Skip to main content

Advertisement

SpringerLink
Log in

Factors Associated with Depression in COPD: A Multicenter Study

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Introduction

Depression is a prevalent comorbidity in COPD and has an impact on the prognosis of these patients, thereby making it important to study the factors associated with depression in patients with COPD.

Method

A multicenter, observational and cross-sectional study was conducted to study the factors associated with depression in patients with COPD measured by the hospital anxiety and depression (HAD) questionnaire. We analyzed anthropometric variables and the number of exacerbations in the previous year and calculated the 6-min walking test and the body mass index, airflow obstruction, dyspnea, and exercise (BODE) index. All the patients completed the quality of life EQ-5D and the LCADL physical activity questionnaires. The relationship of these variables with depression was evaluated with two multiple logistic regression models.

Results

One hundred fifteen patients were evaluated (93 % male) with a mean age of 66.9 years (SD 8.8) and a mean FEV1 % of 44.4 % (SD 15.7 %). 24.3 % presented symptoms of depression (HAD-D > 8). These latter patients had worse lung function, greater dyspnea, reduced exercise capacity, a higher score in the BODE index, poorer quality of life, reduced physical activity, and more exacerbations. In the first logistic regression model, quality of life and the BODE index were associated with depression (AUC: 0.84; 0.74–0.94). In the second model including the variables in the BODE index, quality of life and dyspnea measured with the MRC scale (AUC: 0.87; 0.79–0.95) were associated with depression.

Conclusions

Nearly one-quarter of the patients with COPD in this study presented clinically significant depression associated with worse quality of life, reduced exercise capacity, greater dyspnea, and a higher score in the BODE index.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mathers CD, Loncar D (2006) Projections of global mortality and burden of disease from 2002 to 2030. Plos Med 3:e442

    Article  PubMed  PubMed Central  Google Scholar 

  2. Miravitlles M, Soriano JB, García-Río F et al (2009) Prevalence of COPD in Spain: Impact of undiagnosed COPD on quality of life and daily life activities. Thorax 64:863–868

    Article  CAS  PubMed  Google Scholar 

  3. Nishimura K, Izumi T, Tsukino M, Oga T (2002) on behalf of the Kansai COPD Registry and Research Group in Japan. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest 121(5):1434–1440

    Article  PubMed  Google Scholar 

  4. Garcia-Aymerich J, Lange P, Benet M et al (2006) Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax 61:772–778

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Celli BR, Cote CG, Marín JM et al (2004) The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 350:1005–1012

    Article  CAS  PubMed  Google Scholar 

  6. Miravitlles M, Price D, Rabe K, Schmidt H, Metzdorf N, Celli B (2015) Comorbidities of patients in tiotropium clinical trials: comparison with observational studies of patients with chronic obstructive pulmonary disease. Int J ChronObstPulm Dis 10:549–564

    CAS  Google Scholar 

  7. Haro JM, Palacín C, Vilagut G et al (2006) Prevalencia de los trastornos mentales y factores asociados: resultados del estudio ESEMeD-España. Med Clin (Barc) 126:445–451

    Article  Google Scholar 

  8. Al-Shair K, Dockry R, Mallia-Milanes B et al (2009) Depression and its relatihonship with poor exercise capacity, BODE index and muscle wasting in COPD. Respir Med 102:1572–1579

    Article  Google Scholar 

  9. Schane RE, Woodruff PG, Dinno A et al (2008) Prevalence and risk factors for depressive symptoms in persons with chronic obstructive pulmonary disease. J Gen Intern Med 23(11):1757e62

    Article  Google Scholar 

  10. Ng TP, Niti M, Tan WC et al (2007) Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Arch Intern Med 167(1):60e7

    Article  Google Scholar 

  11. van Manen JG, Bindels PJE, Dekker FW et al (2002) Risk of depression in patients with chronic obstructive pulmonary disease and its determinants. Thorax 57:412–416

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yohannes AM, Roomi J, Baldwin RC, Connolly MJ (1998) Depression in elderly outpatients with disabling chronic obstructive pulmonary disease. Age Ageing 27:155e60

    Google Scholar 

  13. Kim KU, Park HK, Jung HY et al (2014) Association of depression with disease severity in patients with chronic obstructive pulmonary disease. Lung 192:243–249

