Depressed patients with chronic rhinosinusitis (CRS) are more likely to miss days of work or school than those without depression symptoms, according to the results of a new study led by the Sinus Center at Massachusetts Eye and Ear. The findings, published online today in Annals of Allergy, Asthma and Immunology, identify depression symptoms as the primary driver of lost days of productivity in patients with CRS, paving the way for more individualized therapy to improve overall quality of life in these patients.
"In this study, we found that of all symptoms related to CRS — sinus, nasal or otherwise — the severity of depressed mood and depression symptomatology was the predominant factor associated with how often our CRS patients missed work or school due to their CRS," said senior author Ahmad R. Sedaghat, M.D., Ph.D., a sinus surgeon at Mass. Eye and Ear and assistant professor of otolaryngology at Harvard Medical School. "The severity of even symptoms most typically related to CRS, such as nasal congestion, was not associated with how often our patients missed work or school due to their CRS."
One of the more prevalent chronic illnesses in the United States, CRS has been known to cause significant quality of life detriments to affected patients, who often cannot breathe or sleep easily due to obstructed nasal and sinus passages.
The researchers previously identified four categories of symptoms that dominate CRS — disturbances of sleep, nasal obstruction, ear and facial pain and emotional function. In subsequent studies, they showed that disturbed sleep and ear/facial pain are most associated with overall poorer quality of life.
In search of an association with lost productivity, the researchers assessed these four categories of symptoms in 107 patients with CRS using a standardized survey. On average, study participants reported three missed days of work or school in a three-month period, or 12 missed days in a year. When the researchers took a closer look at the surveys, they identified emotional symptoms, in which depression symptoms are the strongest feature, as the primary driver of missed days of work or school.
The researchers were surprised to find that there was not an association between sleep disturbance or nasal obstruction symptoms—symptoms which are more commonly thought of in relation to CRS—with CRS patients missing days of work or school.
"These findings really point to the fact that specific elements (in this case, symptoms) of CRS may be driving specific disease manifestations or consequences of the disease" Dr. Sedaghat said. In an effort to specifically tailor our CRS treatment to each patient, we have to be cognizant not just of the overall severity of the disease, but also of the severity of individual aspects, symptoms and manifestations of the disease. In this case, we have found that depressed mood, which CRS patients commonly experience, is associated with a particular consequence of the disease — that patients may miss work because of CRS — and these results open the door to exploring interventions directed at depressed mood for reducing productivity losses due to CRS."