The study, led by Yan Lin and Liqin Wang of Zhongshan Hospital of Xiamen University together with colleagues in Xiamen and Guangzhou, was published in Frontiers in Medicine. It used a sequential explanatory mixed-methods design, meaning the researchers first ran a structured quantitative survey and then dug into the reasons behind the statistical patterns with in-depth interviews. In the quantitative phase, 175 patients treated with anticoagulants for confirmed lower-extremity deep vein thrombosis completed a battery of validated questionnaires, including the seven-item Generalized Anxiety Disorder scale, known as GAD-7, the Brief Illness Perception Questionnaire, and the Multidimensional Scale of Perceived Social Support.

The results were striking. Using the standard clinical cut-off of a GAD-7 score of 10 or higher, 72 of the 175 participants, or 41.1 percent, screened positive for clinically significant anxiety symptoms, with a 95 percent confidence interval spanning 33.9 to 48.6 percent. The severity distribution told its own story: just over a fifth of patients fell in the minimal range, about 37 percent were mildly anxious, 28 percent moderately anxious, and 13 percent severely anxious. That means more than four in ten patients were carrying anxiety heavy enough to interfere with daily life, a figure that roughly triples what is seen in the general population and aligns with earlier reports that around half of venous thromboembolism patients experience substantial psychological distress.

When the researchers ran a multivariable logistic regression designed around a prespecified conceptual framework, four factors emerged as independently associated with anxiety. Younger patients were more vulnerable, with each additional year of age reducing the odds by about five percent. Patients who viewed their illness in more threatening terms scored higher on illness perception and had dramatically elevated odds of anxiety; expressed per one-standard-deviation increase, a more negative illness perception was associated with nearly seven-fold higher odds. Lower perceived social support worked in the opposite direction, nearly halving the odds with each standard-deviation rise. And one finding stood out as genuinely novel: patients who recalled receiving adequate structured counselling at the moment of diagnosis had 58 percent lower odds of anxiety than those who did not, an odds ratio of 0.42.

That counselling finding deserves unpacking, because it shifts the framing of post-DVT anxiety from an inevitable emotional consequence of a frightening disease to a potentially preventable failure of communication. The team assessed counselling quality using an eight-item checklist that recorded whether patients remembered receiving explanations about the nature and causes of DVT, the warning signs of pulmonary embolism, recurrence risk, bleeding risk, the planned duration of anticoagulation, post-thrombotic syndrome, written educational materials, and an opportunity to ask questions with confirmation of understanding. Only 56 percent of patients met the a priori threshold of adequate counselling, defined as six or more items, and the interviews suggested why the gap matters so much.

In the qualitative phase, the researchers purposively selected 15 participants spanning a maximum-variation matrix of age, sex, anxiety severity, clot extent, and counselling adequacy, and conducted 30-to-50-minute semi-structured interviews analyzed with the six-phase thematic analysis framework of Braun and Clarke. Thematic saturation was reached by the twelfth interview and confirmed with three more. Five overarching themes emerged: fear of complications, treatment-related anxiety, role and functional impairment, information delivery and illness meaning-making, and insufficient emotional and social support. The patients’ own words were often stark. One 65-year-old woman recalled, “The doctor said the clot could move to my lung and kill me at any time. I dare not turn over or walk.” A 24-year-old patient remembered only a fragment of her diagnosis conversation: “I only remembered the word ‘fatal’. After that, every small discomfort made me think I might die.”

The interviews also revealed anxieties that no blood test or ultrasound captures. Patients on warfarin described a constant vigilance about bleeding, with one man saying, “I’m afraid to bump into anything; even a small cut makes me panic.” Others described a corrosive uncertainty about how long treatment would last, with one participant asking, “No one tells me when I can stop medicine. I keep thinking: will it come back?” Perhaps most poignantly, patients described how a swollen leg became an object of obsessive self-monitoring. “Every time my leg becomes swollen, I start checking whether it is another clot. I cannot focus on anything else,” one patient on sick leave explained. Younger participants in particular described the identity shock of moving from family provider to dependent, with financial pressure and interrupted careers amplifying the fear.

The researchers integrated the two strands of evidence in a joint display linking each statistical association to its lived-experience explanation. Younger age mapped onto disrupted work, finances, and family roles; threatening illness perception onto catastrophic beliefs about pulmonary embolism, recurrence, bleeding, and post-thrombotic syndrome; low social support onto the buffering power of family and the unmet need for clinician empathy; and inadequate counselling onto fragmented or frightening risk communication that left patients googling their symptoms at night. The authors anchor this in Leventhal’s Common-Sense Model of Self-Regulation, in which threatening cognitive and emotional representations of illness generate distress, and note the echo of earlier qualitative work describing a “post-thrombotic panic syndrome.” They are careful, however, to flag that the cross-sectional design means causality cannot be established; it is even possible that current anxiety colors how patients remember the counselling they received at diagnosis.

The clinical implications are concrete and, remarkably, inexpensive. The authors recommend routine GAD-7 screening at diagnosis and follow-up visits, with particular attention to younger patients, those with threatening illness perceptions, and those reporting weak social support. They propose structured use of a counselling checklist paired with written materials and teach-back, a technique in which patients repeat critical information in their own words to confirm understanding. They call for referral pathways to psychological services for patients with significant symptoms, and for return-to-work guidance and family involvement in care planning, especially for younger patients facing financial and role disruption. These recommendations align with the broader movement toward value-based, patient-centred venous thromboembolism care championed by the International Consortium for Health Outcomes Measurement, which argues that outcomes beyond death, recurrence, and bleeding, including quality of life and psychosocial well-being, belong at the center of treatment.

Like all single-centre studies, this one carries caveats. It was conducted at one general hospital in China between August 2024 and May 2025, so generalizability to other health systems and cultures is uncertain. Patients with severe pre-existing psychiatric illness were excluded, which may mean the true prevalence of anxiety in the broader DVT population is even higher. The study also could not distinguish new-onset, DVT-related anxiety from anxiety that predated the clot. Yet even with those limitations, the message lands with unusual force: a blood thinner prescription treats the clot, but it does nothing for the terror of a patient who does not understand what warning signs to watch for, when the medication ends, or whether he will ever trust his own leg again. As one patient put it simply, “I need someone to comfort me, not just list risks.” If two in five patients are anxious and better counselling at diagnosis could cut that burden substantially, then a checklist, a printed sheet, and a few extra minutes of empathetic explanation may be among the cheapest mental health interventions in all of medicine.

Subject of Research: Prevalence, associated factors, and lived experiences of anxiety in patients with lower-extremity deep vein thrombosis

Article Title: Anxiety in patients with lower-extremity deep vein thrombosis: a patient-centred sequential explanatory mixed-methods study of prevalence, associated factors, and patient experiences

Article References: Anxiety in patients with lower-extremity deep vein thrombosis: a patient-centred sequential explanatory mixed-methods study of prevalence, associated factors, and patient experiences. (n.d.). https://doi.org/10.3389/fmed.2026.1933822

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1933822

Keywords: deep vein thrombosis, anxiety, GAD-7, illness perception, social support, mixed-methods study, patient-reported outcomes, counselling, anticoagulation, venous thromboembolism, psychosocial care, risk communication