Pediatric Patients With Cystic Fibrosis and Anxiety or Depression Have an Elevated Risk of Dyspnea

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Abstract RATIONALE: The prevalence of anxiety and depression among pediatric patients with cystic fibrosis (CF) is elevated compared to the general population. In other obstructive pulmonary diseases, anxiety and depression are associated with increased perceptions of dyspnea beyond what can be explained by cardiopulmonary physiology. Increased perceptions of dyspnea can significantly impact quality of life. This study aimed to use the TriNetX database to investigate the relationships between the diagnoses of anxiety, depression, and dyspnea among pediatric patients with CF at Cincinnati Children's Hospital Medical Center (CCHMC). METHODS: Data for this retrospective cohort study was collected from TriNetX, a global federated multicenter research database, using the CCHMC Network. Patients 0 to 21 years of age with a diagnosis of cystic fibrosis (ICD-10-CM E84) with and without a diagnosis of depressive episode (ICD-10-CM F32), major depressive disorder (ICD-10-CM F33), or other anxiety disorders (ICD-10-CM F41) were examined for associations with dyspnea (ICD-10-CM R06.0). To capture all patients with CF at CCHMC, no other exclusion criteria were applied. Risk ratios (RR) with 95% confidence intervals (CI) and chi-square tests (two-sided) were performed using 2x2 contingency tables. Additional data were collected to calculate the prevalence of patients ages 0 to 21 with CF and anxiety or depression and the prevalence of patients ages 0 to 21 with CF and dyspnea. RESULTS: Of the 1,279,000 unique patients in the CCHMC Network, 770 patients were included. Being diagnosed with anxiety or depression was associated with a significantly increased risk for a diagnosis of dyspnea among all pediatric patients with CF (RR 2.58 [95% CI 1.80-3.70]; p<0.001). This risk was higher for males (RR 2.75 [95% CI 1.82-4.15]; p<0.001) than females (RR 2.22 [95% CI 1.33-3.72]; p<0.005). 20.8% of all patients with CF were diagnosed with anxiety or depression with a slightly higher prevalence in females (21.1%) compared to males (20%). 13% of all patients with CF were diagnosed with dyspnea with a higher prevalence in males (15%) compared to females (13.2%). CONCLUSIONS: This retrospective cohort study demonstrates that having a diagnosis of anxiety or depression is associated with a greater likelihood of a diagnosis of dyspnea in pediatric patients with CF. Considering the presence of anxiety and depression may help explain perceptions of dyspnea in pediatric patients with CF with normal pulmonary function. However, further research is needed to better characterize these relationships and their impacts on quality of life.

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