Ng, T. P., Niti, M., Tan, W. C., Cao, Z., Ong, K. C. & Eng, P. Depressive symptoms and chronic obstructive pulmonary disease: Effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Arch. Intern. Med. 167, 60-67

Tan Tock Seng Hospital, Tumasik, 00, Singapore
Archives of Internal Medicine (Impact Factor: 17.33). 02/2007; 167(1):60-7. DOI: 10.1001/archinte.167.1.60
Source: PubMed


Depressive symptoms are common among patients with chronic obstructive pulmonary disease (COPD), but depression's impact on COPD outcomes has not been fully investigated. We evaluated the impact of comorbid depression on mortality, hospital readmission, smoking behavior, respiratory symptom burden, and physical and social functioning in patients with COPD.
In this prospective cohort study, 376 consecutive patients with COPD hospitalized for acute exacerbation were followed up for 1 year. The independent associations of baseline comorbid depression (designated as a Hospital Anxiety and Depression Scale score of > or =8) with mortality, hospital readmission, length of stay, persistent smoking, and quality of life (determined by responses to the St George Respiratory Questionnaire) were evaluated after adjusting for potential confounders.
The prevalence of depression at admission was 44.4%. The median follow-up duration was 369 days, during which 57 patients (15.2%) died, and 202 (53.7%) were readmitted at least once. Multivariate analyses showed that depression was significantly associated with mortality (hazard ratio, 1.93; 95% confidence interval, 1.04-3.58), longer index stay (mean, 1.1 more days; P = .02) and total stay (mean, 3.0 more days; P = .047), persistent smoking at 6 months (odds ratio, 2.30; 95% confidence interval, 1.17-4.52), and 12% to 37% worse symptoms, activities, and impact subscale scores and total score on the St George Respiratory Questionnaire at the index hospitalization and 1 year later, even after controlling for chronicity and severity of COPD, comorbidities, and behavioral, psychosocial, and socioeconomic variables.
Comorbid depressive symptoms in patients with COPD are associated with poorer survival, longer hospitalization stay, persistent smoking, increased symptom burden, and poorer physical and social functioning. Interventions that reduce depressive symptoms may potentially affect COPD outcomes.

