Depression, Anxiety, and Quality of Life in Patients with Nontuberculous Mycobacterial Pulmonary Disease (NTM-PD) in the Southeastern United States

RATIONALE. Nontuberculous mycobacterial pulmonary disease (NTM-PD) has a high treatment burden, long treatment duration, and side effects that can impact quality of life (QOL). Anxiety and depression can be seen in NTM-PD patients, with prevalence of depression ranging 26-38% in patients with NTM-PD in Japan (Kakuta et al, 2020). The NTM Research Consortium has placed a priority on management of mental health challenges for patients with NTM-PD (Henkle et al., 2016). We aimed to describe and explore associations between depression, anxiety, QOL and other aspects of mental health for patients with NTM-PD in a multidisciplinary NTM clinical program. METHODS. During NTM clinic visits, patients completed the Patient Health Questionnaire-8 and Generalized Anxiety Questionnaire-7 to assess depression and anxiety, and were asked questions about current mental health treatment. Those with elevated mental health scores were referred for intervention by the team psychologist. Patients also completed the PROMIS single-item general self-rated health question (1 “Poor” to 5 “Excellent”;Hays et al., 2015), and a single-item QOL question, based on the CF-QOL (0 “Worst” to 10 “Best” in the past 2 weeks;Yohannes et al., 2011). Descriptive and correlational statistics were utilized. RESULTS. Patients with NTM-PD who completed screening (N = 50) were 66.6±9.4 years old (Table 1). Fifty-six percent had elevated (≥5) depression symptoms and 32% had elevated anxiety symptoms. Fifty percent (n = 25) of patients were on psychiatric medications at the time of screening, and 32% (n = 16) were taking medication to manage pain;only 6.0% (n = 3) were engaged in counseling/psychotherapy. Higher depression scores were significantly associated with lower perceptions of QOL (r =-.321, p = .025) and worse perceived general health (r =-.565, p < .001). Similarly, higher anxiety scores were significantly associated with lower perceptions of QOL (r =-.301, p = .035) and worse perceived general health (r =-.342, p = .016). CONCLUSIONS. A substantial proportion of patients with NTM-PD in our program experience depression and anxiety symptoms;these symptoms may affect treatment course, and therefore should be an area of focus. Optimization of quality of life and perceptions of health for patients with NTM-PD may benefit from incorporation of treatment of co-occurring mental health symptoms. Limitations of this QI project are our small, albeit growing, group of patients we have been able to screen during COVID-19, and need for tracking of mental health outcomes as they pertain to treatment/health outcomes.