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Ryu, Chun, Sim, and Lee: Depression and Anxiety in Outpatients with Chronic Obstructive Pulmonary Disease
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 62(1): 11-18.

Published online: 31 January 2007

DOI: https://doi.org/10.4046/trd.2007.62.1.11

Depression and Anxiety in Outpatients with Chronic Obstructive Pulmonary Disease

Yon Ju Ryu, M.D., Eun Mi Chun, M.D., Yun Su Sim, M.D., Jin Hwa Lee, M.D.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.

Address for correspondence: Eun Mi Chun, M.D. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongdaemun Hospital, Ewha Womans University, College of Medicine, Jongno 6-ga, Jongno-Ku, Seoul, Republic of Korea. Phone: (02) 760-5053, Fax: (02) 760-5193, cem@ewha.ac.kr

Received 29 September 2006       Accepted 14 December 2006

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

Patients with chronic obstructive pulmonary disease (COPD) have often been reported to suffer from depression and anxiety possibly due to the exacerbation, hospitalization and mortality of COPD. However,scarce data are available in Korea. This study assessed degree of depression and anxiety, and evaluated the factors associated with depressive symptoms in COPD.

Methods

The cross-sectional data on the lung function measurements, smoking behavior, body mass index (BMI), age, gender, depressive symptoms using Beck Depression Inventory (BDI) and anxiety using the State-Trait Anxiety Inventory (STAI) were evaluated in 72 outpatients with COPD and 50 controls without underling lung diseases from September, 2005 to October, 2006 in the Ewha medical center.

Results

1) The age, body mass index (BMI) and serum albumin levels were similar in the patients and controls. The BDI scores (16(0-37) vs. 12(1-30), p=0.001) and the prevalence of depression (36% vs. 6%, p<0.0001) were higher in the COPD patients than in the controls. In the COPD group, the prevalence of depression increased with increasing GOLD stage (p=0.008). The prevalence was 18%(4/22), in mild cases, 30%(6/20) in moderate cases, 52%(13/25) in severe cases and 60%(3/5) in very severe cases. 2) The SAI and TAI scores were higher in the COPD patients (44(20-67) and 47(20-66)) than in the healthy controls (39(26-65) and 44(33-90)). There were a significant correlation between the depression and anxiety scores (p<0.001). 3) A lower BMI, lower postbronchodilator FEV1, current smoking behavior and severity of COPD were univariately associated with the depressive group in COPD, 4) while multivariate logistic analysis revealed only the severe-to-very severe group (OR 3.9, 95% CI 1.2 to 12.9) to be independently associated with depressive symptoms.

Conclusion

COPD is strongly associated with depression and anxiety. Therfore, screening for psychological problems in COPD patients is essential, particularly in patients with severe-to-very severe COPD.

Keywords: Depression, Anxiety, Severity, Chronic obstructive pulmonary disease

Figures and Tables

Table 1
Demographic and clinical characteristics in general population and patients with chronic obstructive pulmonary disease (COPD), grouped according to Global Initiative for Chronic Obstructive Lung Disease staging.
trd-62-11-i001

Values are expressed as means±SD, medians (ranges) or frequencies (%).

*: When compared between COPD and general population.

#p value<0.05 when compared between mild-to-moderate and severe-to-very severe group of COPD

Table 2
Psychological status of depression and anxiety in general population and patients with chronic obstructive pulmonary disease (COPD), grouped according to Global Initiative for Chronic Obstructive Lung Disease staging.
trd-62-11-i002

Values are expressed as means±SD, medians (ranges) or frequencies (%).

*: When compared between COPD and general population.

#p value<0.05 when compared between mild-to-moderate and severe-to-very severe group of COPD

Table 3
Clinical characteristics of patients with chronic obstructive lung disease (COPD) with or without depression by the BDI scoring.
trd-62-11-i003

Values are expressed as means±SD, medians (ranges) or frequencies (%).

Table 4
Predictive factors of depression in patients with chronic obstructive lung disease (COPD).
trd-62-11-i004