    • "Patients suffering from COPD reported that the severity of depressive symptoms was one of the largest negative influences on their quality of life [7]. MDD and depressive symptom severity are associated with increased persistent smoking, higher exacerbation frequency, longer hospitalization, decreased physical and social functioning and higher mortality [8] [9] [10]. Given these negative effects of a comorbid MDD in COPD patients, the adequate treatment of MDD is of key importance . "
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    ABSTRACT: Objective: Earlier studies found chronic nonspecific lung disease (CNSLD) to be associated with depressive symptoms. We aimed to assess whether the association between CNSLD and depressive symptoms varies between ethnic groups. Methods: We used questionnaire data from 10916 participants of the HELIUS study in Amsterdam from six different ethnic groups. We applied logistic regression analysis to determine the association between CNSLD and depressive symptoms and interaction terms to test whether this association varied between ethnic groups. Results: CNSLD prevalence was higher among South-Asian Surinamese, Turkish and Moroccans (10.1% to 12.5%) than African Surinamese, Dutch and Ghanaians (4.8% to 6.3%). The prevalence of depressive symptoms was higher among participants with CNSLD (28.4% vs. 13.7%). This association was not significantly different between ethnic groups. The absolute prevalence of depressive symptoms was higher among the CNSLD patients from ethnic minority groups (19.2 % to 35.6%) as compared with the Dutch-origin majority group (11.2%). Conclusions: CNSLD is associated with a high risk of depressive symptoms, especially among the five ethnic minority groups. These results imply a need to monitor the mental health of CNSLD patients in particular when a patient is from an ethnic minority group.
    No preview · Article · Sep 2015 · General hospital psychiatry
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    • "COPD patients with panic attacks or panic disorder rate their intensity of dyspnoea in response to inspiratory resistive loads significantly higher than COPD patients without panic and healthy age-matched controls (Giardino et al., 2010; Livermore et al., 2008). This finding is important because anxious and depressive symptoms and disorders are common in COPD, and they increase suffering, morbidity, utilisation of health services, and even mortality (Abrams et al., 2011; Celli and MacNee, 2004; Divo et al., 2012; Kunik et al., 2005; Ng et al., 2007). Once distressed psychological states develop they may increase ventilation and worsen perceived dyspnoea to a degree that is disproportionate to impairment in lung function, so creating a vicious cycle of increasing disability (Chida et al., 2008; de Voogd et al., 2011; Parshall et al., 2012; Smoller et al., 1996). "
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    ABSTRACT: There is evidence that psychological factors contribute to the perception of increased difficulty of breathing in patients with chronic obstructive pulmonary disease (COPD), and increase morbidity. We tested the hypothesis that cognitive behaviour therapy (CBT) decreases ratings of perceived dyspnoea in response to resistive loading in patients with COPD. From 31 patients with COPD, 18 were randomised to four sessions of specifically targeted CBT and 13 to routine care. Prior to randomisation, participants were tested with an inspiratory external resistive load protocol (loads between 5-45 cmH20/L/s). Six months later we re-measured perceived dyspnoea in response to the same inspiratory resistive loads and compared results to measurements prior to randomisation. There was a significant 17% reduction in dyspnoea ratings across the loads for the CBT group, and no reduction for the routine care group. The decrease in ratings of dyspnoea suggests that CBT to alleviate breathing discomfort may have a role in the routine treatment of people with COPD. Copyright © 2015. Published by Elsevier B.V.
    Full-text · Article · Jun 2015 · Respiratory Physiology & Neurobiology
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    • "Major mood disorders are increasingly recognized as leading causes of the worldwide burden of disease and disability (Ferrari et al., 2013; Murray and Lopez, 1996; Ustun, 2004; World Health Organization, 2012). In addition to morbidity, disability and costs, depression in unipolar major depressive disorder (UD) and as a major component of bipolar disorders (BDs) also increases mortality associated with other, cooccurring medical illnesses—notably including cardiovascular, endocrine and pulmonary diseases—in addition to its major contribution to risk of suicide and high levels of economic costs (Almeida et al., 2014; Fan et al., 2014; Miller et al., 2014; Ng et al., 2007; Osby et al., 2001; Tondo et al., 2007; Van der Kooy et al., 2007; Wulsin and Singal, 2003; Schaffer et al., 2015). Danger from mood disorders owes to their prevalence, high rates of recurrences, and risks of sustained affective morbidity and disability (Hardeveld et al., 2013; Sutin et al., 2013). "
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    ABSTRACT: BACKGROUND: Long-term symptomatic status in persons with major depressive and bipolar disorders treated clinically is not well established, although mood disorders are leading causes of disability worldwide. AIMS: To pool data on long-term morbidity, by type and as a proportion of time-at-risk, based on published studies and previously unreported data. METHODS: We carried out systematic, computerized literature searches for information on percentage of time in specific morbid states in persons treated clinically and diagnosed with recurrent major depressive or bipolar I or II disorders, and incorporated new data from one of our centers. RESULTS: We analyzed data from 25 samples involving 2479 unipolar depressive and 3936 bipolar disorder subjects (total N=6415) treated clinically for 9.4 years. Proportions of time ill were surprisingly and similarly high across diagnoses: unipolar depressive (46.0%), bipolar I (43.7%), and bipolar II (43.2%) disorders, and morbidity was predominantly depressive: unipolar (100%), bipolar-II (81.2%), bipolar-I (69.6%). Percent-time-ill did not differ between UP and BD subjects, but declined significantly with longer exposure times. CONCLUSIONS: The findings indicate that depressive components of all major affective disorders accounted for 86% of the 43-46% of time in affective morbidity that occurred despite availability of effective treatments. These results encourage redoubled efforts to improve treatments for depression and adherence to their long-term use
    Full-text · Article · Mar 2015 · Journal of Affective Disorders
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