Depression In Chronic Obstructive Pulmonary Disease Patients Research Articles

Positive association between the plasma levels of 5-hydroxyindoleacetic acid and the severity of depression in patients with chronic obstructive pulmonary disease.

BackgroundThe role of plasma monoamines in patients with chronic obstructive pulmonary disease (COPD) with depression is unclear. To investigate monoamines in 20 depressed patients with COPD, the plasma concentrations of serotonin, 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid, and 3-methoxy-4-hydroxyphenylglycol (MHPG) were measured and compared with those in 50 non-depressed COPD patients, and also with 23 age- and gender-matched non-smokers and 13 smokers as non-depressed healthy controls.MethodsDiagnosis of depression was assessed using the Centre for Epidemiologic Studies Depression Scale. Plasma concentrations of monoamines were measured by high-performance liquid chromatography.ResultsNone of the depressed COPD patients had suicidal ideation. The plasma 5-HIAA level [median, (25% and 75% quartiles)] in depressed COPD patients [6.8 ng/mL, (4.9 and 13.1)] was significantly higher than in non-depressed COPD patients [5.4, (4.2 and 7.5)] (p=0.022) and non-smokers [5.1 (3.8 and 7.2)] (p=0.041), but not smokers [4.7, (4.0 and 6.7)] (p>0.05). The plasma 5-HIAA level (r=0.24, p=0.049) was significantly associated with the severity of depression in patients with COPD. The plasma MHPG level was significantly higher in depressed COPD patients (p=0.043) than in smokers, but was not higher than that in non-depressed COPD patients or non-smokers, although the level of MHPG was not associated with the severity of depression.ConclusionThe plasma 5-HIAA level is increased in depressed COPD patients. Plasma monoamines may be a good biomarker for detection of depression in patients with COPD.

Association of Anxiety and Depression with Pulmonary-Specific Symptoms in Chronic Obstructive Pulmonary Disease

To examine the association of anxiety and depression with pulmonary-specific symptoms of Chronic Obstructive Pulmonary Disease (COPD), and to determine the extent to which disease severity and functional capacity modify this association. Patients (N = 162) enrolled in the INSPIRE-II study, an ongoing randomized, clinical trial of COPD patients and their caregivers who received either telephone-based coping skills training or education and symptom monitoring. Patients completed a psychosocial test battery including: Brief Fatigue Inventory, St. George's Respiratory Questionnaire, UCSD Shortness of Breath Questionnaire, State-Trait Anxiety Inventory, and Beck Depression Inventory. Measures of disease severity and functional capacity (i.e., FEV1 and six-minute walk test) were also obtained. After covariate adjustment, higher anxiety and depression levels were associated with greater fatigue levels (ps < .001, deltaR2 = 0.16 and 0.29, respectively), shortness of breath (ps < .001, deltaR2 = 0.12 and 0.10), and frequency of COPD symptoms (ps < .001, deltaR2 = 0.11 and 0.13). In addition, functional capacity was a moderator of anxiety and pulmonary-specific COPD symptoms. The association between anxiety and shortness of breath (p = 0.009) and frequency of COPD symptoms (p = 0.02) was greater among patients with lower functional capacity. Anxiety and depression were associated with higher levels of fatigue, shortness of breath, and frequency of COPD symptoms. It is important for clinicians to be aware of the presence of anxiety and depression in COPD patients, which appears to correlate with pulmonary-specific COPD symptoms, especially in patients with lower functional capacity. Prospective design studies are needed to elucidate the causal relationships between anxiety and depression and pulmonary-specific symptoms in COPD patients.

