• Mary McGrae McDermott, Philip Greenland, Jack M Guralnik, Kiang Liu, Michael H Criqui, William H Pearce, Cheeling Chan, Joseph Schneider, Leena Sharma, Lloyd M Taylor, Adnan Arseven, Maureen Quann, and Lillian Celic.
• Department of Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA. mdm608@northwestern.edu
• J Gen Intern Med. 2003 Jun 1; 18 (6): 461467461-7.

ObjectiveFactors associated with impaired functioning in patients with lower extremity peripheral arterial disease (PAD) are not fully understood. The purpose of this study was to determine the relationship between depressive symptoms and objective measures of lower extremity functioning in persons with PAD.DesignCross-sectional.Patients/ParticipantsFour hundred twenty-three men and women with PAD identified from 3 Chicago area medical centers.Measurements And Main ResultsPAD was defined as ankle brachial index (ABI) <0.90. The Geriatric Depression Scale short form (GDS-S) (0-15 scale, 15 = worst) was completed by all participants. A clinically significant number of depressive symptoms was defined as a GDS-S score >or=6. Six-minute walk distance and usual-and fast-pace walking velocity were determined for all participants. A GDS-S score >or=6 was present in 21.7% of participants with PAD. Adjusting for age, increasing numbers of depressive symptoms were associated with an increasing prevalence of leg pain on exertion and rest (P =.004). Adjusting for age, sex, race, ABI, number of comorbidities, current smoking, and antidepressant medications, increasing numbers of depressive symptoms were associated with shorter 6-minute walk distance (P <.001), slower usual-pace walking velocity (P =.005), and slower fast-pace walking velocity (P =.005). These relationships were attenuated slightly after additional adjustment for presence versus absence of leg pain on exertion and rest and severity of exertional leg symptoms.ConclusionsAmong men and women with PAD, the prevalence of a clinically significant number of depressive symptoms is high. Greater numbers of depressive symptoms are associated with greater impairment in lower extremity functioning. Further study is needed to determine whether identifying and treating depressive symptoms in PAD is associated with improved lower extremity functioning.

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