Chaturvedi Shruti, Oluwole Olalekan, Cataland Spero, McCrae Keith R
Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
Division of Hematology, Department of Medicine, Ohio State University, Columbus, OH, United States.
Thromb Res. 2017 Mar;151:51-56. doi: 10.1016/j.thromres.2017.01.003. Epub 2017 Jan 6.
Survivors of thrombotic thrombocytopenic purpura (TTP) have high rates of chronic morbidities including neurocognitive complications and depression. There is limited information regarding the psychological consequences of TTP. We conducted this cross sectional study to estimate the prevalence of symptoms of PTSD and depression in survivors of TTP.
An online survey tool comprising demographic and clinical information and two validated self-administered questionnaires, the PTSD checklist for DSM-5 (PCL-5) and Beck Depression Inventory-II (BDI-II), was distributed to individuals with TTP. Multivariable regression was used to identify clinical and demographic associations of depression and PTSD.
A total of 236 individuals completed either the BDI II or PCL-5 and were included in the analysis. Median age was 44years and 87.3% were female. Median time from diagnosis was 80months. BDI-II scores >13 indicating at least mild depressive symptoms were present in 80.8% individuals (15.8%, 28.2%, and 36.8% with mild, moderate and severe symptoms, respectively) and 35.1% had a positive screen for PTSD (PCL-5 score≥38). A previous diagnosis of depression [OR 3.65 (95% CI 1.26-10.57); p=0.017] and unemployment attributed to TTP [OR 5.86 (95% CI 1.26-27.09); p=0.024] were associated with depression. Younger age (p=0.017), a pre-existing anxiety disorder [OR 3.57 (95% CI 1.76-7.25), p<0.001], and unemployment attributable to TTP [OR 6.42 (95% CI 2.75-415.00), p<0.001] were associated with PTSD.
We report a high prevalence of PTSD and depression in TTP survivors. These results are concerning and indicate a need for further investigation to better define this association and its consequences.
血栓性血小板减少性紫癜（TTP）幸存者有较高的慢性疾病发生率，包括神经认知并发症和抑郁症。关于TTP心理后果的信息有限。我们开展了这项横断面研究，以评估TTP幸存者中创伤后应激障碍（PTSD）和抑郁症症状的患病率。
向TTP患者发放一个在线调查工具，其中包括人口统计学和临床信息，以及两份经验证的自填问卷，即DSM-5创伤后应激障碍检查表（PCL-5）和贝克抑郁量表第二版（BDI-II）。采用多变量回归分析来确定抑郁症和PTSD的临床及人口统计学关联因素。
共有236人完成了BDI-II或PCL-5调查并纳入分析。中位年龄为44岁，87.3%为女性。自诊断以来的中位时间为80个月。BDI-II评分>13表明至少有轻度抑郁症状，80.8%的个体存在此类情况（轻度、中度和重度症状者分别占15.8%、28.2%和36.8%），35.1%的个体PTSD筛查呈阳性（PCL-5评分≥38）。既往有抑郁症诊断[比值比（OR）3.65（95%置信区间1.26 - 10.57）；p = 0.017]以及因TTP导致失业[OR 5.86（95%置信区间1.26 - 27.09）；p = 0.024]与抑郁症相关。年龄较小（p = 0.017）、既往有焦虑症[OR 3.57（95%置信区间1.76 - 7.25），p < 0.001]以及因TTP导致失业[OR 6.42（95%置信区间2.75 - 415.00），p < 0.001]与PTSD相关。
我们报告TTP幸存者中PTSD和抑郁症的患病率较高。这些结果令人担忧，表明需要进一步调查以更好地明确这种关联及其后果。