Cognitive biases in patients with chronic obstructive pulmonary disease and depression – a pilot study

Comorbid depression is highly prevalent in patients with chronic obstructive pulmonary disease (COPD) and associated with a worse course of disease; however, the exact mechanisms linking both remain unclear. In currently depressed individuals without lung disease, depression-specific biases in information processing have been suggested as risk factors for the development and maintenance of depression. We examined whether comparable biases in cognitive information processing might underlie depression in COPD. Different aspects of cognitive information processing were examined with computer-based tasks measuring selective attention and memory in patients with COPD who were compared with age-matched, currently depressed patients without lung disease and healthy control participants. The Self-Referential Encoding and Incidental Recall Task as well as the emotion face dot-probe task was applied to 21 never-depressed COPD patients, 18 currently depressed COPD patients, 20 currently depressed patients without lung disease and 19 healthy controls to examine cognitive biases. In both patients with COPD who were never and who were currently depressed, depression-like cognitive biases were observed for some attention- and memory-related tasks, but not for all tested aspects of information processing. These biases were particularly prominent in patients with COPD and current depression and comparable to those observed in currently depressed patients without lung disease. The results of this pilot study suggest that patients with COPD may potentially show depression-like biases in some aspects of cognitive information processing. Future studies are required to examine whether these biases represent a vulnerability factor for the development of depression in patients with COPD.

Chronic Obstructive Pulmonary Disease Assessment Test Can Predict Depression: A Prospective Multi-Center Study

This study was conducted to investigate the association between the chronic obstructive pulmonary disease (COPD) assessment test (CAT) and depression in COPD patients. The Korean versions of the CAT and patient health questionnaire-9 (PHQ-9) were used to assess COPD symptoms and depressive disorder, respectively. In total, 803 patients with COPD were enrolled from 32 hospitals and the prevalence of depression was 23.8%. The CAT score correlated well with the PHQ-9 score (r=0.631; P<0.001) and was significantly associated with the presence of depression (β±standard error, 0.452±0.020; P<0.001). There was a tendency toward increasing severity of depression in patients with higher CAT scores. By assessment groups based on the 2011 Global Initiative for Chronic Obstructive Lung Disease guidelines, the prevalence of depression was affected more by current symptoms than by airway limitation. The area under the receiver operating characteristic curve for the CAT was 0.849 for predicting depression, and CAT scores ≥21 had the highest accuracy rate (80.6%). Among the eight CAT items, energy score showed the best correlation and highest power of discrimination. CAT scores are significantly associated with the presence of depression and have good performance for predicting depression in COPD patients.

Screening for Depression in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review

ëª©ì : 우울증은 COPD 환자들에게 흔하게 동반되는 질환이다. 하지만 현재 COPD 환자들에게 우울증의 ì„ ë³„ 검사의 효과와 ì„ ë³„ 검사를 무슨 도구로 시행해야 하는지 ì•Œë ¤ì§„ 바가 ì „í˜€ 없는 ì‹¤ì •ì´ë‹¤. 이에 ì²´ê³„ì  ë¬¸í—Œê³ ì°°ì„ 통해 COPD 환자의 우울증 ì„ ë³„ 검사 효과와 도구에 대해서 알아 ë³´ê³ ìž 하였다. 방법: COPD 환자에서 우울증 ì„ ë³„ 검사 효과와 우울증 진단 도구로 일차 진료의가 ì„ ë³„ 검사 ëª©ì ìœ¼ë¡œ ì‚¬ìš©í• ìˆ˜ 있는 것이 어느 것인지 알아보기 위해 “COPD 환자에게 우울증 ì„ ë³„ 검사를 하는 것이 필요한가?” 와 “우울증 진단 도구 중, ì¼ì„ ì§„ë£Œì˜ì˜ ì„ ë³„ 검사 ëª©ì ìœ¼ë¡œ ê¶Œìž¥í• ë§Œí•œ 것은 무엇인가?” 라는 두 가지 핵심 질문을 ì„ ì •í•˜ê³ ì´ì— 대한 답을 êµ¬í•˜ê³ ìž 하였다. 문헌 검색을 위한 ë°ì´í„°ë² ì´ìŠ¤ë¡œëŠ” 국내의 경우 êµ­ë‚´ì˜í•™í•™ìˆ ì§€ì´ˆë¡ê²€ìƒ‰(kmbase.medric.or.kr), í•™ìˆ ì—°êµ¬ì •ë³´ì„œë¹„ìŠ¤(www.riss.kr), 코리아메드(www.koreamed.org)를 ì´ìš©í•˜ì˜€ê³ êµ­ì™¸ì˜ 경우는 Medline, Embase, Cochrane Library를 이용하였다. ê²°ê³¼: COPD가 있을 경우 우울증의 발생 또한 높아진다. 우울증이 동반이 ë ê²½ìš° COPD 환자들이 삶의 질에 나쁜 영향을 받았다. 우울증 ì„ ë³„ 검사 도구 중 한글화되어 있는 도구는 8가지가 있으며 각 도구는 비슷한 ì •ë„ì˜ ì‹ ë¢°ë„ì™€ 타당도를 가진다. ê²°ë¡ : COPD 환자에서 우울증의 ì„ ë³„ 검사는 필요하며 우울증 ì„ ë³„ì„ 위해서 한글화된 8가지 도구 사용이 모두 가능하다. 그중에서 문항수가 ì ê³ í™˜ìžì˜ 자가 ê¸°ìž ì´ 가능한 도구가 현재의 진료 현실에서는 ì í•©í• ê²ƒìœ¼ë¡œ 생각된다. 중심 단어: 만성폐쇄성폐질환; COPD; 우울증; ì„ ë³„ 검사

