A Cross-Sectional Study of Prevalence of Depression and Anxiety among Patients with Peripheral Arterial Occlusive Disease and its Correlation with Disease Severity

Peripheral Arterial Occlusive Disease is a commonly occurring lifestyle disease, mostly associated with claudication pain, tissue death and in more severe cases, lower extremity amputation. The disease carries a global burden of more than 230 million people worldwide. Though it is widely prevalent in India, there is a lack of specific guidelines or recommendations for PAD management, which is due to lack of awareness, and also because majority of the focus shifts to treating coronary vascular disease as they have a higher percentage of prevalence. Major etiology involved is arteriosclerosis where build-up of plaque narrows the lumen of the artery. As a compensating mechanism, the artery continues to dilate, by after a point, the lumen becomes very narrow leading to reduced blood flow and subsequent ischemia. Other rare causes also include inflammation, injury, or radiation exposure.  Risk factors commonly seen are diabetes, smoking, hypertension, and hypercholesterolemia. The primary treatment goals include reducing further cardiovascular damage and improving the motility of the limb which is further aided by physiotherapy to enhance the ability of patient to walk. PAOD also remains largely undiagnosed and misdiagnosed, as clinicians consider the constant leg pain to be a part of normal ageing process, or misdiagnose it as arthritis or spinal degrative disease etc. This further can amplify the chances of underdiagnosing depression and anxiety in such patients. Since, the disease is known to have a prolonged treatment, multiple hospital visits, may involve surgical intervention, thereby leading to reduction in productivity, it potentially stirs up various mental health issues like depression and anxiety. Both suspected and diagnosed PAOD patients have substantially higher levels of depression and anxiety symptoms, and often report poor results in Health related quality of life scale. Anxiety and depression is widespread among PAOD patients and often goes undiagnosed by their primary physician. The major obstacle to physical activity among patients with intermittent claudication are pain post daily activity and the presence of other co-morbidities. This study will assess the prevalence of depression and anxiety in POAD patients. Furthermore, severity of POAD using the Fontaine classification will be corelated with depression and anxiety severity scale using PHQ9 and GAD7 respectively. Fontaine staging of POAD is a commonly used scale in clinical research and categorizes patients in total 4 stages. Stage I is Asymptomatic, Stage IIa is pain free, but claudication on more than 200 m, Stage IIb is pain-free but claudication on less than 200m, Stage III is Rest/Nocturnal pain, Stage IV is Necrosis or Gangrene. PHQ9 and GAD7 are WHO approved, easy to use questionnaire based self assessment forms used to assess the prevalence of depression and anxiety respectively. No such study has previously been done in a tertiary setup in coastal Karnataka and will be the first of its kind. The coast is mostly inhabited with fishermen, farmers, rural workers, belonging to lower class, lower and upper middle class, comprising of mostly of people having a direct impact on their wages and livelihood when diagnosed with POAD, thereby making them more prone to developing anxiety and depression.  Patients from lower socioeconomic classes as well as women, are predisposed to have fewer attempts at revascularization, they mostly undergo major amputation and hence are at a higher risk to suffer a major complication postoperatively. These variations in limb preservation outcomes and unequal access to healthcare highlight the urgent need for a holistic umbrella approach to tackle psychosocial and mental health burden of individuals with POAD. This study will not only help address the problem at large, but also spread awareness among people affected and encourage them to seek treatment.