Anxiety and Depression in Adults with Primary Immunodeficiencies (PID's)—How Much Do These Patients Experience and What Factors May Increase Patients' Risk?

Rationale: Primary Immunodeficiency (PID) is a rare group of disorders that manifest similarly with infection, neoplasms, allergic and autoimmune diseases and are treated with injectable medications.  Often the burden of disease and cost of management is excessive and premature death is not uncommon.  In light of above features of PID, it was our objective to survey our cohort to assess for additional morbidity from depression and anxiety.

Methods: We used an investigator-administered survey, the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale, after IRB approval, to determine the extent of anxiety and depression, as compared to the general public, that our PID patients experienced. The differences between groups were tested using Wilcoxon Rank Sum tests, Kruskal Wallis tests, and Chi-square tests.

Results: Patients with PID had significantly increased depression compared to normal populations, as assessed by the Hamilton Depression Rating (HAM-D) scale. Risk factors associated with significantly elevated HAM-D scores included: not driving, intravenous immunoglobulin therapy (vs. subcutaneous), nurse-administered therapy (vs. self-administered), having unpleasant side effects from therapy, previously attempting suicide, and having family members with reported anxiety and/or depression. Anxiety was also significantly increased in our cohort. Risk factors for significantly elevated HAM-A scores included: having poor health, an unhealthy diet, lack of refreshing sleep, and family members with reported anxiety and/or depression.

Conclusions: Depression and anxiety add to the morbidity of PID; patients should be assessed for depression and anxiety, and treatment or referrals should be initiated to improve our patients’ quality of life and outcomes.