Female sex a risk factor for depressive symptoms in patients with COPD

Female sex was identified as a main risk factor for depressive symptoms in COPD in a study published in BMC Pulmonary Medicine.

“Previous studies have reported risk factors for depression in patients with COPD, including living alone, severe COPD, impaired physical function,” Ji Soo Choi, MD, from the division of pulmonary, allergy and critical care medicine at Yongin Severance Hospital at Yonsei University College of Medicine, South Korea, and colleagues wrote. “However, studies on how the risk factors of depressive symptoms in COPD patients differ according to sex are insufficient.”

The population-based, cross-sectional study evaluated data from 877 participants (mean age, 66.1 years; 71.5% men) from the 2014 and 2016 Korea National Health and Nutrition Examination Surveys. COPD was defined as FEV₁/FVC ratio less than 0.7 on spirometry. Presence of depressive symptoms was defined as a score of at least 5 on the Patient Health Questionnaire-9.

In total, 17.8% of participants reported depressive symptoms. There were more women with depressive symptoms compared with women without (47.4% vs. 24.4%).

Risk factors for depressive symptoms in adjusted regression analyses were female sex (RR = 2.38; 95% CI, 1.55-3.66; P < .001), living alone (RR = 1.46; 95% CI, 1.08-1.97; P = .013), current smoking (RR = 1.7; 95% CI, 1.15-2.52; P = .008), underweight (RR = 1.58; 95% CI, 1-2.49; P = .049) and GOLD stage III and IV (RR = 1.92; 95% CI, 1.19-3.09; P = .007), according to the results.

In addition, researchers observed a 43% reduction in risk for depressive symptoms in adults with COPD among participants with higher household incomes (RR = 0.57; 95% CI, 0.33-0.97; P = .039).

Among men, risk factors for depressive symptoms were lower income (RR = 0.5; 95% CI, 0.29-0.89; P = .017), living alone (RR = 1.97; 95% CI, 1.18-3.28; P = .009), having two or more chronic disorders (RR = 2.04; 95% CI, 1.15-3.63; P = .015) and being underweight (RR = 3.35; 95% CI, 1.16-9.68; P = .026), according to the results.

However, among women, risk factors for depressive symptoms were educational attainment up to middle school (RR = 0.5; 95% CI, 0.23-1.09; P = .08), urban living (RR = 0.56; 95% CI, 0.36-0.88; P = .012) and current smoking (RR = 1.51; 95% CI, 0.76-2.99; P = 0.233), according to the results.

Screening and providing interventions for depression early in COPD treatment should be emphasized to prevent disease worsening because depression is common in patients with chronic diseases, according to the researchers.

“We suggest that COPD patients found to have these risk factors should be kept under close observation to prevent depression and exacerbation of disease-related symptoms,” the researchers wrote.