    Article  CAS  PubMed  Google Scholar 

  14. Hanania N, Müllerova H, Locantore W, Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Study Investigators et al (2011) Determinants of depression in the ECLIPSE chronic obstructive pulmonary disease cohort. Am J Respir Crit Care Med 183:604–611

    Article  PubMed  Google Scholar 

  15. Miravitlles M, Molina J, Quintano JA, Campuzano A, Pérez J, Roncero C (2014) Factors associated with depression and severe depression in patients with COPD. Respir Med 108:1615–1625

    Article  PubMed  Google Scholar 

  16. Jordan N, Lee TA, Valenstein M, Weiss KB (2007) Effect of care setting on evidence-based depression treatment for veterans with COPD and comorbid depression. J Gen Intern Med 22:1447–1452

    Article  PubMed  PubMed Central  Google Scholar 

  17. Xu W, Collet JP, Shapiro S et al (2008) Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. Am J Respir Crit Care Med 178:913–920

    Article  PubMed  Google Scholar 

  18. Quint JK, Baghai-Ravary R, Donaldson GC, Wedzicha JA (2008) Relationship between depression and exacerbations in COPD. Eur Respir J 32:53–60

    Article  CAS  PubMed  Google Scholar 

  19. Dahlen I, Janson C (2002) Anxiety and depression are related to the outcome of emergency treatment in patients with obstructive pulmonary disease. Chest 122:1633–1637

    Article  PubMed  Google Scholar 

  20. Stage KB, Middelboe T, Pisinger C (2005) Depression and chronic obstructive pulmonary disease (COPD). Impact on survival. Acta Psychiatr Scand 111:320–323

    Article  CAS  PubMed  Google Scholar 

  21. Dalal A, Shah M, Lunacsek O, Hanania NA (2011) Clinical and economic burden of depression/anxiety in chronic obstructive pulmonary disease patients within a managed care population. COPD 8(4):293–299

    Article  PubMed  Google Scholar 

  22. Alcázar B, García-Polo C, Herrejon A et al (2012) Factors associated with hospital admission for exacerbation of chronic obstructive pulmonary disease. Arch Bronconeumol 48(3):70–76

    Article  PubMed  Google Scholar 

  23. García-Polo C, Alcázar-Navarrete B, Ruiz-Iturriaga LA, Herrejón A, Ros-Lucas JA, García-Sidro P et al (2012) Factors associated with high resource utilisation among COPD patients. Respir Med 106:1734–1742

    Article  PubMed  Google Scholar 

  24. Herrero MJ, Blanch J, Peri JM et al (2003) A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population. Gen Hosp Psychiatry 25:277–283

    Article  CAS  PubMed  Google Scholar 

  25. Bestall JC, Paul EA, Garrod R et al (1999) Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability inpatients with chronic obstructive pulmonary disease. Thorax 54:581–586

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  27. Badia X, Roset M, Monserrat S et al (1999) La versión española del EuroQoL: descripción y aplicaciones. Med Clin (Barc) 112:79–86

    Google Scholar 

  28. Vilaró J, Gimeno E, Sánchez Férez N et al (2007) Actividades de la vida diaria en pacientes con enfermedad pulmonar obstructiva crónica: validación de la traducción española y análisis comparativo de 2 cuestionarios. Med Clin (Barc) 29:326–332

    Article  Google Scholar 

  29. Miravitlles M, Soler-Cataluña JJ, Calle M, Molina J, Almagro P, Quintano JA et al (2014) Spanish guideline for COPD (GesEPOC). Update 2014. Arch Bronconeumol 50(Suppl 1):1–16

    PubMed  Google Scholar 

  30. Iguchi A, Senjyu H, Hayashi Y et al (2013) Relationhip between depression in patients with COPD and the percent of predicted FEV1, BODE Index, and Health-Related Quality of Life. Respir Care 58(2):334–339

    PubMed  Google Scholar 

  31. Cleland JA, Lee AJ, Hall S (2007) Associations of depression and anxiety with gender, age, health-related quality of life and symptoms in primary care COPD patients. Fam Pract 24:217–223

    Article  PubMed  Google Scholar 

  32. Gudmundsson G, GislasonTh Janson Ch et al (2006) Depression, anxiety and health status after hospitalization for COPD: a multicentre study in the Nordic countries. Respir Med 100:87–93

