish thoracic society. Thorax.
AAMJ, VOL (12), NO (4), OCT 2014
AL-AZHAR ASSIUT MEDICAL JOURNAL
ORIGINAL ARTICLE ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
DEPRESSION IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS Ayman Amin*, Moustafa Zedan*, Khaled Halima*and A. Ismail** Chest Diseases*and Psychiatry**Departments, Faculty of Medicine, Al- Azhar University ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ ABSTRACT Background and aim of the work: depression carries enormous global morbidity and is more likely to occur in individuals with chronic illness than in the general population. Idiopathic pulmonary fibrosis (IPF) has a rising incidence with a severe impact on quality of life. An indication of the prevalence of depression in this group with IPF is therefore of paramount interest. Patients and methods: In this study, 40 Patients (18 males and 22 females) with IPF who attended Chest Diseases Department .Al-Azhar University Hospitals from April 2012 to October 2013 were recruited. Informed consent was obtained. The male to female ratio was 45%:55%. The Beck Depression Inventory (BDI), which is a 21-question multiple- choice self-report inventory, was used for assessment of depression disorder (scores ≥11 denote a depressed state). Pulmonary function tests, arterial blood gases analysis and Six-minute walk test were measured in addition to assessment of need for 02 therapies to correlate disease severity with depression scores. Results: 28 patients had significant depressive symptoms scoring ≥11. The mean depression score of female participants was 22 ± 8.38, compared with a mean male score of 19.31 ±5.96. Disease severity and consequently functional performance were significantly correlated with depression. While age, smoking index, duration since diagnosis and number of 195
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Ayman Amin et al
co-morbidities were not significantly correlated with depression.
In
conclusions: the study population had a high prevalence of depressive symptoms. Medical therapy for pulmonary fibrosis is limited and therefore palliation of symptoms and pulmonary rehabilitation form the main strategy for management. Recommendation:
depression should be actively screened in
patients with IPF. INTRODUCTION Interstitial lung disease (ILD) is a diverse group of conditions that is characterized by inflammation and fibrosis of the pulmonary parenchyma. In general, ILD are chronic and progressive diseases that result in substantial morbidity and mortality. The cardinal symptom of ILD is dyspnea; however, other pulmonary and extrapulmonary symptoms are often present [1]. Depression is a common comorbidity of many chronic diseases and directly impacts quality of life [2]. Comorbid depression has also been shown to predict future development of clinically relevant outcomes in several chronic diseases, including increased mortality [3]. In patients with chronic obstructive pulmonary disease, depression is highly prevalent [4] and predicts mortality, [5] and treatment of depression improves quality of life [6]. Little is known about depression in patients with ILD. Recent studies have reported clinically meaningful depression in approximately one quarter of patients with ILD, and that depression is a strong and independent predictor of dyspnea [7]. However, these results do not describe whether patient or diseasespecific variables are related to depression severity and whether these variables confound or contribute to the prevalence and severity of depression. It is also unknown from these cross-sectional studies whether a one-time measure of depression severity predicts the presence or development of chronic depressive symptoms. A better understanding of the characteristics and natural history of 196
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depression in ILD may provide insight into potential novel management approaches [8]. AIM OF THE WORK The aim of this study was to determine the prevalence of depression and characterize the association of depression with selected clinical variables in patients with ILD. PATIENTS AND METHODS This study included 40 patients (18 males and 22 females) with a mean age of (42,8 ±9.53) with a diagnosis of IPF attending Chest Diseases Department, AL- Azhar University Hospitals between April 2012 and October 2013. All diagnoses of IPF were made by multidisciplinary review of clinical, pathological and radiological data in accordance with published guidelines [1, 9]. All patients after providing written informed consent were subjected to the following: - Full history taking and clinical examination - Pulmonary function tests: The forced vital capacity (FVC), the forced expiratory volume in the first second (FEV1), the ratio of FEV1 to FVC and the forced expiratory flow (FEF25-75 %) were measured. The presence of an FVC/FEV1 > 0.70 together with FVC
