Mental health burden in progressive pulmonary fibrosis and idiopathic pulmonary fibrosis: Depression and anxiety

Mental health burden in progressive pulmonary fibrosis and idiopathic pulmonary fibrosis: Depression and anxiety

Authors

  • Jovan Javorac Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
  • Dejan Živanović Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Department of Psychology, Academy of Human Development, Belgrade, Serbia
  • Miljana Miladinović Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Andrijana Mikić Department of Psychology, Academy of Human Development, Belgrade, Serbia
  • Vesna Dukanac Department of Psychology, Academy of Human Development, Belgrade, Serbia
  • Miroslav Ilić Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
  • Ana Milenković Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
  • Sonja Peričević Medić Department of Occupational Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Department of Occupational Medicine, Institute of Occupational Health of Novi Sad, Novi Sad, Serbia
  • Tamara Popović Clinic for Psychiatry, University Clinical Center of Vojvodina, Novi Sad, Serbia
  • Svetlana Kašiković Lečić Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia

Keywords:

Anxiety, Depression, quality of life, pulmonary fibrosis, idiopathic pulmonary fibrosis

Abstract

Background and aim: Progressive pulmonary fibrosis (PPF) is an umbrella term for several interstitial lung diseases characterized by the progressive proliferation of fibrous tissue within the lung interstitium. This study aimed to assess the prevalence of depressive and anxiety symptoms among PPF patients and their repercussions on quality of life.

Methods: Thirty-seven PPF patients undergoing treatment at the Institute for Pulmonary Diseases of Vojvodina, Serbia were enrolled. The SGRQ questionnaire assessed quality of life, while the DASS-21 questionnaire evaluated anxiety and depression symptoms. Sociodemographic and clinical factors were correlated with questionnaires outcomes, and the influence of anxiety and depression symptoms on quality of life was examined.

Results: Anxiety symptoms were detected in 56.75% of PPF patients and were more prevalent in patients previously diagnosed with depression and/or anxiety. Depression symptoms were detected in 45.95% of PPF patients and were more pronounced in the patients with longer duration of PPF, and positive history of malignancies. Stress symptoms were linked to lower PaO2 values and were detected in 37.84% of participants. HRQL was moderately to severely decreased and was lower in patients who, in addition to PPF, also suffered from other respiratory diseases, and was statistically significantly associated with lower DLCO values. A statistically significant correlation has been proven between the presence of anxiety, depression, and stress symptoms and HRQL, as measured through the "Symptoms" and "Impact" subscales of the SGRQ questionnaire.

Conclusions: Anxiety and depression symptoms are highly prevalent among PPF patients, exerting substantial impacts on their quality of life.

References

1. Rajan SK, Cottin V, Dhar R, et al. Progressive pulmonary fibrosis: an expert group consensus statement. Eur Respir J. 2023;61(3):2103187. doi: 10.1183/13993003.03187-2021

2. Selman M, Pardo A. When things go wrong: exploring possible mechanisms driving the progressive fibrosis phenotype in interstitial lung diseases. Eur Respir J. 2021;58(3):2004507. doi: 10.1183/13993003.04507-2020

3. Raghu G, Remy-Jardin M, Richeldi L, et al. Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2022;205(9):e18–47. doi: 10.1164/rccm.202202-0399st

4. He X, Ji J, Pei Z, et al. Anxiety and depression status in patients with idiopathic pulmonary fibrosis and outcomes of nintedanib treatment: an observational study. Ann Med. 2024;56(1):2323097. doi: 10.1080/07853890.2024.2323097

5. Tzouvelekis A, Karampitsakos T, Kourtidou S, et al. Impact of depression on patients with idiopathic pulmonary fibrosis. Front Med (Lausanne). 2020;7:29. doi: 10.3389/fmed.2020.00029

6. Lee YJ, Choi SM, Lee YJ, et al. Clinical impact of depression and anxiety in patients with idiopathic pulmonary fibrosis. PLoS One. 2017;12(9):e0184300. doi: 10.1371/journal.pone.0184300

7. Antoniou K, Kamekis A, Symvoulakis EK, Kokosi M, Swigris JJ. Burden of idiopathic pulmonary fibrosis on patients' emotional well being and quality of life: a literature review. Curr Opin Pulm Med. 2020;26(5):457–63. doi: 10.1097/mcp.0000000000000703

8. Belkin A, Albright K, Swigris JJ. A qualitative study of informal caregivers’ perspectives on the effects of idiopathic pulmonary fibrosis. BMJ Open Respir Res. 2014;1(1):e000007. doi: 10.1136/bmjresp-2013-000007

9. Swigriss JJ, Fairclough D. Patient-reported outcomes in idiopathic pulmonary fibrosis research. Chest. 2012;142(2):291–7. doi: 10.1378/chest.11-2602

10. Hurtado-Ruzza R, Iglesias ÓÁ, Dacal-Quintas R, et al. Asthma, much more than a respiratory disease: influence of depression and anxiety. Rev Assoc Med Bras. 2021;67(4):571–6. doi: 10.1590/1806-9282.20201066

11. Jones PW, Quirk FH, Baveystock CM. The St George's Respiratory Questionnaire. Respir Med. 1991;85(Suppl B):25–31. doi: 10.1016/s0954-6111(06)80166-6

