Effect of Incident Pulmonary Arterial Hypertension on Risk of Newly-Diagnosed Mental Health Conditions

Pulmonary arterial hypertension (PAH) is a life-limiting disease with psychosocial burden, although US population-level estimates of incident mental health (MH) disorders remain limited. In this retrospective cohort study using Komodo Research Data (01/01/2016-03/31/2024), we evaluated the association between PAH diagnosis and risk of newly diagnosed MH conditions. Adults (≥ 18 years) with incident PAH were identified alongside a non-PAH control group. Among patients with PAH (N = 4005), the risks of newly diagnosed MH conditions were compared before and after the PAH diagnosis date (index date). Between-group comparisons of newly diagnosed MH conditions post-index used inverse probability weighting to balance PAH and non-PAH patients. Outcomes included 12-month cumulative incidence and hazard ratios (HRs) from Cox models for any MH condition and prespecified categories (anxiety, mood, sleep-wake, substance use). Post-diagnosis, the 12-month risk of any newly diagnosed MH condition nearly doubled compared with pre-diagnosis (48.1% vs 24.9%; HR: 2.29; p < 0.001). Post-diagnosis risks were also higher for sleep-wake (27.1% vs 11.5%; 2.59), anxiety-spectrum (11.4% vs 8.4%; 1.37), mood (9.7% vs 6.0%; 1.65), and opioid use disorders (1.5% vs 0.7%; 2.07; all p < 0.05). Compared with matched controls (N = 421,987), PAH patients had higher risks of any MH condition (39.5% vs 17.8%; HR: 2.57), anxiety (10.1% vs 6.5%; 1.58), mood (8.7% vs 5.3%; 1.68), and substance use disorders (5.2% vs 3.4%; 1.53; all p < 0.001). Adults with PAH experienced marked increases in newly diagnosed MH conditions after PAH onset and significantly higher risk than matched non-PAH controls, supporting routine MH screening and integrated, proactive MH care in PAH management.