Abstract
BackgroundChronic obstructive pulmonary disease (COPD) impairs physical status and impacts on mental health. This prospective study was designed to assess associations between mental health and systemic biomarkers, and their combined relationship with long-term survival in stable severe COPD.MethodsForty-five patients with severe but stable COPD (forced expiratory volume in 1 s of 29.8 (quartiles: 22.6; 41.4) %predicted) were assessed using the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ), St. George’s Respiratory Questionnaire and the State-Trait Anxiety Inventory (STAI). The following serum biomarkers were measured: 25-OH-cholecalciferol, C-reactive protein, erythrocyte sedimentation rate, leucocyte number, serum amyloid-A (SA-A), N-terminal pro-brain natriuretic peptide, troponin I, glycosylated haemoglobin, haemoglobin (Hb), haematocrit (Hc), creatinine and thyroid-stimulating hormone. Patients were followed-up for 36 months. Associations between aspects of mental health and biomarkers, and their utility as predictors of 3-year survival were evaluated by regression analyses.ResultsThe prevalence of anxiety (HADS-A: 89.9 %), depression (HADS-D: 58.8 %; PHQ: 60.6 %), somatisation (PHQ-15: 81.8 %) and psychosocial stress (PHQ-stress: 60.6 %) was high. There was a significant positive association between the leucocyte count and SA-A level with STAI-trait anxiety (p = 0.03 and p = 0.005, respectively), and between leucocytes and PHQ-stress (p = 0.043). Hb and Hc were significantly negatively associated with HADS-depression (p = 0.041 and p = 0.031, respectively). Univariate Cox regression analyses revealed that leucocyte count (hazard ratio (HR) 2.976, 95 % CI 1.059-8.358; p = 0.038), and stress (HR 4.922, 95 % CI 1.06–22.848; p = 0.042) were linked to long-term survival. In multivariate Cox regression analyses, including known risk factors for survival in COPD, PHQ-stress (HR 45.63, 95 % CI 1.72–1,208.48; p = 0.022) remained significantly associated with survival.ConclusionIn this pilot study different dimensions of mental health were correlated to serum biomarkers, probably reflecting systemic effects of COPD. While leucocyte number and PHQ-stress were associated with long-term survival in univariate analyses, PHQ-stress remained in multivariate analyses as independent prognostic factor.
Highlights
Chronic obstructive pulmonary disease (COPD) impairs physical status and impacts on mental health
Among the 279 COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage III/IV patients, 106 (38 %) had no interest in participating, 86 (30.8 %) showed characteristics leading to exclusion, and 42 (15.1 %) did not come to a scheduled visit (Fig. 1)
Mental health We found that the prevalence of anxiety (HADS-A: 84.9 %) and depression (HADS-D: 58.8 %; Patient Health Questionnaire (PHQ)-9: 60.6 %) was higher than reported in studies that included patients in primary care with moderate to very severe COPD of comparable age (Centers for Epidemiologic Studies Depression scale: 25 % [38]; Hospital Anxiety and Depression Scale (HADS)-A: 32.7 %, HADS-D:: 20.8 % [39])
Summary
Chronic obstructive pulmonary disease (COPD) impairs physical status and impacts on mental health. This prospective study was designed to assess associations between mental health and systemic biomarkers, and their combined relationship with long-term survival in stable severe COPD. Chronic obstructive pulmonary disease (COPD) is a systemic disease whose multiple dimensions are increasingly uncovered by research. This has promoted the concept of clinical phenotypes, which attempts to identify specific subgroups of COPD patients with similar clinical characteristics, treatment needs and prognosis [1]. COPD impairs physical status and has impacts on mental health [2,3,4,5]. Depression and anxiety are strongly related to worse long-term outcome in COPD [6,7,8]
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