Clinical Characteristics of Patients With COPD and Comorbid Depression and Anxiety: Data From a National Multicenter Cohort Study.

Abstract

Background: Most studies on mental health among individuals with chronic obstructive pulmonary disease (COPD) utilize screening questionnaires, which detect psychiatric symptoms, but cannot be used to diagnose depression/anxiety disorders. We utilized the Mini-International Neuropsychiatric Interview (MINI) to identify depression/anxiety disorders meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnostic criteria and described associated disease burden in people with COPD.

Methods: This is a cross-sectional, secondary analysis of a multicenter study designed to evaluate anxiety questionnaires in COPD patients. Research coordinators administered both the MINI and screening questionnaires to determine participants who met diagnostic criteria for depression/anxiety disorders and to capture symptom burden, respectively. Bivariate analyses were conducted to assess differences in COPD and patient-reported outcomes between those with and without depression/anxiety disorders.

Results: Of 220 participants, 18 (8%) met the MINI criteria for depression and 17 (8%) for anxiety. Depression was associated with more breathlessness (modified Medical Research Council Dyspnea Scale 4 versus 3, p=0.045), higher COPD disease burden (COPD Assessment Test [CAT] 27 versus 17, p<0.001), worse sleep quality (Pittsburgh Sleep Quality Index 11 versus 7, p=0.001) and health-related quality of life (5-Level EQ-5D 0.31 versus 0.59, p<0.001). Anxiety was associated with lower CAT scores and worse health-related quality of life and function. Most with depression/anxiety disorders were not using antidepressants/anxiolytics, or receiving mental health counseling.

Conclusion: Depression and anxiety disorders meeting diagnostic criteria are relatively common comorbidities that substantially impair quality of life and are undertreated, highlighting a need to prioritize mental health as an integral part of comprehensive COPD care.