An Observational Study of Anxiety and Depression in Idiopathic Pulmonary Fibrosis

Aims: Anxiety and depression are common in idiopathic pulmonary fibrosis (IPF). The longitudinal relationships between mental health and disease severity, progression and symptom burden are unknown. This study aims to identify if the prevalence and severity of anxiety and depression in IPF is associated with disease severity and progression. Also, to observe whether changes in cough and breathlessness symptom severity are associated with changes in mental health.

Study Design: Retrospective case note review.

Place and Duration of Study: Department of Respiratory Medicine, University Hospital Llandough, Cardiff between November 2010 and August 2012.

Methodology: Data was collected from 37 patients with IPF from two out-patient visits 12 months apart. Data included patient demographics, lung function measurements (FVC/TLco), hospital anxiety and depression scores, Denver ILD breathlessness score and Leicester cough questionnaire.

Results: The proportion of patients with depressive symptoms increased from 24.3% at baseline to 43.6% at 12 months. Anxiety rates fell from 40.5% at baseline to 35.1%. 12 patients (32%) had severe pulmonary fibrosis and 14 patients (38%) had progressive fibrosis. Patients with severe or progressive disease were more likely to have a clinically important increase in anxiety (severe P = .02, progressive P = .008) and depression scores (severe P = .008, progressive P = .04) compared with those with mild or stable disease. An association was identified between worsening depression and increasing dyspnoea (r = .60, P = .01) and cough related quality of life (r = -.47, P = .01). Increasing anxiety was also associated with dyspnoea (r = .38, P = .05) and cough (r = -.39, P = .05).

Conclusion: Anxiety and depression are highly prevalent in IPF and are associated with severe and progressive disease. Increasing symptom burden is associated with worsening mental health.