References

1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet. 1997. 349:1498–1504.
2. Kim DS, Kim YS, Jung KS, Chang JH, Lim CM, Lee JH, et al. Prevalence of chronic obstructive pulmonary disease in Korea: a population-based spirometry survey. Am J Respir Crit Care Med. 2005. 172:842–847.
3. Dahlen I, Janson C. Anxiety and depression are related to the outcome of emergency treatment in patients with obstructive pulmonary disease. Chest. 2002. 122:1633–1637.
4. Gudmundsson G, Gislason T, Janson C, Lindberg E, Hallin R, Ulrik CS, et al. Risk factors for rehospitalisation in COPD: role of health status, anxiety and depression. Eur Respir J. 2005. 26:414–419.
5. Crockett AJ, Cranston JM, Moss JR, Alpers JH. The impact of anxiety, depression and living alone in chronic obstructive pulmonary disease. Qual Life Res. 2002. 11:309–316.
6. Stage KB, Middelboe T, Pisinger C. Depression and chronic obstructive pulmonary disease (COPD): impact on survival. Acta Psychiatr Scand. 2005. 111:320–323.
7. Light RW, Merrill EJ, Despars JA, Gordon GH, Mutalipassi LR. Prevalence of depression and anxiety in patients with COPD: relationship to functional capacity. Chest. 1985. 87:35–38.
8. Kunik ME, Roundy K, Veazey C, Souchek J, Richardson P, Wray NP, et al. Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest. 2005. 127:1205–1211.
9. Wagena EJ, Arrindell WA, Wouters EF, van Schayck CP. Are patients with COPD psychologically distressed? Eur Respir J. 2005. 26:242–248.
10. van Ede L, Yzermans CJ, Brouwer HJ. Prevalence of depression in patients with chronic obstructive pulmonary disease: a systematic review. Thorax. 1999. 54:688–692.
11. Borson S, Claypoole K, McDonald GJ. Depression and chronic obstructive pulmonary disease: treatment trials. Semin Clin Neuropsychiatry. 1998. 3:115–130.
12. Chung KH, Kim JH, Hah ES, Kim SJ, Lee KJ, Lee SH, et al. Frequency and clinical characteristics of depression and anxiety disorder in COPD patients. Tuberc Respir Dis. 2005. 59:Suppl 2. 62.
13. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961. 4:561–571.
14. Han HM, Yum TH, Shin YW, Kim KH, Yoon DJ, Chung KJ. A standardization study of back depression inventory in Korea. Neuropsychiatry. 1986. 25:487–498.
15. Spielberger CD, Gorsuch RL, Lushene RE. State-trait anxiety inventory for adults(form x). 1970. CA: Consulting Psychologistspress.
16. Chavannes NH, Huibers MJ, Schermer TR, Hendriks A, van Weel C, Wouters EF, et al. Associations of depressive symptoms with gender, body mass index and dyspnea in primary care COPD patients. Fam Pract. 2005. 22:604–607.
17. Gudmundsson G, Gislason T, Janson C, Lindberg E, Suppli Ulrik C, Brondum E, et al. Depression, anxiety and health status after hospitalisation for COPD: a multicentre study in the Nordic countries. Respir Med. 2006. 100:87–93.
18. van Manen JG, Bindels PJ, Dekker FW, Ijzermans CJ, van der Zee JS, Schade E. Risk of depression in patients with chronic obstructive pulmonary disease and its determinants. Thorax. 2002. 57:412–416.
19. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001. 163:1256–1276.
20. Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988. 8:77–100.
21. Kim JT, Shin DK. A Study Based on the Standardization of the STAI for Korea. New Med J. 1978. 21:69–75.
22. Yohannes AM, Baldwin RC, Connolly MJ. Depression and anxiety in elderly outpatients with chronic obstructive pulmonary disease: prevalence, and validation of the BASDEC screening questionnaire. Int J Geriatr Psychiatry. 2000. 15:1090–1096.
23. Dowson C, Laing R, Barraclough R, Town I, Mulder R, Norris K, et al. The use of the Hospital Anxiety and Depression Scale (HADS) in patients with chronic obstructive pulmonary disease: a pilot study. N Z Med J. 2001. 114:447–449.
24. Klein DF. Testing the suffocation false alarm theory of panic disorder. Anxiety. 1994. 1:1–7.
25. Ley R. Pulmonary function and dyspnea/suffocation theory of panic. J Behav Ther Exp Psychiatry. 1998. 29:1–11.
26. Suhara T, Sudo Y, Yoshida K, Okubo Y, Fukuda H, Obata T, et al. Lung as reservoir for antidepressants in pharmacokinetic drug interactions. Lancet. 1998. 351:332–335.
27. Wagena EJ, Kant I, van Amelsvoort LG, Wouters EF, van Schayck CP, Swaen GM. Risk of depression and anxiety in employees with chronic bronchitis: the modifying effect of cigarette smoking. Psychosom Med. 2004. 66:729–734.
28. de Godoy DV, de Godoy RF. A randomized controlled trial of the effect of psychotherapy on anxiety and depression in chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2003. 84:1154–1157.
29. Simon GE, von Korff M, Lin E. Clinical and functional outcomes of depression treatment in patients with and without chronic medical illness. Psychol Med. 2005. 35:271–279.
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