Patients with COPD plus depression or anxiety experience greater disease burden
Key takeaways:
- Patients with COPD underwent the Mini-International Neuropsychiatric Interview.
- Receipt of mental health counseling was reported by small proportions of patients with COPD plus a depression/anxiety disorder.
Patients with COPD plus a depression/anxiety disorder had poorer scores related to disease burden and health-related quality of life, according to data published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation.
“This study confirms that depression and anxiety disorders are common among people with COPD,” Gennie (Jing) Wang, MD, assistant professor of internal medicine and medical director of the pulmonary function testing lab at The Ohio State University Wexner Medical Center, told Healio. “There is a need for greater recognition and treatment of comorbid depression and anxiety among patients with COPD and to include mental health assessments as part of comprehensive COPD care.”
In a cross-sectional, secondary analysis of the Anxiety and COPD Evaluation, Wang and colleagues assessed 220 patients with COPD who underwent the Mini-International Neuropsychiatric Interview (MINI) to determine the prevalence of depression and anxiety disorders that meet diagnostic criteria in this population.
Researchers then compared several measures of disease burden captured via questionnaires in patients with vs. without depression/anxiety disorders.
Based on MINI criteria, the study reported a current major depressive disorder in 18 patients (8%) and a current anxiety disorder in 17 patients (8%).
After breaking down those with an anxiety disorder into specific diagnoses, researchers noted that 10 had agoraphobia, six had a panic disorder, six had PTSD, four had generalized anxiety disorder and three had social anxiety disorder.
Between those with vs. without a depressive disorder, researchers found significant differences in age (median, 60 years vs. 66 years; P = .016) and household income (< $22,000; 61% vs. 30%; P = .014).
Switching to those with vs. without an anxiety disorder, age significantly differed between the two groups (median, 59 years vs. 65 years; P = .018), as did age of COPD onset (median, 48 years vs. 55 years; P = .03).
Questionnaire results
Patients with vs. without depression reported significantly poorer scores on several disease/health-related questionnaires, one of which was the COPD Assessment Test where a higher score on the 0 to 40 scale signals greater disease burden (CAT; 27 vs. 17; P < .001), according to the study.
Through the remaining measures, researchers revealed that those with COPD and depression vs. those with COPD without depression reported a higher modified Medical Research Council Dyspnea Scale (mMRC) score indicating more breathlessness (4 vs. 3; P = .045), a higher Pittsburgh Sleep Quality Index (PSQI) score indicating worse sleep quality (11 vs. 7; P = .001) and a lower 5-Level EQ-5D questionnaire score (0.31 vs. 0.59; P < .001) and Patient-Reported Outcomes Measurement Information System (PROMIS-29) Physical Function questionnaire score (34 vs. 39; P = .002), both indicating poorer health-related quality of life.
In addition to PROMIS-29 Physical Function, six other PROMIS-29 measures were found to be significantly less favorable among patients with vs. without depression: Anxiety, Depression, Fatigue, Sleep Disturbance, Social and Pain Interference.
Similar to above, the study found significantly poorer outcomes among patients with COPD and anxiety when compared with patients with COPD without anxiety, including CAT score (24 vs. 17; P = .001), PSQI score (10 vs. 7; P = .003) and EQ-5D-5L score (0.4 vs. 0.59; P = .003).
In contrast to the depression analysis, researchers observed no significant difference in mMRC scores and PROMIS-29 Physical Function scores between patients with anxiety and patients without anxiety. However, six other PROMIS-29 scores — Anxiety, Depression, Fatigue, Sleep Disturbance, Pain Interference and Pain Intensity — did significantly differ between these groups, with less favorable scores observed in the group with anxiety.
On four depression and anxiety screening questionnaires (the Generalized Anxiety Disorder-7 questionnaire, Hospital Anxiety and Depression Scale [HADS]-Anxiety, the Patient Health Questionnaire for Depression and Anxiety and HADS-Depression), score comparisons between those with vs. without depression showed more depressive and anxiety symptoms among those with depression. The study said this was also true for patients with anxiety.
Treatment
When analyzing antidepressant use, less than 50% of those with a depressive disorder reported use (39%), and this was also the case when researchers assessed anxiolytic use in the population with anxiety disorders, as only 41% reported use.
Lastly, receipt of mental health counseling was reported by small proportions of patients in the current depressive disorder group (22%) and patients in the current anxiety disorder group (47%), according to the study.
“It was surprising that people with COPD and comorbid depression or anxiety disorders were undertreated and still had significant symptom burden,” Wang told Healio.
“Future studies should focus on practical strategies of identifying and treating comorbid mental health conditions among patients with COPD,” Wang said.
For more information:
Gennie (Jing) Wang, MD, can be reached at jing.wang2@osumc.edu.
Reference:
- Lack of appropriate mental health care impacts quality of life for people with COPD. https://www.copdfoundation.org/About-Us/Press-Room/Press-Releases/Article/2163/Lack-of-appropriate-mental-health-care-impacts-quality-of-life-for-people-with.aspx. Published March 6, 2025. Accessed March 6, 2025.
Perspective
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This methodologically rigorous study of people with COPD found that 22% of those with major depressive disorder and half of those with an anxiety disorder were not receiving any mental health counseling. The results of this study underline the importance of integrating mental health considerations into the care of COPD patients.
To remedy the substantial underdiagnosis and undertreatment of mental health concerns in COPD patients, regular screenings and appropriate referrals to mental health specialists, such as social workers or psychologists, should be part of routine COPD care.
Several recent studies suggest that cognitive behavioral therapy, a talk-based intervention lasting approximately 8 weeks, can improve both depression and anxiety symptoms among those with COPD. Research is still needed to determine if cognitive behavioral therapy might also benefit the physical health of these patients.
Previous studies of individuals with COPD have indicated that both anxiety and depressive symptoms are linked to poorer adherence to treatment, prolonged hospital stays and increased premature mortality. Anxiety symptoms further correlate with greater health care utilization and lower quality of life. The current cross-sectional study found that almost half of the patients with COPD had at least mild depressive symptoms and 17% had at least mild anxiety symptoms, which is in keeping with previous research.
It would be helpful to know how mental health symptoms vary across the progression of the disease. To accomplish this aim, future research would benefit from longitudinal, multi-year studies of the mental health of patients with COPD.
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