Depression and Anxiety Common, Not Likely to Affect COPD’s Course

Patricia Inácio, PhD avatar

by Patricia Inácio, PhD |

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Depression and anxiety are highly prevalent in people with chronic obstructive pulmonary disease (COPD) a study of patients in Spain reported, with depression linked to a greater risk of a repeat hospitalization due to acute disease worsening.

No association, however, was found between prognosis, or the disease’s likely course, and depression or anxiety. According to researchers, early detection of depression may help reduce the risk of a later hospitalization.

The study, “Impact of anxiety and depression on the prognosis of copd exacerbations,” was published in the journal BMC Pulmonary Medicine.

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Estimates suggest that depression affects 8%–80% of COPD patients, while anxiety ranges from 2% to 96%. Both symptoms have a negative impact on patients’ quality of life.

However, whether these symptoms affect a patient’s prognosis is still under debate, with some studies suggesting a correlation with more severe disease progression and others reporting no such link.

A team led by researchers in Spain assessed the prevalence of depression and anxiety in COPD patients hospitalized for episodes of acute worsening, also known as exacerbations or flares. They investigated whether these symptoms influenced a patient’s prognosis.

Data analyzed covered 288 COPD patients (mean age 73.7 years; 84.7% men) who had been hospitalized for acute exacerbations from 2016 to 2018 across three hospitals in Galicia, Spain.

Depression and anxiety were assessed using the hospital anxiety and depression scale (HADS). Possible depression was marked by a score of eight or higher, and probable depression by scores of 11 or higher on the HADS depression subscale. The same scoring in the HADS anxiety subscale was used for evaluating possible and probable anxiety.

More than half of the patients (67.7%) were diagnosed with possible depression, and 41.7% with probable depression. Anxiety was possible in 68.4% of these people and probable in 35.4%. Over half of the patients (60.4%) showed symptoms of both anxiety and depression.

Patients remained in the hospital for a mean of 6.8 days, and four patients died (1.4%).

During the study period, 18 patients (6.3%) were readmitted to the hospital for an acute exacerbation within 15 days after being discharged (early readmission). A total of 118 patients (41%) eventually came back to the hospital (late readmission). By 1.5 years, the mortality rate was 47%.

Statistical analysis showed that patients with anxiety and depression had a higher probability of being readmitted later on, and had a lower mortality risk at 18 months (1.5 years).

Probable depression correlated with a two times higher risk of late hospital readmission and a lower risk of mortality, which fell nearly by half at 18 months.

No significant link, however, was found between probable and possible anxiety and prognosis, as well as between possible depression and prognosis.

Overall, these findings suggest that the “prevalence of anxiety and depression in COPD patients is high,” the researchers wrote.

“Depression seems to be an independent factor for [acute COPD exacerbations], so early detection and a multidisciplinary approach could improve the prognosis of both entities,” the study concluded.