The potential of psychological intervention to decrease the risk of anxiety and depression in pulmonary fibrosis.

BACKGROUND

Emotional distress in pulmonary fibrosis remains under-recognised and poorly addressed. This study assessed changes in anxiety and depressive symptoms following an individualised psychological intervention.

METHODS

Single-centre, single-arm before-and-after observational study of an individualised psychological intervention delivered in routine ILD care, combining acceptance and commitment therapy, humanistic-existential techniques, and psychophysiological interventions. Anxiety and depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS) before and after the intervention. Patient- and caregiver-reported experience measures (PREMs) were collected. Response was analysed across characteristics defined before any analysis of outcome data (age, sex, disease severity [ILD-GAP], frailty [CFS], time since diagnosis, and baseline HADS).

RESULTS

Thirty patients were included (50.0% women; mean age 71.0 years). At baseline, 76.7% scored ≥8 on HADS-anxiety and 76.7% on HADS-depression, indicatingclinically relevant symptom risk. Six patients discontinued (lung transplantation, palliative care, or death; n = 2 each). Among 24 evaluable patients, mean HADS-anxiety decreased from 11.3 to 6.6 (mean difference 4.7; 97.5% CI 2.6-6.9; p < 0.001) and HADS-depression from 10.7 to 5.5 (mean difference 5.2; 97.5% CI 3.2-7.2; p < 0.001). HADS-anxiety score improved in 19 patients, was unchanged in 3 and worsened in 2; HADS-depression score improved in 20, was unchanged in 2 and worsened in 2. No patient worsened in HADS category. No differences in response were detected by age, sex, disease severity, frailtyor time since diagnosis. Patient- and caregiver-reported experience scores were high (totalscore 9.4 [SD 0.7] in patients and 9.5 [SD 0.7] in caregivers).

CONCLUSION

In this uncontrolled study, an individualised psychological intervention was associated with reduced anxiety and depressive symptoms and a lower proportion of patients at risk of clinically relevant anxiety and depression in pulmonary fibrosis. These findings suggest the potential of psychological care within routine ILD follow-up and require confirmation in randomised controlled trials.