, Volume 195, Issue 6, pp 759–768 | Cite as

Anxiety, Depression, and Health-Related QOL in Patients Diagnosed with PAH or CTEPH

  • Elena Pfeuffer
  • Holger Krannich
  • Michael Halank
  • Heinrike Wilkens
  • Philipp Kolb
  • Berthold Jany
  • Matthias HeldEmail author



Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are life-threatening diseases with a high burden of symptoms. Although depression, anxiety, and reduced health related quality of life (HRQOL) have also been reported, a comparative analysis which explores these traits and their underlying factors was lacking.


A retrospective analysis of depression, anxiety, and health related QOL was conducted using a Hospital anxiety and depression scale (HADS) as well as the SF-36 HRQOL questionnaire. Results from these tools were compared with haemodynamic and functional parameters in 70 PAH and 23 CTEPH outpatients from a German tertiary care center specializing in pulmonary hypertension.


Although HRQOL was reduced in both cohorts of patients, individuals diagnosed with CTEPH scored lower in nearly all SF-36 parameters. Significance was noted in both “mental health” (p = 0.01) and “mental component summary score” (MCS) (p = 0.02). Depression was also more frequent in patients with CTEPH (56%) than in patients with PAH (30%), (p = 0.03). Overall, depression and anxiety correlated with most SF-36 scales in both PAH and CTEPH. In CTEPH, depression also correlated with the Borg Dyspnea Scale (r = 0.44, p = 0.01). These patients also had significantly lower pCO2 levels than the PAH cohort reflecting more severe ventilation/perfusion mismatch. All other haemodynamic and functional parameters did not differ across the groups.


While both cohorts of patients suffer from a reduced HRQOL as well as depression and anxiety, decreases in mental health parameters are more pronounced in the CTEPH cohort. This suggests a strong effort to improve early detection, especially in dyspneic patients with classical risk factors for CTEPH and PAH and argues for mental illness interventions alongside routine clinical care provided to patients diagnosed with PAH or CTEPH.


Depression Quality of life Mental health CTEPH PAH Pulmonary hypertension Hyperventilation 



There was no funding of the presented work.

Compliance with Ethical Standards

Conflict of interest

Dr. Elena Pfeuffer has nothing to disclose. Dr. Krannich has nothing to disclose. Dr. Halank reports personal fees for lectures and consultations and travel/accommodation, meeting expenses from Actelion, AstraZeneca, Bayer, BERLIN CHEMIE, GILEAD, GSK, Lilly, MSD, Novartis, OMT, and Pfizer, outside the submitted work. Prof. Dr. Wilkens reports grants and personal fees from Actelion, personal fees from Bayer Vital, Glaxo Smith Kline, Pfizer, Biotest, Boehringer Ingelheim, and Roche outside the submitted work. Philipp Kolb has nothing to disclose. Prof. Dr. Jany has nothing to disclose. Dr. Held reports grants from Actelion, honoraria for lectures from Actelion, Bayer HealthCare, Berlin Chemie, Boehringer Ingelheim, GSK, Novartis, Pfizer, honoraria for advisory board activities from Actelion, Bayer HealthCare, GSK, MSD, and partizipation in clinical trials of Actelion, Bayer HealthCare, GSK, Pfizer, United Therapeutics, outside the submitted work.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Research Involving Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors.

Supplementary material

408_2017_52_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 27 kb)


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© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Internal Medicine, Academic Teaching Hospital of the Julius Maximilian University of WürzburgMedical Mission HospitalWürzburgGermany
  2. 2.Medical Clinic ILeopoldina HospitalSchweinfurtGermany
  3. 3.Department of Quality Management and Clinical Risk ManagementHospital of Julius Maximilian University of WürzburgWürzburgGermany
  4. 4.Internal Medicine I, University Hospital Carl Gustav CarusTechnical University DresdenDresdenGermany
  5. 5.Department of Internal Medicine V, Pulmonology, Allergology, Respiratory Intensive Care MedicineSaarland UniversityHomburg SaarGermany
  6. 6.Department of Medicine, Firestone Institute for Respiratory Health, Pathology & Molecular MedicineMcMaster UniversityHamiltonCanada

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