12. Ghogare AS, Patil PS, Spoorthy MS, et al. Depression, anxiety, stress and resilience among undergraduate health sciences students of a rural tertiary healthcare centre in Maharashtra during the Covid-19 lockdown: a cross-sectional, online survey. Natl Med J India. 2022;35(3):147–52. doi: 10.25259/nmji-35-3-147

13. Park SH, Song YJC, Demetriou EA, et al. Validation of the 21-item depression, anxiety, and stress scales (DASS-21) in individuals with autism spectrum disorder. Psychiatry Res. 2020;291:113300. doi: 10.1016/j.psychres.2020.113300

14. Edwards GD, Polgar O, Patel S, et al. Mood disorder in idiopathic pulmonary fibrosis: response to pulmonary rehabilitation. ERJ Open Res. 2023;9(3):00585-2022. doi: 10.1183/23120541.00585-2022

15. Akhtar AA, Ali MA, Smith RP. Depression in patients with idiopathic pulmonary fibrosis. Chron Respir Dis. 2013;10(3):127–33. doi: 10.1177/1479972313493098

16. Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J. 2009;33(5):1165–85. doi: 10.1183/09031936.00128008

17. Niedzwiedz CL, Knifton L, Robb KA, et al. Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority. BMC Cancer. 2019;19(1):943. doi: 10.1186/s12885-019-6181-4

18. Delameillieure A, Dobbels F, Fieuws S, et al. Behavioural and psychological patterns of patients with idiopathic pulmonary fibrosis: a prospective study. Respir Res. 2022;23(1):124. doi: 10.1186/s12931-022-02041-6

19. Matsuda T, Taniguchi H, Ando M, et al. Depression is significantly associated with the health status in patients with idiopathic pulmonary fibrosis. Intern Med J. 2017;56(13):1637–44. doi: 10.2169/internalmedicine.56.7019

20. Yenibertiz D, Akıncı Özyürek B, Aydın MS, et al. Evaluation of anxiety and depression in idiopathic pulmonary fibrosis. Mid Blac Sea J Health Sci. 2020;6(3):333–9. doi: 10.19127/mbsjohs.818494

21. Uzer F, Cilli A, Hanta I, et al. Assessment of quality of life in IPF patients: a multicenter observational study. Sarcoidosis Vasc Diffuse Lung Dis. 2024;41(3):e2024043. doi: 10.36141/svdld.v41i3.15805

22. Rajpoot A, Garg K, Saini V, et al. Psychological morbidity in interstitial lung disease: a study from India. Monaldi Arch. 2020;90(4). doi: 10.4081/monaldi.2020.1434

23. Pryce CR, Fontana A. Depression in autoimmune diseases. Curr Top Behav Neurosci. 2017;31:139–54. doi: 10.1007/7854_2016_7

24. Yalnız E, Polat G, Demirci F, et al. Are idiopathic pulmonary fibrosis patients more anxious and depressive than patients with other interstitial lung disease? Sarcoidosis Vasc Diffuse Lung Dis. 2019;36(4):294–301. doi: 10.36141/svdld.v36i4.8418

25. Bae W, Cho J, Lee J, et al. Longitudinal comparison of anxiety and depression between idiopathic pulmonary fibrosis (IPF) and non-IPF interstitial lung disease: a prospective cohort study. Am J Respir Crit Care Med. 2019;199:A3364. doi: 10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A3364

26. Swigris JJ, Esser D, Conoscenti CS, et al. The psychometric properties of the St George’s Respiratory Questionnaire (SGRQ) in patients with idiopathic pulmonary fibrosis: a literature review. Health Qual Life Outcomes. 2014;12:124. doi: 10.1186/s12955-014-0124-1

27. Mackintosh JA, Keir G, Troy LK, et al. Treatment of idiopathic pulmonary fibrosis and progressive pulmonary fibrosis: a position statement from the Thoracic Society of Australia and New Zealand 2023 revision. Respirology. 2024;29(2):105–35. doi: 10.1111/resp.14656

28. Yan W, Peng LY, Ban CJ, et al. Incidence and clinical characteristics of pulmonary hypertension in patients with idiopathic pulmonary fibrosis. Chin Med J (Engl). 2015;128(7):896–901. doi: 10.4103/0366-6999.154284

29. Han MK, Swigris J, Liu L, et al. Gender influences health-related quality of life in IPF. Respir Med. 2010;104(5):724–30. doi: 10.1016/j.rmed.2009.11.019

30. Glaspole IN, Chapman SA, Cooper WA, et al. Health-related quality of life in idiopathic pulmonary fibrosis: data from the Australian IPF Registry. Respirology. 2017;22(5):950–6. doi: 10.1111/resp.12989

31. Akihiko S, Tomohiro H, Toru O, et al. The association between health-related quality of life and disease progression in idiopathic pulmonary fibrosis: a prospective cohort study. Sarcoidosis Vasc Diffuse Lung Dis. 2017;34(3):226–35. doi: 10.36141/svdld.v34i3.5214

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Published

25-06-2025

Issue

Section

Original Articles: Clinical Research

How to Cite

1.
Javorac J, Živanović D, Miladinović M, Mikić A, Dukanac V, Ilić M, et al. Mental health burden in progressive pulmonary fibrosis and idiopathic pulmonary fibrosis: Depression and anxiety. Sarcoidosis Vasc Diffuse Lung Dis [Internet]. 2025 Jun. 25 [cited 2025 Jul. 3];42(2):16342. Available from: https://mail.mattioli1885journals.com/index.php/sarcoidosis/article/view/16342