Abstract
To the Editor
Sarcoidosis is a chronic multisystem granulomatous disorder of unknown aetiology that commonly affects the respiratory system. Western literature describes varying rates (18−60% prevalence) of depression in patients with sarcoidosis (Drent, 1998; Curtis and Borson, 2001; Westney, 2007). Direct neurological effects of sarcoidosis on the central nervous system, chronicity of the disease, and prolonged therapy are some of the factors hypothesized to be involved in the evolution of depression. This issue remains unexplored in developing countries. So we report the prevalence of depression in a cross-sectional sample of patients with sarcoidosis.
Our sample included 148 consecutive patients with mediastinal lymphadenopathy consulting a tertiary care general hospital in India between September 2009 and October 2011. Trans bronchial needle aspiration and biopsy (TBNA) of mediastinal lymph nodes was performed to ascertain the diagnosis of sarcoidosis. Rapid on-site evaluation (ROSE) of the specimen by the pathologist was used in all cases. Samples were subjected to both cytology and histological (if applicable) processing, by standard methods. Roentgenographic staging of sarcoidosis was conducted and a Hamilton depression rating scale (HDRS) was administered to all patients (Hamilton, 1960). Patients with a score 7 or more were considered to be ‘cases’ of depression (score of 8−13 was considered mild depression and 14−18 was categorized as moderate depression).
There were 63 (42.6%) males and 85 (57.4%) females. Age (mean ± SD) was 48.14±12.6 years. Mean duration of symptoms was found to be 3.3±2.1 months. Prevalence of depression was found to be 25.7 % (mild 23%, moderate 2.7%). Mean HDRS score was 10.5%, amounting to 25.7% depression in this sample.
Prevalence of depression in patients with sarcoidosis appears to be higher than that of the general population. To our knowledge, this is the first study in Asia to report prevalence of depression in sarcoidosis patients. Though, there are limitations (no structured interview was used to diagnose depression, no comparative sample from the general population/patients with other medical disorders), this study draws attention to an important clinical issue in consultation liaison psychiatry. Further prospective studies are urgently needed to study depression in sarcoidosis.