With IRB approval, this was a prospective cohort study of adults presenting for a specialist evaluation of CRS, studied with two validated instruments: the Rhinosinusitis Symptom Inventory (RSI) and the Hospital Anxiety and Depression Scale. Since the correlation between anxiety and depression is high, we used established cutoff scores to construct 3 groups, each with 3 levels of symptoms: anxiety, depression, and the combination of anxiety and depression (combined psychopathology group) into Low, Moderate, and High (sensitive and specific for a DSM depression or anxiety disorder).

143 patients were studied (mean age, 43.4 years; 70.0% female). Low, moderate and high levels of anxiety were reported by 48.3%, 25.9% and 25.9% of patients. Low, moderate and high levels of depression were found in 76.2%, 9.1% and 14.7%. For the combined psychopathology group, 43.3%, 25.9%, and 30% were low, moderate, and high. High levels of anxiety, depression, or combined psychopathology were associated with significant elevations of the four symptom domains on the RSI: Nasal, Facial, Oropharyngeal, and Systemic (p<.05). High anxiety or High combined psychopathology were associated with more frequent physician visits (p<.05). High depression was associated with increased antibiotic utilization, missed workdays, and physician visits (p<0.05).

Both anxiety and depression are prevalent in patients undergoing evaluation for CRS. Both are significantly associated with amplified symptom presentation in CRS and are associated with increased healthcare utilization. Depression is associated with greater sinus symptoms and impairment than anxiety. Further identification of the role psychopathology plays in CRS and how anxiety and depression may impact treatment is needed.