Depression and Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease

Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-0111, USA.
The American journal of medicine (Impact Factor: 5). 08/2009; 122(8):778.e9-15. DOI: 10.1016/j.amjmed.2009.01.036
Source: PubMed


Prior research on the risk of depression in chronic obstructive pulmonary disease (COPD) has yielded conflicting results. Furthermore, we have an incomplete understanding of how much depression versus respiratory factors contributes to poor health-related quality of life.
Among 1202 adults with COPD and 302 demographically matched referents without COPD, depressive symptoms were assessed using the 15-item Geriatric Depression Score. We measured COPD severity using a multifaceted approach, including spirometry, dyspnea, and exercise capacity. We used the Airway Questionnaire 20 and the Physical Component Summary Score to assess respiratory-specific and overall physical quality of life, respectively.
In multivariate analysis adjusting for potential confounders including sociodemographics and all examined comorbidities, COPD subjects were at higher risk for depressive symptoms (Geriatric Depression Score >or=6) than referents (odds ratio [OR] 3.6; 95% confidence interval [CI], 2.1-6.1; P <.001). Stratifying COPD subjects by degree of obstruction on spirometry, all subgroups were at increased risk of depressive symptoms relative to referents (P <.001 for all). In multivariate analysis controlling for COPD severity as well as sociodemographics and comorbidities, depressive symptoms were strongly associated with worse respiratory-specific quality of life (OR 3.6; 95% CI, 2.7-4.8; P <.001) and worse overall physical quality of life (OR 2.4; 95% CI, 1.8-3.2; P <.001).
Patients with COPD are at significantly higher risk of having depressive symptoms than referents. Such symptoms are strongly associated with worse respiratory-specific and overall physical health-related quality of life, even after taking COPD severity into account.

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Available from: Theodore A Omachi
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    • "This further emphasizes the importance of respiratory symptoms in overall health. In another study, individuals with mild obstruction were more likely to have depressive symptoms than adults without obstruction [4]. Unfortunately, data regarding respiratory symptoms was not included in that analysis. "
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    ABSTRACT: We examined the association of impaired lung function and respiratory symptoms with measures of health status and health-related quality of life (HRQOL) among US adults. The sample included 5139 participants aged 40--79 years in the National Health and Nutrition Examination Survey 2007--2010 who underwent spirometric testing and responded to questions about respiratory symptoms, health status, and number of physically unhealthy, mentally unhealthy, or activity limitation days in the prior 30 days. Among these adults, 7.2% had restrictive impairment (FEV1/FVC >= 70%; FVC < 80% of predicted), 10.9% had mild obstruction (FEV1/FVC < 70%; FEV1 >= 80% predicted), and 9.0% had moderate--severe obstruction (FEV1/FVC < 70%; FEV1 < 80% predicted). Individuals with restrictive impairment or moderate--severe obstruction were more likely to report fair/poor health compared to those with normal lung function (prevalence ratio (PR) =1.5 [95% CI: 1.2-1.9] and 1.5 [1.3-1.8]), after controlling for sociodemographics, non-respiratory chronic diseases, body mass index, smoking, and respiratory symptoms. Frequent mental distress (FMD; >=14 mentally unhealthy days), frequent physical distress (FPD; >=14 physically unhealthy days), and frequent activity limitation (FAL; >=14 activity limitation days) did not differ by lung function status. Adults who reported any respiratory symptoms (frequent cough, frequent phlegm, or past year wheeze) were more likely to report fair/poor health (PR = 1.5 [1.3-1.7]), FPD (PR = 1.6 [1.4-1.9]), FMD (PR = 1.8 [1.4-2.2]), and FAL (PR = 1.4 [1.1-1.9]) than those with no symptoms. These results suggest the importance of chronic respiratory symptoms as potential risk factors for poor HRQOL and suggest improved symptom treatment and prevention efforts would likely improve HRQOL.
    Full-text · Article · Sep 2013 · BMC Public Health
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    • "depression and anxiety) and their ADO index. Patients with COPD are at significantly higher risk of having depressive symptoms and their depression is associated with exacerbations of COPD and increased COPD-related hospitalization [38,39]. Moreover, anxiety is reportedly involved in diminished exercise performance, lower quality of life, and shortness of breath [13,40]. "
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    ABSTRACT: Patients with chronic obstructive pulmonary disease (COPD) often have organ dysfunction and resulting poor quality of life; however, in China little information is available regarding factors that affect their health. Here, the relationship between risk factors, activities and psychological disorders and health of patients with COPD in rural areas of Xuzhou, China was assessed. A cross-sectional study of 7597 COPD patients randomly selected by place of residence from 24,641 COPD patients who had been identified by screening of the 1.10 million health records of all residents of the target area was carried out to evaluate the relationships between risk factors, activities, psychological disorders and the ADO index (age, dyspnea, and airflow obstruction). The participants were assessed by spirometry and by administering a newly designed face-to-face questionnaire, which included items on general factors, risk factors, activities and psychological disorders. Correlations between the ADO index and the items addressed by the questionnaire were calculated. The mean score of the ADO index was 3.7 +/- 1.6. The ADO indices of current smokers, ex-smokers, and non-smokers were 3.9 +/- 2.1, 3.7 +/- 1.9, and 3.2 +/- 1.5, respectively (P < 0.001). The ADO indices of cooks and non-cooks were 4.0 +/- 2.2 and 3.5 +/- 1.7, respectively (P < 0.001). The correlation coefficient between self-assessment of health status and ADO index was 0.976 (P < 0.001). Only 5.7% of patients reported no limitation of their daily living activities. The correlation coefficient between daily living activities and ADO index was 0.981 (P < 0.001). Only 5.5% of patients reported no limitation of social activities. The correlation coefficient between social activities and ADO index was 0.989 (P < 0.001), between the assessed anxiety score and ADO index 0.972 (P < 0.001), and between the assessed depression score and ADO index 0.989 (P < 0.001). COPD severity was significantly correlated with behavior (especially regarding smoking and cooking with biofuel in confined spaces), physical strength, daily living activities, social activities, anxiety and depression. Comprehensive approaches are required for the prevention and treatment of COPD.
    Full-text · Article · Jul 2013 · BMC Public Health
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    • "Chronic airway occlusion, as occurs in diseases such as chronic obstructive pulmonary disease, has been implicated in an increased incidence of anxiety and depression (Di Marco et al., 2006; Omachi et al., 2009). In the present study, several genes were found to be significantly altered following tracheal occlusions that play important roles in the development of depressive and other psychological disorders. "
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