P-1032 - Inflammation as a hypothetic mechanisms underlying depression in patients with chronic obstructive pulmonary disease

Introduction Depression is a highly prevalent comorbidity in patients suffering from chronic obstructive pulmonary disease (COPD). Both, depression and COPD are believed to be associated with inflammation. The aim of our study was to verify hypothesis that altered inflammatory response causes depression in patients with chronic obstructive pulmonary disease. Material and methods Blood was collected from 45 patients of whom 18 had COPD, 18 were depressed and 9 had COPD with comorbid depression. Total of 27 age and sex matched healthy controls were also included in the study. IL-2, IL-8 and IL-17A concentrations were assayed by ELISA technique in sera of all subjects. Results We observed significantly decreased concentration of IL-17A in a group of depressed patients (D) when compared with controls, 4.46 ± 0.573 pg/mL vs. 8.87 ± 1.182 pg/mL, respectively, P = 0.0005. Increased concentration of IL-2 in depressed patients (D) as compared with controls, 3.00 ± 0.223 pg/mL vs. 2.30 ± 0.176 pg/mL, respectively, P = 0.013 was also revealed. There was also increased concentration of IL-8 in COPD subjects if compared with controls and depression group, 4.55 ± 0.176 pg/mL vs. 3.71 ± .132 and 3.95 ± 0.118 pg/mL, respectively, P = 0.008. Conclusions The results from our study suggest that there is significant difference between depression and COPDs with respect to IL-8 concentration also a lower concentration of IL-17A was noticeable in depressed patients (P = 0.06). We need more data on depressed COPD patients to argue the role of inflammation on depression in COPD patients.

Depression and Sleep Disturbance in Patients with Chronic Obstructive Pulmonary Disease

The goal of this study was to examine the unique contributions of sleep disturbance to depression in patients with chronic obstructive pulmonary disease (COPD) after controlling for other contributing variables, including patient characteristics, self-efficacy, and physical activity. One hundred thirty-one outpatients diagnosed with COPD from 3 hospitals in South Korea participated in the study. Data were collected from March to June 2010 and analyzed with descriptive statistics, Pearson correlation, and hierarchical multiple regression using the SPSS WIN program. The level of depression reported in this study was 13.84. Sleep disturbance, not living with a spouse, and self-efficacy were all predictors of depression and accounted for 45% of the variance. These findings show the need to screen routinely for sleep disturbance in patients with COPD and support potential benefits of interventions to enhance self-efficacy and quality of sleep in reducing depression in COPD patients.

Anxiety and depression in COPD patients and correlation with sputum and BAL cytology

Background and aimsAnxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD). The degree of lung function may not explain anxiety and depression. The aim of our study was to assess the psychological aspects of COPD, to test the BODE index (a composite score of body mass, obstruction, dyspnea and exercise capacity), and to evaluate the association between atypical cytologic findings of sputum, bronchoalveolar lavage (BAL) and the pyschological components of the disease.MethodsCOPD was classsified according to the GOLD stages based on forced expiratory volume in 1 second (FEV1) in 60 stable patients. The BODE index was calculated for grading COPD. The Hospital anxiety and depression (HAD) scale was used to appraise the anxiety and depression symptoms. Cytologic examination of sputum and BAL samples were performed in each patient. The cytologic findings were classified as normal, mild, moderate or severe atypia.ResultsThe overall prevalance of anxiety and depression symptoms was 41.7% and 46.7% respectively. The prevalance of these symptoms increased with increasing BODE stages and correlated well with the severity of atypical BAL cytology results (p < 0.001). Dyspnea and reduced exercise capacity were the predominant mechanisms leading to anxiety and depression symptoms associated with COPD.ConclusionsWe conclude that the BODE index is superior to GOLD stratification for explaining anxiety and depression symptoms in COPD. BAL cytologic findings, which reflect the distal parenchymal lung structure, correlated significantly with the presence of the anxiety and depression symptoms.

The impact of psychological distress on exacerbation rates in COPD

exacerbations are common in chronic obstructive pulmonary disease (COPD) and contribute significantly to COPD morbidity and mortality. COPD is also associated with high levels of psychological distress, which has been shown to be associated with higher exacerbation rates. However, the existing literature on the association between psychological distress and exacerbation risk remains largely misunderstood. to critically review the current literature on the association between psychological distress (defined as anxiety and depressive symptoms or anxiety and depressive disorders) and COPD exacerbations in COPD patients, to highlight the limitations of the existing literature, and to provide recommendations for future research. a critical review of English-language peer-reviewed longitudinal and retrospective studies was conducted. The Ovid portal to Medline, EMBASE, and PsycINFO databases were accessed. some acceptable evidence suggested that psychological distress confers greater risk for exacerbations, more specifically symptom-based exacerbations or those treated in the patient's own environment. However, most studies showed an absence of a positive association, especially with exacerbations leading to hospitalization. methodological weaknesses and the use of a wide range of psychological tools mean that there is an inconsistent association between psychological distress and exacerbations in the current literature. However, psychological distress may confer greater risk for symptom-based rather than event-based defined exacerbations. Further studies are needed to more comprehensively assess the question, particularly in light of the high levels of both anxiety and depression in COPD patients.

Symptoms of anxiety and depression in COPD patients entering pulmonary rehabilitation

Chronic obstructive pulmonary disease (COPD) patients may suffer from symptoms of anxiety and depression. Whether and to what extent symptoms of anxiety and depression may be present in COPD patients entering pulmonary rehabilitation and which patient characteristics are associated with psychological distress remains currently unknown. The objective of the present study is to determine the prevalence and the determinants of clinically relevant symptoms of anxiety and depression in COPD patients entering pulmonary rehabilitation. Symptoms of anxiety and depression have been assessed in 701 COPD patients entering pulmonary rehabilitation using the Hospital Anxiety and Depression Scale. Additionally, disease-specific health status, pulmonary function, body composition, exercise capacity, co-existing morbidities, smoking status, symptoms, long-term oxygen therapy and the use of antidepressant and anxiolytic drugs have been recorded. Patients had mean anxiety scores of 7.6 points and mean depression scores of 7.2 points. Anxiety scores >or=10 points were present in 225 patients (32%) and depression scores >or=10 points were present in 192 patients (27%). Patients at risk of having symptoms of anxiety were female or used antidepressant or anxiolytic drugs. Patients at risk of having symptoms of depression experienced dyspnea, had a body mass index (BMI) <21 kg/m(2) or used antidepressant or anxiolytic drugs. A considerable proportion of the COPD patients entering pulmonary rehabilitation report symptoms of anxiety and/or depression, which may significantly impair disease-specific health status. Patients at risk of having symptoms of anxiety and/or depression are female, experience dyspnea, have a low BMI or use antidepressant and/or anxiolytic drugs.

