Abstract
BackgroundDepression and anxiety are very common in people with chronic obstructive pulmonary disease (COPD) and are associated with excess morbidity and mortality. Patients prefer non-drug treatments and clinical guidelines promote non-pharmacological interventions as first line therapy for depression and anxiety in people with long term conditions. However the comparative effectiveness of psychological and lifestyle interventions among COPD patients is not known. We assessed whether complex psychological and/or lifestyle interventions are effective in reducing symptoms of anxiety and depression in patients with COPD. We then determined what types of psychological and lifestyle interventions are most effective.Methods and FindingsSystematic review of randomised controlled trials of psychological and/or lifestyle interventions for adults with COPD that measured symptoms of depression and/or anxiety. CENTRAL, Medline, Embase, PsychINFO, CINAHL, ISI Web of Science and Scopus were searched up to April 2012. Meta-analyses using random effects models were undertaken to estimate the average effect of interventions on depression and anxiety. Thirty independent comparisons from 29 randomised controlled trials (n = 2063) were included in the meta-analysis. Overall, psychological and/or lifestyle interventions were associated with small reductions in symptoms of depression (standardised mean difference −0.28, 95% confidence interval −0.41 to −0.14) and anxiety (standardised mean difference −0.23, 95% confidence interval −0.38 to −0.09). Multi-component exercise training was the only intervention subgroup associated with significant treatment effects for depression (standardised mean difference −0.47, 95% confidence interval −0.66 to −0.28), and for anxiety (standardised mean difference −0.45, 95% confidence interval −0.71 to −0.18).ConclusionsComplex psychological and/or lifestyle interventions that include an exercise component significantly improve symptoms of depression and anxiety in people with COPD. Furthermore, multi-component exercise training effectively reduces symptoms of anxiety and depression in all people with COPD regardless of severity of depression or anxiety, highlighting the importance of promoting physical activity in this population.
Highlights
One in four patients with chronic obstructive pulmonary disease (COPD) will have clinically significant depression, which is twice the prevalence observed in people without COPD [1]
The COPD patients had a median age of 66.3 years; one study recruited a male only sample
The majority of studies recruited patients with moderate [33,34,35,36,42,43,44,45,46,47,48] or severe COPD [38,49,50,51,52,53,54,55,56,57,58,59,60]; one study recruited patients with mild to moderate COPD [37], and in three studies patients in the intervention group had milder disease than patients in the control group, but this did result in baseline imbalance [32,61,62]
Summary
One in four patients with chronic obstructive pulmonary disease (COPD) will have clinically significant depression, which is twice the prevalence observed in people without COPD [1]. Depression is associated with increased mortality, impaired health related quality of life and longer hospital stay after acute exacerbation [5], increased risk of exacerbation and hospital admission [6], hospital readmission [7], and poorer exercise performance [8]. Anxiety is associated with increased risk of exacerbations, poorer health related quality of life and worse exercise performance [2], relapse within one-month of receiving emergency treatment [9], and hospital readmission [10]. Depression and anxiety are very common in people with chronic obstructive pulmonary disease (COPD) and are associated with excess morbidity and mortality. We assessed whether complex psychological and/or lifestyle interventions are effective in reducing symptoms of anxiety and depression in patients with COPD. We determined what types of psychological and lifestyle interventions are most effective
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