Depressed mood modulates impact of chronic rhinosinusitis symptoms on quality of life

Publication date: Available online 8 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Raphael G. Banoub, Lloyd P. Hoehle, Katie M. Phillips, Brian J. Schulman, David S. Caradonna, Stacey T. Gray, Ahmad R. Sedaghat
BackgroundIt is unknown how severity of depressed mood affects the well-recognized relationship between chronic rhinosinusitis (CRS) symptom burden and decreased general health-related quality of life (QOL).ObjectiveTo determine if depressed mood would affect the relationship between CRS symptom burden and decreased general health-related QOL.MethodsFor this cross-sectional study, 610 participants with CRS were prospectively recruited. CRS symptom burden was measured with the 22-item Sinonasal Outcomes Test (SNOT-22). General health-related QOL was measured with the EuroQol 5-dimensional health utility value (EQ-5D HUV) and visual analog scale (EQ-5D VAS). Depressed mood was measured using the Patient Health Questionnaire-2 (PHQ-2). Participants were stratified as having well-controlled CRS symptoms (SNOT-22<35) and poorly-controlled CRS symptoms (SNOT-22≥35). Good general health-related QOL was determined as EQ-5D HUV≥0.9 or EQ-5D VAS≥80, in contrast to low general health-related QOL.ResultsIn participants with well-controlled CRS symptoms, both SNOT-22 and PHQ-2 were significantly and negatively associated with good general health-related QOL (p<0.020 in all cases using multivariable regression). In participants with poorly-controlled CRS symptoms, PHQ-2 was significantly and negatively associated with good general health-related QOL using EQ-5D HUV (adjusted odds ratio [OR]= 0.37, 95%CI: 0.22–0.62, p<0.001) or EQ-5D VAS (adjusted OR= 0.74, 95%CI: 0.57–0.96, p=0.024). In contrast, SNOT-22 was not associated with general health-related QOL in these patients.ConclusionDepressed mood modulates the association between CRS symptom burden and general health-related QOL. Our results suggest a threshold of CRS symptom burden or control, beyond which depressed mood—not CRS symptom burden—drives the association with general health-related QOL.