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The Association Between Depression, Lung Function, and Health-Related Quality of Life Among Adults With Cystic Fibrosis^*

^* From the Divisions of Pulmonary and Critical Care Medicine (Drs. Riekert, Boyle, and Rand), and Rheumatology (Dr. Bartlett), Johns Hopkins School of Medicine, Baltimore MD; and the Section of Pulmonary and Critical Care Medicine (Dr. Krishnan), University of Chicago, Chicago, IL.

Correspondence to: Kristin Riekert, PhD, Assistant Professor, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 5501 Hopkins Bayview Circle, JHAAC Room 3B.35, Baltimore, MD 21224; e-mail: krieker1{at}jhmi.edu

Abstract

Background: More than 40% of people born with cystic fibrosis (CF) now reach adulthood. Greater attention is being focused on improving their health-related quality of life (HRQoL). While markers of disease severity such as lung function are only modestly associated with HRQoL, in other chronic illnesses depression is an important correlate. The objective of this study was to evaluate the relationships among lung function (ie, FEV₁ percent predicted), depressive symptoms, and HRQoL among adults with CF.

Methods: Seventy-six adults with CF completed a mail-based survey. The Beck Depression Inventory and the Cystic Fibrosis Questionnaire were used to assess depressive symptoms and HRQoL, respectively. Values for FEV₁ percent predicted were abstracted from the medical record.

Results: Thirty percent of participants screened positive for depressive symptoms. Depressive symptoms and lung function were inversely correlated (rho = –0.25; p < .05). Correlations between depressive symptoms and HRQoL were maintained after stratifying by lung function. In the absence of depressive symptoms, those patients with good lung function (ie, FEV₁, > 70% predicted) reported better physical HRQoL than those with poor lung function. Participants with both depressive symptoms and poor lung function reported significantly worse HRQoL on all domains than participants without depressive symptoms regardless of lung function status.

Conclusions: Depressive symptoms are prevalent among adults with CF and are associated with poorer HRQoL even after controlling for lung function. These results suggest that screening for and treating depression is important and may potentially improve HRQoL among patients with CF.

Key Words: adults • cystic fibrosis • depression • health-related quality of life • lung function • psychosocial • pulmonary function test