Journal Article Annotations
2018, 3rd Quarter
Annotations by Aum Pathare, MD
Type of study: Population-based cohort study
The finding: Severe symptoms of anxiety and depression were associated with an elevated risk of bloodstream infection, with adjustment for comorbidities, BMI and lifestyle partly attenuating the risk. A similar trend was noted with moderate depressive symptoms and BSI-linked mortality, although the relatively low total number of events limit the utility of this finding. Two measurements of elevated mixed symptom scores of anxiety and depression, in the first and second study (ten years apart), did not constitute any higher risk than one measurement alone at baseline.
Strength and weaknesses: The population-based nature of the study, large sample, and a well-linked health care system are the strengths for this study. The Hospital Anxiety and Depression Scale (HADS), and Anxiety and Depression Index (ADI-4), preclude the inclusion of somatic symptoms overlapping with anxiety and depression, but are less specific, report smaller effects than clinical interviews, and are not considered diagnostic. The chronological sequence of events is unclear, especially as the symptom scales offer only a cross-sectional view of the patient’s state.
Relevance: BSI is a significant cause of mortality and morbidity, meeting clinical sepsis criteria in ~98% of the patients. Other studies have shown increased HADS (A & D) scores to be associated with worse physical health, along with nonadherence towards interventions for changing the lifestyle, such as healthy eating, physical activity, and smoking cessation, which are in turn found to increase the risk of sepsis. In this study, severe anxiety and depression symptoms were associated with an increased risk of BSI, again modulated by BMI, lifestyle and comorbid conditions. Early focus on detection and treatment of these psychiatric symptoms may lower catastrophic complications associated with BSI, and positively influence other risks associated with sepsis, which appear have a bidirectional relationship with them. This is especially relevant as integrated care expands, specifically in initiatives for infection prevention, in order to utilize appropriate behavioral health screening/treatment with C-L psychiatrist participation.