    Article  PubMed  Google Scholar 

  33. Mishima M, Oku Y, Muro Sh et al (1996) Relationship between dyspnea in daily life and psycho-physiologic state in patients with chronic obstructive pulmonary disease during long-term domiciliary oxygen therapy. Intern Med 35:453–458

    Article  CAS  PubMed  Google Scholar 

  34. Pooler A, Beech R (2014) Examining the relationship between anxiety and depression and exacerbations of COPD which result in hospital admission: a systematic review. Int J Chron Obst Pulm Dis 9:315–330

    Article  Google Scholar 

  35. Di Marco F, Terraneo S, Roggi MA et al (2014) Physical actvity impairment in depressed COPD subjects. Respir Care 59:726–734

    Article  PubMed  Google Scholar 

  36. Miravitlles M, Cantoni J, Naberan K (2014) Factors associated with a low level of physical activity in patients with chronic obstructive pulmonary disease. Lung 192(2):259–265

    Article  PubMed  Google Scholar 

  37. Lou P, Zhu Y, Chen P et al (2012) Prevalence and correlations with depression, anxiety, and other feratures in outpatients with chronic obstructive pulmonary disease in China: a cross-sectional case control study. BMC Pulm Med 12:53

    Article  PubMed  PubMed Central  Google Scholar 

  38. Funk GC, Kirchheiner K, Bughuber OC et al (2009) BODE index versus GOLD classification for explaining anxious and depressive symptoms in patients with COPD—a cross-sectional study. Respir Res 10:1

    Article  PubMed  PubMed Central  Google Scholar 

  39. Tetikkurt C, Ozdemir I, Tetikkurt S, Yilmaz N et al (2011) Anxiety and depression in COPD patients and correlation with sputum and BAL cytology. Multdiscip Respir Med 6(4):226–231

    Article  Google Scholar 

  40. Balcells E, Gea J, Ferrer J et al (2010) Factors affecting the relationship between psychological status and quality of life in COPD patients. Health Qual Life Outcomes 8:108

    Article  PubMed  PubMed Central  Google Scholar 

  41. Lacasse Y, Rousseau L, Maltais F (2001) Prevalence of depressive symptoms and depression in patients with severe oxygen-dependent chronic obstructive pulmonary disease. J Cardiopulm Rehabil 21(2):80–86

    Article  CAS  PubMed  Google Scholar 

  42. Hajiro T, Nishimura K, Tsukino M et al (2000) Stages of disease severity and factors that affect the health status of patients with chronic obstructive pulmonary disease. Respir Med 94(9):841–846

    Article  CAS  PubMed  Google Scholar 

  43. Di Marco F, Verga M, Reggente M et al (2006) Anxiety and depression in COPD patients: the roles of gender and disease severity. Respir Med 100:1767–1774

    Article  PubMed  Google Scholar 

  44. Paz-Diaz H, Montes de Oca M, Lopez JM, Celli BR (2007) Pulmonary rehabilitation improves depression, anxiety, dyspnea and health status in patients with COPD. Am J Phys Med Rehabil 86:30–36

    Article  PubMed  Google Scholar 

  45. Kozora E, Tran ZV, Make B (2002) Neurobehavioral improvement after brief rehabilitation in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil 22:426–430

    Article  PubMed  Google Scholar 

  46. Eiser N, Harte R, Spiros K et al (2005) Effect of treating depression on quality-of-life and exercise tolerance in severe COPD. COPD 2:233–241

    Article  PubMed  Google Scholar 

  47. Borson S, McDonald GJ, Gayle T et al (1992) Improvement in mood, physical symptoms, and function with nortriptyline for depression in patients with chronic obstructive pulmonary disease. Psychosomatics 33:190–201

    Article  CAS  PubMed  Google Scholar 

  48. Maurer J, Rebbapragada V, Borson S et al (2008) ACCP Workshop Panel on Anxiety and Depression in COPD. Anxiety and depression in COPD: current understanding, unanswered questions, and research areas. Chest 134(Suppl 4):43S–56S

