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Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations.
Am J Respir Crit Care Med 2008; 178(9):913-20AJ

Abstract

RATIONALE

Depression and anxiety are significant comorbid and potentially modifiable conditions in chronic obstructive pulmonary disease (COPD), but their effects on exacerbations are not clear.

OBJECTIVES

To investigate the independent effect of depression and anxiety on the risk of COPD exacerbations and hospitalizations.

METHODS

A multicenter prospective cohort study in 491 patients with stable COPD in China. Multivariate Poisson and linear regression analyses were used, respectively, to estimate adjusted incidence rate ratios (IRRs) and adjusted effects on duration of events.

MEASUREMENTS AND MAIN RESULTS

Depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS) at baseline. Other measurements included sociodemographic, clinical, psychosocial, and treatment characteristics. Patients were then monitored monthly for 12 months to document the occurrence and characteristics of COPD exacerbations and hospitalizations. Exacerbation was determined using both symptom-based (worsening of > or =1 key symptom) and event-based definitions (> or =1 symptom worsening plus > or =1 change in regular medications). A total of 876 symptom-based and 450 event-based exacerbations were recorded, among which 183 led to hospitalization. Probable depression (HADS depression score > or = 11) was associated with an increased risk of symptom-based exacerbations (adjusted IRR, 1.51; 95% confidence interval [CI], 1.01-2.24), event-based exacerbations (adjusted IRR, 1.56; 95% CI, 1.02-2.40), and hospitalization (adjusted IRR, 1.72; 95% CI, 1.04-2.85) compared with nondepression (score < or = 7). The duration of event-based exacerbations was 1.92 (1.04-3.54) times longer for patients with probable anxiety (HADS anxiety score > or = 11) than those with no anxiety (score < or = 7).

CONCLUSIONS

This study suggests a possible causal effect of depression on COPD exacerbations and hospitalizations. Further studies are warranted to confirm this finding and to test the effectiveness of antidepressants and psychotherapies on reducing exacerbations and improving health resource utilizations.

Authors+Show Affiliations

Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18755925

Citation

Xu, Wanning, et al. "Independent Effect of Depression and Anxiety On Chronic Obstructive Pulmonary Disease Exacerbations and Hospitalizations." American Journal of Respiratory and Critical Care Medicine, vol. 178, no. 9, 2008, pp. 913-20.
Xu W, Collet JP, Shapiro S, et al. Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. Am J Respir Crit Care Med. 2008;178(9):913-20.
Xu, W., Collet, J. P., Shapiro, S., Lin, Y., Yang, T., Platt, R. W., ... Bourbeau, J. (2008). Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. American Journal of Respiratory and Critical Care Medicine, 178(9), pp. 913-20. doi:10.1164/rccm.200804-619OC.
Xu W, et al. Independent Effect of Depression and Anxiety On Chronic Obstructive Pulmonary Disease Exacerbations and Hospitalizations. Am J Respir Crit Care Med. 2008 Nov 1;178(9):913-20. PubMed PMID: 18755925.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. AU - Xu,Wanning, AU - Collet,Jean-Paul, AU - Shapiro,Stanley, AU - Lin,Yingxiang, AU - Yang,Ting, AU - Platt,Robert W, AU - Wang,Chen, AU - Bourbeau,Jean, Y1 - 2008/08/28/ PY - 2008/8/30/pubmed PY - 2008/12/17/medline PY - 2008/8/30/entrez SP - 913 EP - 20 JF - American journal of respiratory and critical care medicine JO - Am. J. Respir. Crit. Care Med. VL - 178 IS - 9 N2 - RATIONALE: Depression and anxiety are significant comorbid and potentially modifiable conditions in chronic obstructive pulmonary disease (COPD), but their effects on exacerbations are not clear. OBJECTIVES: To investigate the independent effect of depression and anxiety on the risk of COPD exacerbations and hospitalizations. METHODS: A multicenter prospective cohort study in 491 patients with stable COPD in China. Multivariate Poisson and linear regression analyses were used, respectively, to estimate adjusted incidence rate ratios (IRRs) and adjusted effects on duration of events. MEASUREMENTS AND MAIN RESULTS: Depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS) at baseline. Other measurements included sociodemographic, clinical, psychosocial, and treatment characteristics. Patients were then monitored monthly for 12 months to document the occurrence and characteristics of COPD exacerbations and hospitalizations. Exacerbation was determined using both symptom-based (worsening of > or =1 key symptom) and event-based definitions (> or =1 symptom worsening plus > or =1 change in regular medications). A total of 876 symptom-based and 450 event-based exacerbations were recorded, among which 183 led to hospitalization. Probable depression (HADS depression score > or = 11) was associated with an increased risk of symptom-based exacerbations (adjusted IRR, 1.51; 95% confidence interval [CI], 1.01-2.24), event-based exacerbations (adjusted IRR, 1.56; 95% CI, 1.02-2.40), and hospitalization (adjusted IRR, 1.72; 95% CI, 1.04-2.85) compared with nondepression (score < or = 7). The duration of event-based exacerbations was 1.92 (1.04-3.54) times longer for patients with probable anxiety (HADS anxiety score > or = 11) than those with no anxiety (score < or = 7). CONCLUSIONS: This study suggests a possible causal effect of depression on COPD exacerbations and hospitalizations. Further studies are warranted to confirm this finding and to test the effectiveness of antidepressants and psychotherapies on reducing exacerbations and improving health resource utilizations. SN - 1535-4970 UR - https://www.unboundmedicine.com/medline/citation/18755925/Independent_effect_of_depression_and_anxiety_on_chronic_obstructive_pulmonary_disease_exacerbations_and_hospitalizations_ L2 - http://www.atsjournals.org/doi/full/10.1164/rccm.200804-619OC?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -