Elsevier

The American Journal of Medicine

Volume 122, Issue 8, August 2009, Pages 778.e9-778.e15
The American Journal of Medicine

AJM online
Clinical research study
Depression and Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease

https://doi.org/10.1016/j.amjmed.2009.01.036Get rights and content

Abstract

Background

Prior research on the risk of depression in chronic obstructive pulmonary disease (COPD) has yielded conflicting results. Furthermore, we have an incomplete understanding of how much depression versus respiratory factors contributes to poor health-related quality of life.

Methods

Among 1202 adults with COPD and 302 demographically matched referents without COPD, depressive symptoms were assessed using the 15-item Geriatric Depression Score. We measured COPD severity using a multifaceted approach, including spirometry, dyspnea, and exercise capacity. We used the Airway Questionnaire 20 and the Physical Component Summary Score to assess respiratory-specific and overall physical quality of life, respectively.

Results

In multivariate analysis adjusting for potential confounders including sociodemographics and all examined comorbidities, COPD subjects were at higher risk for depressive symptoms (Geriatric Depression Score ≥6) than referents (odds ratio [OR] 3.6; 95% confidence interval [CI], 2.1-6.1; P <.001). Stratifying COPD subjects by degree of obstruction on spirometry, all subgroups were at increased risk of depressive symptoms relative to referents (P <.001 for all). In multivariate analysis controlling for COPD severity as well as sociodemographics and comorbidities, depressive symptoms were strongly associated with worse respiratory-specific quality of life (OR 3.6; 95% CI, 2.7-4.8; P <.001) and worse overall physical quality of life (OR 2.4; 95% CI, 1.8-3.2; P <.001).

Conclusions

Patients with COPD are at significantly higher risk of having depressive symptoms than referents. Such symptoms are strongly associated with worse respiratory-specific and overall physical health-related quality of life, even after taking COPD severity into account.

Section snippets

Participants

The Function, Living, Outcomes, and Work study is an ongoing cohort study of patients with COPD and matched referents without COPD.14 The cohort was derived from members of Kaiser Permanente (KP). Previously, patient recruitment has been described in detail.14 Briefly, we identified all adult KP members living within a 30-mile radius of our research clinic who were treated recently for COPD.14 The age range was restricted to 40-65 years because an important focus of the Function, Living,

Patient Characteristics

By design, patients with and without COPD were similar in age, sex, and race (Table 1). Compared with referents, patients with COPD had a higher prevalence of all examined comorbidities, higher average BMI, and greater prevalence of depressive symptoms (P <.001 for all).

COPD and the Risk of Depressive Symptoms

In multivariate analysis adjusting for sociodemographics and comorbidities, depressive symptoms were much more common in patients with COPD than in referents (OR 3.6; 95% CI 2.1-6.1; P <.001). In addition, when COPD subjects

Discussion

In a population-based sample, COPD was associated with a greater risk of depressive symptoms compared with a matched referent group. The fact that increasing COPD severity is associated with an increasing likelihood of depressive symptoms provides further evidence for an association between COPD and depression. Depressive symptoms also appeared to negatively impact quality of life, highlighting the importance of depression in these patients. Targeting depression in COPD could therefore be an

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    Funding: Dr. Omachi was supported by the Agency for Healthcare Research and Quality, Grant number F32 HS017664. Dr. Eisner was supported by R01HL077618 from the National Heart, Lung, and Blood Institute, National Institutes of Health, and UCSF Bland Lane FAMRI Center of Excellence on Secondhand Smoke CoE2007.

    Conflict of Interest: None.

    Authorship: All authors had access to the data and a role in writing the manuscript.

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