    Article  PubMed  PubMed Central  Google Scholar 

  49. Anderson IM, Nutt DJ, Deakin JF (2000) Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines. British Association for Psychopharmacology. J Psychopharmacol 14(1):3–20

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pneumology Service, University Hospital Germans Trias i Pujol, Ctra. Canyet s/n, 08916, Badalona, Spain

    Carlos Martinez Rivera

  2. Clínico Lozano Blesa Hospital, Saragossa, Spain

    Joaquín Costan Galicia

  3. Alta Resolución Hospital, Loja, Granada, Spain

    Bernardino Alcázar Navarrete

  4. Unit of Clinical Management of Pneumology, Puerta del Mar Hospital, Cádiz, Spain

    Cayo Garcia-Polo

  5. University Hospital of Cruces, Vizcaya, Spain

    Luis Alberto Ruiz Iturriaga

  6. Dr. Pesset Hospital, Valencia, Spain

    Alberto Herrejón

  7. Virgen de Arrixaca Hospital, Murcia, Spain

    Jose Antonio Ros Lucas

  8. University Hospital de La Plana, Vilarreal, Spain

    Patricia García-Sidro

  9. University Hospital Puerto Real, Cádiz, Spain

    Gema Tirado-Conde

  10. Medical-Surgical Unit of Respiratory Diseases Virgen del Rocio University Hospital, Biomedicine Institute of Seville (IBiS), Seville, Spain

    Jose Luis López-Campos

  11. Ramón y Cajal Hospital, Madrid, Spain

    Sagrario Mayoralas Alises

  12. Pneumology Department, Hospital Gregorio Marañon, Madrid, Spain

    Javier de Miguel-Díez

  13. Pneumology Department, Vall d’Hebron University Hospital, CIBER de Enfermedades Respiratorias (CIBERS), Barcelona, Spain

    Cristina Esquinas & Marc Miravitlles

Authors
  1. Carlos Martinez Rivera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joaquín Costan Galicia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bernardino Alcázar Navarrete
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cayo Garcia-Polo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luis Alberto Ruiz Iturriaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alberto Herrejón
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jose Antonio Ros Lucas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Patricia García-Sidro
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gema Tirado-Conde
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jose Luis López-Campos
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sagrario Mayoralas Alises
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Javier de Miguel-Díez
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Cristina Esquinas
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Marc Miravitlles
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlos Martinez Rivera.

Ethics declarations

Conflict of Interest

Carlos Martinez Rivera has received speaker’s fees from Boehringuer Ingelheim, Chiesi, GlaxoSmithKline, Merck, and Novartis. Bernardino Navarrete Alcazar has received grants from Novartis, Menarini, Ferrer, personal fees from Novartis AG, GSK, Boehringer Ingelheim, Astra Zeneca, Gebro Pharma, Menarini, Ferrer, Rovi, and non-financial support from Novartis, GSK, Boehringer Ingelheim, Chiesi, Astra Zeneca, Menarini, and Ferrer. Jose Luis López Campos has received consulting fees from Chiesi, Astra Zeneca, Novartis, Nycomed, Faes, Almirall, Boehringer, payment for lectures from GSK, MSD, AstraZeneca, Esteve, Almirall, Novartis, Nycomed, Boehringer, Ferrer, Pfizer and fees for manuscript preparation from Novartis. Sagrario Mayoralas has received personal fees from GSK. Marc Miravitlles has received speaker’s fees from Almirall, Boehringer Ingelheim, Pfizer, AstraZeneca, Chiesi, Esteve, GlaxoSmithKline, Menarini, Grifols and Novartis, and consulting fees from Almirall, Boehringer Ingelheim, Pfizer, GlaxoSmithKline, GebroPharma, CLS Behring, MediImmune, Takeda, Novartis, and Grifols. Jose de Miguel Díez, Joaquin Costan Galicia, Cristina Esquinas, Cayo García Polo, Luis Alberto Ruiz, Jose Antonio Ros Lucas, Patricia Garcia-Sidro, and Gema Tirado-Conde have no conflict of interest to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martinez Rivera, C., Costan Galicia, J., Alcázar Navarrete, B. et al. Factors Associated with Depression in COPD: A Multicenter Study. Lung 194, 335–343 (2016). https://doi.org/10.1007/s00408-016-9862-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-016-9862-7

Keywords

Search

Navigation