Thromb Haemost 2009; 102(06): 1219-1226
DOI: 10.1160/TH09-05-0316
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Association of fatigue and psychological distress with quality of life in patients with a previous venous thromboembolic event

Paul S. Lukas
1   Department of General Internal Medicine, Bern University Hospital, Inselspital, and University of Bern, Switzerland
,
René Krummenacher
1   Department of General Internal Medicine, Bern University Hospital, Inselspital, and University of Bern, Switzerland
,
Franziska Demarmels Biasiutti
2   University Clinic of Hematology and Central Hematology Laboratory, Bern University Hospital, Inselspital, and University of Bern, Switzerland
,
Stefan Begré
1   Department of General Internal Medicine, Bern University Hospital, Inselspital, and University of Bern, Switzerland
,
Hansjörg Znoj
3   Clinical Psychology and Psychotherapy, University of Bern, Switzerland
,
Roland von Känel
1   Department of General Internal Medicine, Bern University Hospital, Inselspital, and University of Bern, Switzerland
› Author Affiliations
Further Information

Publication History

Received: 18 May 2009

Accepted after major revision: 08 July 2009

Publication Date:
28 November 2017 (online)

Summary

Health-related quality of life (QoL) has been associated with several social and medical conditions in patients with deep vein thrombosis (DVT) and pulmonary embolism (PE).To the best of our knowledge,there is no study investigating the relationship of QoL with psychological variables in this patient population.We assumed as a hypothesis an association between heightened levels of fatigue and psychological distress, as well as decreased QoL in patients with an objectively diagnosed venous thromboembolic event. Study participants were 205 consecutively enrolled out-patients (47.4 years, 54.6% men) with DVT and/or PE. Approximately 10 days before blood collection for thrombophilia work-up, QoL, fatigue, and psychological distress were assessed using the Short Form Health Survey (SF-12), the Multidimensional Fatigue Symptom Inventory Short Form (MFSI-SF) as well as the Hospitality Anxiety and Depression scale (HADS). After controlling for demographic and medical factors, fatigue (p<0.01) but not psychological distress (p>0.05) was negatively associated with physical QoL, explaining 11.0% of the variance. Fatigue (p<0.001) and psychological distress (p<0.001) were significant predictors of mental QoL,explaining an additional 36.2% and 3.6% of the variance. Further analyses revealed that all subscales of the HADS (e.g. anxiety and depression) and of the MFSI-SF (e.g. general fatigue, physical fatigue, emotional fatigue, mental fatigue and vigor) were significant predictors of mental QoL. MFSI-SF subscales also predicted physical QoL. The findings suggest that fatigue and psychological distress substantially predict QoL in patients with a previous venous thromboembolic event above and beyond demographic factors.

