Anxiety and depression in severe chronic obstructive pulmonary disease: the effects of pulmonary rehabilitation.

Abstract

Previous studies have demonstrated high levels of anxiety and depression among patients with chronic obstructive pulmonary disease (COPD). The effects of an outpatient pulmonary rehabilitation (PR) program on psychological morbidity were examined in patients with severe COPD. Levels of anxiety and depression in 95 patients with severe COPD (FEV1 < 40% predicted) were measured on entry to an outpatient PR program using the Hospital Anxiety and Depression (HAD) scale. HAD scores were remeasured at the completion of PR (3 months) and at 6 month follow-up. The effects of PR on mean HAD scores and on the number of patients with significant anxiety or depression were determined. Improvements in exercise capacity after PR were compared in patients with high and low HAD scores. Of patients, 35 (29.2%) had significant anxiety at screening and 18 (15%) significant depression. PR produced statistically significant falls in mean HAD scores for anxiety and depression, both of which remained significantly lowered at 6-month follow-up. PR also reduced the number of patients with significant anxiety or depression. Patients with high anxiety levels showed significantly greater improvements in shuttle walk distance than those with low HAD scores. Levels of anxiety and depression were high in a significant minority of this group of patients with severe COPD and were significantly improved by PR. Patients with higher HAD scores had lower baseline shuttle walk distances than those with low HAD scores. Anxious patients showed statistically greater improvements in exercise capacity following PR.