Depression-Specific Outcomes After Treatment of Chronic Rhinosinusitis

Abstract

IMPORTANCE Depression is frequently undiagnosed in patients with chronic rhinosinusitis (CRS) and affects quality of life, productivity, and health care use. OBJECTIVE To examine depression-specific outcomes after medical or surgical treatment of CRS. DESIGN, SETTING, AND PARTICIPANTS A multi-institutional, prospective study of patients with refractory CRS treated at tertiary academic rhinology centers was performed from March 1, 2011, to November 1, 2015. Data analysis was performed from October 1, 2015, to November 1, 2015. INTERVENTIONS Patients self-selected to undergo continued medical management or endoscopic sinus surgery for refractory CRS. MAIN OUTCOMES AND MEASURES Patients completed the 22-item Sinonasal Outcome Test (SNOT22), Rhinosinusitis Disability Index (RSDI), Pittsburgh Sleep Quality Index (PSQI), and missed productivity and medication use questionnaires before and at least 6 months after treatment. Computed tomography and endoscopy scoring were performed with reviewers masked to patient-reported data. Depression-specific outcomes were recorded using the 2-item Patient Health Questionnaire (PHQ2). RESULTS Baseline data were available on 685 patients, with 167 (24.4%) having depression according to the PHQ2 scores. The mean (SD) age of the patients was 50.5 (15.0) years, and 332 (48.4%) were male. Revision surgery status was the only baseline factor associated with depression (53.9%vs 38.0%, P < .001). Patients with depression had worse baseline SNOT22 (mean, 64.5 vs 47.6), PSQI (mean, 12.8 vs 8.4), productivity (mean, 22.8 vs 5.2 days missed), and medication use scores for oral antibiotics (mean, 23.8 vs 14.8) and oral corticosteroids (mean, 17.8 vs 9.9) (P < .001 for all). Medical and surgical treatments had similar outcomes for patients with depression with mean improvement in the PHQ2 scores from 3.96 to 1.91 (P < .001), and 110 of 167 patients (65.9%) categorized as having depression at baseline were categorized as not having depression after treatment. Improvements in the PHQ2 scores were associated with improvements in the SNOT22, PSQI, oral antibiotic use, and productivity scores (P ≤ .001 for all). CONCLUSIONS AND RELEVANCE Depression is a common comorbidity in patients with CRS and affects numerous quality-of-life and health care outcomes. There are few objective baseline factors to aid physicians in identifying depression in patients with CRS. Medical and surgical treatments for CRS improve depression and related clinical outcomes.

Burden of Illness: A Systematic Review of Depression in Chronic Rhinosinusitis

“…19 With regard to depression, there were no studies that used strict Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. 20 Nine studies used a validated questionnaire to screen for depression, 9,11,[13][14][15][16][17][18][19] and four studies relied on a previous physician diagnosis. 7,8,10,12 There were four studies that used physician-diagnosed depression (n ϭ 631 patients).…”

“…The only study to use PHQ2 was also the largest (n ϭ 685 patients) and reported a prevalence of 24.4% 17 (Table 1). Two studies used PHQ9, and both reported a prevalence of 25% (Table 1).…”

“…The other BDI study used a cutoff of Ն14 to diagnose depression and found a prevalence of 31.0%. 18 Among the nine studies that used validated questionnaires, 9,11,[13][14][15][16][17][18][19] the prevalence of depression ranged from 11.0 to 40.0%. As seen from both the HADS and BDI data, the score used to define depression varied among the studies, and the lower thresholds for defining depression resulted in higher prevalences (Table 1).…”

“…Three studies examined baseline medication usage, productivity, or physician visits, and found that comorbid depression was uniformly associated with worse performance across each of these metrics (Table 2). 7,9,17 Two studies 19,21 reported worse baseline olfaction in patients with CRS and depression, although one of these studies was limited to patients with CRS with nasal polyposis. 21 …”

“…One study examined medical therapy for CRS and found that it also improves 22-item Sino-Nasal Outcome Test in patients with depression, similar to endoscopic sinus surgery. 17 Four studies examined depression-specific outcomes after CRSspecific medical or surgical therapy, and all found improvement in depression. 11,16,17,22 These studies aimed to determine whether treatment of CRS specifically would impact comorbid depression secondarily.…”