Prevalence of anxiety and depression in chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Yongjian ¹ ,  TIAN Xinlun ¹ , GUO Xiheng ² , WU Bin ³ , WANG Li ⁴ , WANG Shaoting ¹ , CAI Baiqiang ¹ ,  HAN Jiangna ¹

1. Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, P. R. China;
2. Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100730, P. R. China;
3. Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, P. R. China;
4. Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100730, P. R. China;

Corresponding author：

TIAN Xinlun, Email: xinlun_t@sina.com; HAN Jiangna, Email: 13520053104@139.com

Keywords：

Anxiety; Depression; Hospital Anxiety and Depression Scale; CAT score; Chronic obstructive pulmonary disease

DOI：

10.7507/1671-6205.202001049

Video：

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Objective To investigate prevalence of anxiety and depression in chronic obstructive pulmonary disease (COPD) in order to increase the awareness of physicians on this comorbidity.Methods Patients were from a multicenter prospective cohort study and 13 institutions or hospitals participated in the study. Four hundred and ten patients with a prior diagnosis of COPD were prospectively recruited from January 2017 to January 2019, and baseline date were analyzed. Hospital Anxiety and Depression Scale was used to identify anxiety and depression.Results The cohort had a mean age of (60.7±10.0) years with 76.8% males and 74.3% smokers. Seventy-nine patients (19.3%) had anxiety or depression. Among them, 36 subjects (8.8%) had anxiety, and 64 patients (15.6%) were with depression, and 21 patients (5.1%) with anxiety and depression. The prevalence of severe anxiety (2.7%) and severe depression (2.4%) was low. Compared to patients without anxiety or depression, patients with anxiety or depression had significantly higher CAT scores (17.8±9.3 with anxiety, 17.4±8.4 with depression, 12.5±7.3 without anxiety or depression, P 0.002 and 0.000 respectively). The risk of acute exacerbations was higher in patients with depression (37.5% vs. 22.7%, P=0.016). Proportion of patients categorized into GOLD group D was higher in patients with depression (P=0.001).Conclusions About 20% COPD patients has anxiety or depression. Prevalence of depression is two times that of anxiety. The prevalence of severe anxiety or severe depression is low. Patients with depression have lower quality of life, higher risk of acute exacerbations, and higher proportion of patients categorized into GOLD group D.

Citation： LIU Yongjian, TIAN Xinlun, GUO Xiheng, WU Bin, WANG Li, WANG Shaoting, CAI Baiqiang, HAN Jiangna. Prevalence of anxiety and depression in chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(5): 425-429. doi: 10.7507/1671-6205.202001049 Copy

1.	Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019. In, 2019.
2.	Yin P, Wang H, Vos T, et al. A Subnational Analysis of Mortality and Prevalence of COPD in China From 1990 to 2013: Findings From the Global Burden of Disease Study 2013. Chest, 2016, 150(6): 1269-1280.
3.	Zhong N, Wang C, Yao W, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med, 2007, 176(8): 753-760.
4.	Wang C, Xu J, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet, 2018, 391(10131): 1706-1717.
5.	Zhang MW, Ho RC, Cheung MW, et al. Prevalence of depressive symptoms in patients with chronic obstructive pulmonary disease: a systematic review, meta-analysis and meta-regression. Gen Hosp Psychiatry, 2011, 33(3): 217-223.
6.	Galic K, Dodaj A, Corluka-Cerkez V, et al. Study of depression and anxiety in patients with asthma and chronic obstructive pulmonary disease. Psychiatr Danub, 2019, 31(Suppl 1): 112-117.
7.	Phan T, Carter O, Waterer G, et al. Determinants for concomitant anxiety and depression in people living with chronic obstructive pulmonary disease. J Psychosom Res, 2019, 120: 60-65.
8.	Iyer AS, Holm KE, Bhatt SP, et al. Symptoms of anxiety and depression and use of anxiolytic-hypnotics and antidepressants in current and former smokers with and without COPD-A cross sectional analysis of the COPDGene cohort. J Psychosom Res, 2019, 118: 18-26.
9.	Stage KB, Middelboe T, Stage TB, et al. Depression in COPD--management and quality of life considerations. Int J Chron Obstruct Pulmon Dis, 2006, 1(3): 315-320.
10.	Martinez Rivera C, Costan Galicia J, Alcazar Navarrete B, et al. Factors associated with depression in COPD: a multicenter study. Lung, 2016, 194(3): 335-343.
11.	DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med, 2000, 160(14): 2101-2107.
12.	Miravitlles M, Molina J, Quintano JA, et al. Factors associated with depression and severe depression in patients with COPD. Respir Med, 2014, 108(11): 1615-1625.
13.	Sawalha S, Hedman L, Backman H, et al. The impact of comorbidities on mortality among men and women with COPD: report from the OLIN COPD study. Ther Adv Respir Dis, 2019, 13: 1753466619860058.
14.	Atlantis E, Fahey P, Cochrane B, et al. Bidirectional associations between clinically relevant depression or anxiety and COPD: a systematic review and meta-analysis. Chest, 2013, 144(3): 766-777.
15.	Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand, 1983, 67(6): 361-370.
16.	Xu W, Collet JP, Shapiro S, et al. Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. Am J Respir Crit Care Med, 2008, 178(9): 913-920.
17.	von Siemens SM, Jorres RA, Behr J, et al. Effect of COPD severity and comorbidities on the result of the PHQ-9 tool for the diagnosis of depression: results from the COSYCONET cohort study. Respir Res, 2019, 20(1): 30.
18.	Pooler A, Beech R. Examining the relationship between anxiety and depression and exacerbations of COPD which result in hospital admission: a systematic review. Int J Chron Obstruct Pulmon Dis, 2014, 9: 315-330.
19.	Montserrat-Capdevila J, Godoy P, Marsal JR, et al. Overview of the impact of depression and anxiety in chronic obstructive pulmonary disease. Lung, 2017, 195(1): 77-85.
20.	许银芳, 韩淑华, 林勇. 慢性阻塞性肺疾病患者合并焦虑/抑郁障碍的相关因素. 中国老年学杂志, 2012, 32: 3180-3182.
21.	Harryanto H, Burrows S, Moodley Y. A high COPD assessment test score may predict anxiety in COPD. BMC Psychiatry, 2018, 13: 955-957.
22.	Rosrita NN, Yunus F, Ginting TT, et al. Depression in patients with stable chronic obstructive pulmonary disease: a cross-sectional study in the national center for respiratory diseases in Indonesia. Pneumologia, 2016, 65(4): 197-200.

1. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019. In, 2019.
2. Yin P, Wang H, Vos T, et al. A Subnational Analysis of Mortality and Prevalence of COPD in China From 1990 to 2013: Findings From the Global Burden of Disease Study 2013. Chest, 2016, 150(6): 1269-1280.
3. Zhong N, Wang C, Yao W, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med, 2007, 176(8): 753-760.
4. Wang C, Xu J, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet, 2018, 391(10131): 1706-1717.
5. Zhang MW, Ho RC, Cheung MW, et al. Prevalence of depressive symptoms in patients with chronic obstructive pulmonary disease: a systematic review, meta-analysis and meta-regression. Gen Hosp Psychiatry, 2011, 33(3): 217-223.
6. Galic K, Dodaj A, Corluka-Cerkez V, et al. Study of depression and anxiety in patients with asthma and chronic obstructive pulmonary disease. Psychiatr Danub, 2019, 31(Suppl 1): 112-117.
7. Phan T, Carter O, Waterer G, et al. Determinants for concomitant anxiety and depression in people living with chronic obstructive pulmonary disease. J Psychosom Res, 2019, 120: 60-65.
8. Iyer AS, Holm KE, Bhatt SP, et al. Symptoms of anxiety and depression and use of anxiolytic-hypnotics and antidepressants in current and former smokers with and without COPD-A cross sectional analysis of the COPDGene cohort. J Psychosom Res, 2019, 118: 18-26.
9. Stage KB, Middelboe T, Stage TB, et al. Depression in COPD--management and quality of life considerations. Int J Chron Obstruct Pulmon Dis, 2006, 1(3): 315-320.
10. Martinez Rivera C, Costan Galicia J, Alcazar Navarrete B, et al. Factors associated with depression in COPD: a multicenter study. Lung, 2016, 194(3): 335-343.
11. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med, 2000, 160(14): 2101-2107.
12. Miravitlles M, Molina J, Quintano JA, et al. Factors associated with depression and severe depression in patients with COPD. Respir Med, 2014, 108(11): 1615-1625.
13. Sawalha S, Hedman L, Backman H, et al. The impact of comorbidities on mortality among men and women with COPD: report from the OLIN COPD study. Ther Adv Respir Dis, 2019, 13: 1753466619860058.
14. Atlantis E, Fahey P, Cochrane B, et al. Bidirectional associations between clinically relevant depression or anxiety and COPD: a systematic review and meta-analysis. Chest, 2013, 144(3): 766-777.
15. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand, 1983, 67(6): 361-370.
16. Xu W, Collet JP, Shapiro S, et al. Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. Am J Respir Crit Care Med, 2008, 178(9): 913-920.
17. von Siemens SM, Jorres RA, Behr J, et al. Effect of COPD severity and comorbidities on the result of the PHQ-9 tool for the diagnosis of depression: results from the COSYCONET cohort study. Respir Res, 2019, 20(1): 30.
18. Pooler A, Beech R. Examining the relationship between anxiety and depression and exacerbations of COPD which result in hospital admission: a systematic review. Int J Chron Obstruct Pulmon Dis, 2014, 9: 315-330.
19. Montserrat-Capdevila J, Godoy P, Marsal JR, et al. Overview of the impact of depression and anxiety in chronic obstructive pulmonary disease. Lung, 2017, 195(1): 77-85.
20. 许银芳, 韩淑华, 林勇. 慢性阻塞性肺疾病患者合并焦虑/抑郁障碍的相关因素. 中国老年学杂志, 2012, 32: 3180-3182.
21. Harryanto H, Burrows S, Moodley Y. A high COPD assessment test score may predict anxiety in COPD. BMC Psychiatry, 2018, 13: 955-957.
22. Rosrita NN, Yunus F, Ginting TT, et al. Depression in patients with stable chronic obstructive pulmonary disease: a cross-sectional study in the national center for respiratory diseases in Indonesia. Pneumologia, 2016, 65(4): 197-200.

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