Impact of social support and self-efficacy on functioning in depressed older adults with chronic obstructive pulmonary disease.

The objective of this study was to examine the association between social support, self-efficacy, and functioning among a sample of depressed older adults with chronic obstructive pulmonary disease (COPD). Participants were recruited immediately following admission to an acute pulmonary rehabilitation unit of a rehabilitation hospital. One hundred and fifty-six subjects completed assessments of depression, functioning, social support, and self-efficacy at admission to the rehabilitation unit. Regression analyses were conducted to evaluate the impact of different aspects of social support and self-efficacy on overall functioning at admission. Controlling for depression, COPD severity, and age, subjective social support (p = 0.05) and self-efficacy (p < 0.01) were associated with overall functioning. The perception of social support as well as self-efficacy are important constructs related to overall functioning among depressed older adults with COPD. Attention to these psychosocial variables in health management interventions may help maintain or improve the overall functioning of depressed COPD patients.

Improving outcomes for COPD patients with mild‐to‐moderate anxiety and depression: A systematic review of cognitive behavioural therapy

Anxiety and depression are highly prevalent in patients with chronic obstructive pulmonary disease (COPD) and are associated with lower levels of self-efficacy, impaired health status, poorer treatment outcomes and reduced survival following emergency admission. Cognitive behavioural therapy (CBT) may be effective for treating anxiety and depression in COPD patients but evidence for this is uncertain. A systematic review of controlled trials that evaluated the effectiveness of CBT for treating mild-to-moderate anxiety or depression in adults with clinically stable COPD. Ovid electronic bibliographic databases were searched from inception to May 2006; all content held by the Cochrane Library Issue 3, 2006 was also searched. One small randomized controlled trial (RCT) of moderate quality showed that CBT, when given with exercise training and education, was associated with large and significant treatment effects for both anxiety (-1.39 (95% CIs -2.19, -0.59)) and depression (-0.86 (95% CIs -1.61, -0.11)). Additionally, a larger RCT of higher quality demonstrated that CBT, when given with exercise and education, was associated with large and significant treatment effects for depression (-0.76 (95% CIs -1.34, -0.17)), but not for anxiety. No other included study reported significant reductions in either anxiety or depression in COPD patients given CBT. There is only limited evidence that CBT, when used with exercise and education, can contribute to significant reductions in anxiety and depression in COPD patients. There is scope for a well-powered RCT to evaluate the effectiveness and acceptability of CBT among this patient population.

The screening and treatment of undiagnosed depression in patients with chronic obstructive pulmonary disease (COPD) in a general practice

To screen for, and to treat, depression in COPD patients in a general practice surgery, and to test the feasibility of the screening method. We sent The Beck Depression Inventory (BDI) Short-Form Questionnaire to all patients on the COPD register (n=69) by post, excluding those already diagnosed with depression (n=3). We sent appointments to all responders with moderate to severe depression and offered them treatment including antidepressants and pulmonary rehabilitation if the diagnosis was confirmed. Of the 66 patients to whom we sent questionnaires, 43 were returned completed and 13 of these had significant depression (30%). 10 of these patients were contactable and attended for review. The diagnosis of depression was confirmed in all 10 cases. Treatment options were discussed; five chose antidepressant medication, three chose pulmonary rehabilitation and two declined treatment. We identified and treated a significant number of depressed COPD patients in a general practice setting using this screening method. This method could have wider applications for screening, although further trials are needed.

