Anxiety and depression in patients with chronic obstructive pulmonary disease and their relation to serum vitamin D levels

Abstract

Objectives: To determine whether serum vitamin D levels wererelated to the prevalence of anxiety and depression among patientswith chronic obstructive pulmonary disease (COPD), as well as theirspirometry parameters, disease severity, and other clinical findings.Materials and Methods: Ninety-two stable patients withCOPD aged over 18 years with no exacerbations in the previousmonth were included. Symptom severity was assessed using themodified Medical Research Council (mMRC) dyspnea scale andCOPD Assessment Test (CAT) scores. Spirometry tests wereperformed and previous hospitalization histories were recordedto determine ABCD groups of the patients according to theircombined COPD assessments. Their Body mass index, airflowObstruction, Dyspnea and Exercise capacity (BODE) indices werecalculated and the Hospital Anxiety and Depression Scale (HADS)was administered. Serum vitamin D levels were determined usingimmune electrochemiluminescence.Results: According to the HADS scores, 16 patients (17.4%) hadthe risk of anxiety and 29 (31.5%) had the risk of depression. Therisk of anxiety differed significantly (P= 0.016 Fischer’s exact test)between the ABCD groups. Anxiety scores were positively correlatedwith both mMRC (r= 0.315; P= 0.002) and CAT (r= 0.445; P= 0.000)scores. Similarly, depression scores correlated positively with mMRC(r= 0.249; P= 0.017) and CAT (r= 0.373; P= 0.000) scores. Neitheranxiety nor depression scores were significantly correlated with % ofpredicted FEV1 (p= 0.339, P= 0.671). Serum vitamin D levels wereinversely correlated with anxiety (r= -0.215; P= 0.039) and depression(r= -0.244; P= 0.019) scores. Anxiety scores were positively correlatedwith BODE although not statistically significantly (r= 0.199; P= 0.058).Conclusion: A negative correlation was revealed betweenserum vitamin D levels and HADS scores, and symptom scoreswere positively correlated to HADS scores, independent of % ofpredicted FEV1.