 
  • References

  • 1 Cohen AT, Alikhan R, Arcelus JI. et al. Assessment of venous thromboembolism risk and the benefits of thromboprophylaxis in medical patients. Thromb Haemost 2005; 94 (04) 750-759.
  • 2 Cohen AT, Agnelli G, Anderson FA. et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98 (04) 756-764.
  • 3 Kroegel C, Reissig A. Principle mechanisms underlying venous thromboembolism: epidemiology, risk factors, pathophysiology and pathogenesis. Respiration 2003; 70 (01) 7-30.
  • 4 Meissner MH, Wakefield TW, Ascher E. et al. Acute venous disease: venous thrombosis and venous trauma. J Vasc Surg 2007; 46 Suppl S 25S-53S.
  • 5 Rosengren A, Freden M, Hansson PO. et al. Psychosocial factors and venous thromboembolism: a long-term follow-up study of Swedish men. J Thromb Haemost 2008; 06 (04) 558-564.
  • 6 Sakuma M, Nakamura M, Hanzawa K. et al. Acute pulmonary embolism after an earthquake in Japan. Semin Thromb Hemost 2006; 32 (08) 856-860.
  • 7 Watanabe H, Kodama M, Tanabe N. et al. Impact of earthquakes on risk for pulmonary embolism. Int J Cardiol 2008; 129 (01) 152-154.
  • 8 Kahn SR, Lamping DL, Ducruet T. et al. VEINESQOL/Sym questionnaire was a reliable and valid disease-specific quality of life measure for deep venous thrombosis. J Clin Epidemiol 2006; 59 (10) 1049-1056.
  • 9 Michota F. Venous thromboembolism: epidemiology, characteristics, and consequences. Clin Cornerstone 2005; 07 (04) 8-15.
  • 10 van Korlaar IM, Vossen CY, Rosendaal FR. et al. The impact of venous thrombosis on quality of life. Thromb Res 2004; 114 (01) 11-18.
  • 11 Kahn SR, Shbaklo H, Lamping DL. et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost 2008; 06 (07) 1105-1112.
  • 12 van Korlaar IM, Vossen C, Rosendaal F. et al. Quality of life in venous disease. Thromb Haemost 2003; 90 (01) 27-35.
  • 13 Kahn SR, Ginsberg JS. Relationship between deep venous thrombosis and the postthrombotic syndrome. Arch Intern Med 2004; 164 (01) 17-26.
  • 14 Kahn SR, Ducruet T, Lamping DL. et al. Prospective evaluation of health-related quality of life in patients with deep venous thrombosis. Arch Intern Med 2005; 165 (10) 1173-1178.
  • 15 Kahn SR, Elman EA, Bornais C. et al. Post-thrombotic syndrome, functional disability and quality of life after upper extremity deep venous thrombosis in adults. Thromb Haemost 2005; 93 (03) 499-502.
  • 16 Kahn SR, M'lan CE, Lamping DL. et al. Relationship between clinical classification of chronic venous disease and patient-reported quality of life: results from an international cohort study. J Vasc Surg 2004; 39 (04) 823-828.
  • 17 Ware Jr. J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34 (03) 220-233.
  • 18 Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30 (06) 473-483.
  • 19 Resnick B, Parker R. Simplified scoring and psychometrics of the revised 12-item Short-Form Health Survey. Outcomes Manag Nurs Pract 2001; 05 (04) 161-166.
  • 20 Salyers MP, Bosworth HB, Swanson JW. et al. Reliability and validity of the SF-12 health survey among people with severe mental illness. Med Care 2000; 38 (11) 1141-1150.
  • 21 Burdine JN, Felix MR, Abel AL. et al. The SF-12 as a population health measure: an exploratory examination of potential for application. Health Serv Res 2000; 35 (04) 885-904.
  • 22 Lundberg L, Johannesson M, Isacson DG. et al. The relationship between health-state utilities and the SF-12 in a general population. Med Decis Making 1999; 19 (02) 128-140.
  • 23 Macran S, Weatherly H, Kind P. Measuring population health: a comparison of three generic health status measures. Med Care 2003; 41 (02) 218-231.
  • 24 Herrmann C, Buss U, Snaith RP. HADS-D Hospital Anxiety and Depression Scale Deutsche Version: Ein Fragebogen zur Erfassung von Angst und Depressivität in der somatischen Medizin. Bern: Huber Verlag; 1995.
  • 25 Herrmann C. International experiences with the Hospital Anxiety and Depression Scale--a review of validation data and clinical results. J Psychosom Res 1997; 42 (01) 17-41.
  • 26 Stein KD, Martin SC, Hann DM. et al. A multidimensional measure of fatigue for use with cancer patients. Cancer Pract 1998; 06 (03) 143-152.
  • 27 Stein KD, Jacobsen PB, Blanchard CM. et al. Further validation of the multidimensional fatigue symptom inventory-short form. J Pain Symptom Manage 2004; 27 (01) 14-23.
  • 28 Faul F, Erdfelder E, Lang AG. et al. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39 (02) 175-191.
  • 29 Cohen J. Statistical Power Analysis for the Behavioral Sciences. 1 ed. Hillsdale: Lawrence Erlbaum Associates; 1969.
  • 30 Voller H, Taborski U, Dovifat C. et al. ProTime selfmanagement yielding improvement of fluency and quality of life. Thromb Haemost 2007; 98 (04) 889-895.
  • 31 Kucher N, Tapson VF, Goldhaber SZ. Risk factors associated with symptomatic pulmonary embolism in a large cohort of deep vein thrombosis patients. Thromb Haemost 2005; 93 (03) 494-498.
  • 32 Hedner E, Carlsson J, Kulich KR. et al. An instrument for measuring health-related quality of life in patients with Deep Venous Thrombosis (DVT): development and validation of Deep Venous Thrombosis Quality of Life (DVTQOL) questionnaire. Health Qual Life Outcomes 2004; 02: 30.
  • 33 Lamping DL, Schroter S, Kurz X. et al. Evaluation of outcomes in chronic venous disorders of the leg: development of a scientifically rigorous, patient-reported measure of symptoms and quality of life. J Vasc Surg 2003; 37 (02) 410-419.