Anxiety and depression in COPD patients: The roles of gender and disease severity

The aim of our study was to assess the prevalence of anxiety and depression in the whole chronic obstructive pulmonary disease (COPD) population and in subgroups according to sex and severity classification. A secondary objective was to evaluate the possible differences between patients with and without a significant high level of anxiety, depression, or both, and finally to find out a correlation between psychological aspects, symptoms, functional parameters, and quality of life (QoL). Two hundred and two COPD patients were enrolled. Their levels of anxiety, depression, dyspnea, and QoL were assessed using specific questionnaires. One hundred and fourteen sex- and age-matched healthy subjects were used as the control population. The prevalences of anxiety and depression were high (28.2% and 18.8%) in COPD even when it was of mild degree, compared to the control group, in which the prevalence of anxiety and depression were 6.1% and 3.5%, respectively. Female patients had higher levels of anxiety and depression and worse symptom-related QoL. Female patients reported a higher level of dyspnea than males for the same level of ventilatory impairment. Dyspnea was more strongly correlated with depression in women than in men. Anxiety and depressive symptoms are common in patients affected by COPD, even when their disease is mild in terms of FEV1 and respiratory symptoms. Female patients appear to be more exposed to psychological impairment, which correlates well with some specific symptomatic aspects of the disease, such as dyspnea. Psychological aspects need to be carefully assessed in COPD patients, particularly in females.

Increased risk of depression in COPD patients with higher education and income

This study examined potential modifying effects of income and education on the relationship between chronic obstructive pulmonary disease (COPD) and depression. The analysis was based on 44,963 Canadians aged 35 years or more who participated in the Canadian National Population Health Survey in 1996-1997. Logistic regression analysis was used to examine the association between prevalence of depression and COPD according to sex, income adequacy or educational level. We used a bootstrap procedure to take sampling weights and design effects into account. People with COPD had twice the prevalence of depression compared to those without COPD. The association tended to be stronger in well-educated men [adjusted odds ratio (OR) = 3.02, 95% confidence interval (CI) = 1.04, 8.75] and women (OR = 2.60, 95% CI = 1.55, 4.38) than those less educated (men: OR= 1.19, 95% CI = 0.47, 3.05; women: OR = 1.93, 95% CI = 0.96, 3.87). An increased prevalence of depression associated with COPD was also found in women with higher household income (adjusted odds ratio = 4.57, 95% CI = 2.27, 9.19) than those with lower income. However, this pattern was not found in men. In conclusion, COPD patients with higher education are more likely to be depressed. The modifying effect of income may vary by gender. Possible reasons for these findings are explored.

Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). A review

A review of the literature revealed high comorbidity of chronic obstructive pulmonary disease (COPD) and states of anxiety and depression, indicative of excess, psychiatric morbidity in COPD. The existing studies point to a prevalence of clinical significant symptoms of depression and anxiety amounting to around 50%. The prevalence of panic disorder and major depression in COPD patients is correspondingly markedly increased compared to the general population. Pathogenetic mechanisms remain unclear but both psychological and organic factors seem to play a role. The clinical and social implications are severe and the concurrent psychiatric disorders may lead to increased morbidity and impaired quality of life. Furthermore, the risk of missing the proper diagnosis and treatment of a concurrent psychiatric complication is evident when COPD patients are treated in medical clinics. Until now only few intervention studies have been conducted, but results suggest that treatment of concurrent psychiatric disorder leads to improvement in the physical as well as the psychological state of the patient. Panic anxiety as well as generalized anxiety in COPD patients is most safely treated with newer antidepressants. Depression is treated with antidepressants according to usual clinical guidelines. There is a need for further intervention studies to determine the overall effect of antidepressants in the treatment of anxiety and depression in this group of patients.