Depressive symptoms in peripheral arterial disease: A follow-up study on prevalence, stability, and risk factors

Background: Depressive symptoms are associated with poor prognosis in coronary artery disease, but there is a paucity of research on these symptoms in peripheral arterial disease (PAD). We examined the clinical correlates and 18-month course of depressive symptoms in PAD patients. Methods: 166 patients with symptomatic lower-extremity PAD (39% women; M age = 64.9 +/- 10 years) completed the 10-item Center for Epidemiological Studies Depression scale. A score >= 4 indicates clinically relevant depressive symptoms. Depressive symptoms were re-assessed at 6, 12, and 18 months follow-up. Ankle-brachial index (ABI) and treadmill walking distance were used to assess PAD severity. Results: At baseline, depressive symptoms (CES-D >= 4) were present in 16% of the patients. Depressed patients performed worse regarding pain free (p = 0.003) and maximum (p = 0.005) walking distance. After adjusting for age, sex, education, ABI, psychotropic medication use, cardiovascular risk factors, and comorbidity, depressive symptoms remained stable in initially depressed patients. Using mixed modelling, three subgroups were identified in the total sample. The majority of PAD patients did not have depressive symptoms (58%), but there were two groups who persistently experienced either subclinical (27%) or clinically manifest (15%) depressive symptoms. Limitations: Only baseline data of ABI and treadmill walking performance were available. Conclusions: Depressive symptomatology was present in a substantial number of PAD patients, tended to be stable, and was associated with reduced walking distance. These apparently evident results are overlooked thus far in this patient group and deserve further attention in research and clinical care. (C) 2008 Elsevier B.V. All rights reserved.