Psychological burden associated with worse clinical outcomes in sarcoidosis

Abstract

IntroductionSarcoidosis is a multisystem granulomatous inflammatory disorder. Sarcoidosis is associated with significant morbidity and rising healthcare utilisation. Patients with sarcoidosis report higher psychological symptoms than the general population. We evaluated the association between depressive and anxiety symptoms and clinical outcomes in patients with pulmonary sarcoidosis requiring treatment.MethodsAdult patients in the Johns Hopkins Sarcoidosis Clinic diagnosed with pulmonary sarcoidosis on treatment were eligible for enrollment. Questionnaires were administered to assess depressive and anxiety symptoms, healthcare utilisation and health-related quality of life (HRQoL).Results112 participants were enrolled (57% women, 53% African American, median age: 57 years). 34% of participants screened positive for mild and 20% for moderate–severe depressive symptoms. 25% of participants screened positive for mild and 12% for moderate–severe anxiety symptoms. Participants with moderate–severe psychological symptoms had a higher odds of an emergency department visit in the previous 6 months (8.87 for depressive symptoms and 13.05 for anxiety symptoms) and worse HRQoL compared with participants without psychological symptoms. Participants with moderate–severe depressive symptoms had lower diffusion capacity of the lungs for carbon monoxide % predicted compared with those without depressive symptoms. There was no association between elevated psychological symptoms and the odds of hospitalisation, forced vital capacity % predicted and forced expiratory volume in 1 second % predicted.ConclusionPsychological symptoms may be associated with worse clinical outcomes in sarcoidosis. Improving the recognition through clinic screening and referral for treatment of depression and anxiety in sarcoidosis may reduce acute healthcare utilisation and improve HRQoL.

Nonlife-Threatening Sarcoidosis

“…9 Psychological symptoms, especially depression and anxiety, are reported in 17 to 66% of the patients and may be associated with worse clinical outcomes in sarcoidosis. 9,58 Depressive and anxious symptoms may predict the development of severe fatigue. 56 Depressive symptoms and consequently poor self-care may indirectly lead to increased symptoms in chronic diseases.…”

“…59 An improvement of the recognition and referral for specific treatment of psychological conditions may reduce acute health care utilization and improve the QOL related to health. 58 Dyspnea is a multifactorial complaint and should be evaluated from an embracing perspective. During the initial evaluation and follow-up in sarcoidosis, clinical, laboratory, and lung functional tests have to be comprehensive and include the multiple causes of dyspnea, especially when refractory/relapsing disease is considered.…”

Keys to Successful Survey Research in Health Professions Education

“…Over the past two decades, the propagation of easy-to-use web-based tools to design and administer surveys has in part led to increases in survey-based research publications ( 1 ). In pulmonary and critical care medicine (PCCM), this has included studies addressing topics in medical education ( 2 – 5 ), the assessment of clinicians’ attitudes toward critical care practices ( 6 , 7 ), understanding the perspectives of patients living with pulmonary diseases ( 8 , 9 ), and determining factors that can optimize critical care delivery ( 10 , 11 ). Although the ubiquity of survey-based research in these areas could suggest that surveys are easy to conduct and publish, the quality and reporting of such studies remain challenges for the field ( 12 – 15 ).…”