Acute venous thromboembolism (VTE) was associated with a more than doubled risk for depression, according to results from a Danish study published in the Journal of Thrombosis and Haemostasis.
“VTE is a sudden, dangerous, and life-altering event, [and] still we know very little about mental health complications in individuals that have suffered a VTE,” said study researcher Helle Jørgensen, who is a PhD student at the Arctic University of Norway. “Even though there were indications that patients [with VTE] experience psychological distress and symptoms of post-traumatic stress disorder, we did not know how many might actually suffer from adverse mental health after experiencing a VTE.”
Previous research has shown that VTE is a highly prevalent chronic disease that affects around 900,000 Americans each year, including 100,000 VTE-related deaths, Ms. Jørgensen explained.
Those who survive a VTE often suffer from long-term physical complications such as recurrence, post-thrombotic syndrome, post-pulmonary embolism (PE) syndrome, and bleeding from anticoagulation.
“Getting depression on top of this may result in non-adherence to medication and treatment, functional impairment, early exit from work-life, and even increased risk of morbidity and mortality,” Ms. Jørgensen said. “We therefore need more and better knowledge about how many [patients who experienced VTE] this might affect.”
To gain a better understanding of the relationship between VTE and depression, Ms. Jørgensen and colleagues gathered data on 64,596 individuals in Danish nationwide registries who had incident VTE from 1996 to 2016. These individuals were compared with a cohort of 322,999 individuals from the general population. Study participants were followed for three years.
Depression was defined as any hospital diagnosis of depression or one or more prescriptions for an antidepressant. In all, depression occurred in 6,225 individuals from the VTE cohort and 16,363 in the comparison cohort. This translated to an incidence rate of 44.4 per 1,000 years in the VTE cohort compared with 19.4 per 1,000 years in the comparison group.
Risk for depression was 2.35-fold greater in the VTE group compared with the general population. The absolute risk for depression was 10.3% for the VTE cohort compared with 5.6% in the comparison cohort.
Ms. Jørgensen said the researchers were not that surprised to find an association between VTE and depression, but “were surprised, however, to find that depression occurred so frequently, with one in every 10 [patients who experienced VTE] being affected within three years after the VTE.”
These results indicate the need for clinicians to more intentionally assess the mental health consequences of VTE, so that, in the long term, they can offer targeted and integrated treatment for patients who are at increased risk of adverse mental health outcomes.
“The knowledge-based information on the psychological impact of VTE that is available for patients and their next of kin, today, is very scarce,” Ms. Jørgensen said. “Our findings will help to improve the understanding of the mental health burden of VTE and provide both health care professionals and patients with more adequate information on how it is to live with a VTE.”
A better understanding of which patients are at greatest risk of adverse mental health outcomes will also help both medical practitioners and patients make evidence-based decisions regarding risk, prevention, and follow-up after a VTE, Ms. Jørgensen added.
Researchers mentioned several limitations of their study, including a lack of data on the quality and outcomes of post-VTE care, as well as information on recurrence, post-thrombotic syndrome, or post-PE syndrome.
“Importantly, not only do mental health challenges impact the health-related treatment burden of VTE, they may also have a major impact on society through increased use of welfare needs, reduced working capacity, and reduced taxation revenue,” Ms. Jørgensen said. “If we can improve the mental health in [patients who experienced VTE], it may not only reduce the demand for health and welfare services, but also increase participation in the labor market, and thereby ease the economic and health care burden of VTE in society.”
Any conflicts of interest declared by the authors can be found in the original article.
Reference
Jørgensen H, Horváth-Puhó E, Laugesen K, Brækkan SK, Hansen J-B, Sørensen HT. Venous thromboembolism and risk of depression: a population-based cohort study. J Thromb Haemost. 2022;S1538-7836(22):18244-18249.
