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Original Investigation |

Depression-Specific Outcomes After Treatment of Chronic Rhinosinusitis

Rodney J. Schlosser, MD1; J. Madison Hyer, MS2; Timothy L. Smith, MD, MPH3; Jess C. Mace, MPH3; Bernadette M. Cortese, PhD4; Thomas W. Uhde, MD4; Luke Rudmik, MD, MSc5; Zachary M. Soler, MD, MSc1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
2Department of Public Health Sciences, Medical University of South Carolina, Charleston
3Department of Otolaryngology–Head and Neck Surgery, Oregon Health & Science University, Portland
4Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
5Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
JAMA Otolaryngol Head Neck Surg. 2016;142(4):370-376. doi:10.1001/jamaoto.2015.3810.
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Importance  Depression is frequently undiagnosed in patients with chronic rhinosinusitis (CRS) and affects quality of life, productivity, and health care use.

Objective  To examine depression-specific outcomes after medical or surgical treatment of CRS.

Design, Setting, and Participants  A multi-institutional, prospective study of patients with refractory CRS treated at tertiary academic rhinology centers was performed from March 1, 2011, to November 1, 2015. Data analysis was performed from October 1, 2015, to November 1, 2015.

Interventions  Patients self-selected to undergo continued medical management or endoscopic sinus surgery for refractory CRS.

Main Outcomes and Measures  Patients completed the 22-item Sinonasal Outcome Test (SNOT22), Rhinosinusitis Disability Index (RSDI), Pittsburgh Sleep Quality Index (PSQI), and missed productivity and medication use questionnaires before and at least 6 months after treatment. Computed tomography and endoscopy scoring were performed with reviewers masked to patient-reported data. Depression-specific outcomes were recorded using the 2-item Patient Health Questionnaire (PHQ2).

Results  Baseline data were available on 685 patients, with 167 (24.4%) having depression according to the PHQ2 scores. The mean (SD) age of the patients was 50.5 (15.0) years, and 332 (48.4%) were male. Revision surgery status was the only baseline factor associated with depression (53.9% vs 38.0%, P < .001). Patients with depression had worse baseline SNOT22 (mean, 64.5 vs 47.6), PSQI (mean, 12.8 vs 8.4), productivity (mean, 22.8 vs 5.2 days missed), and medication use scores for oral antibiotics (mean, 23.8 vs 14.8) and oral corticosteroids (mean, 17.8 vs 9.9) (P < .001 for all). Medical and surgical treatments had similar outcomes for patients with depression with mean improvement in the PHQ2 scores from 3.96 to 1.91 (P < .001), and 110 of 167 patients (65.9%) categorized as having depression at baseline were categorized as not having depression after treatment. Improvements in the PHQ2 scores were associated with improvements in the SNOT22, PSQI, oral antibiotic use, and productivity scores (P ≤ .001 for all).

Conclusions and Relevance  Depression is a common comorbidity in patients with CRS and affects numerous quality-of-life and health care outcomes. There are few objective baseline factors to aid physicians in identifying depression in patients with CRS. Medical and surgical treatments for CRS improve depression and related clinical outcomes.

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Figure 1.
Change in Total 22-Item Sinonasal Outcome Test (SNOT22) vs Change in 2-Item Patient Health Questionnaire (PHQ2) Scores

After medical or surgical therapy for chronic rhinosinusitis, improvements in the PHQ2 scores were associated with improvements in the total SNOT22 scores (P = .007). Decreasing PHQ2 and SNOT22 scores indicate clinical improvement.

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Figure 2.
Change in Missed Productivity vs Change in the 2-Item Patient Health Questionnaire (PHQ2) Score

After medical or surgical therapy for chronic rhinosinusitis, improvements in the PHQ2 scores were associated with improvements in missed productivity (P = .004). Decreasing PHQ2 scores and missed productivity values indicate clinical improvement.

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Figure 3.
Change in Oral Antibiotic Use vs Change in the 2-Item Patient Health Questionnaire (PHQ2) Score

After medical or surgical therapy for chronic rhinosinusitis, improvements in the PHQ2 scores were associated with improvements in days of oral antibiotic use (P = .004). Decreasing PHQ2 scores and days of antibiotic use indicate clinical improvement.

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