Published online Apr 19, 2020. doi: 10.5498/wjp.v10.i4.59
Peer-review started: November 4, 2019
First decision: December 26, 2019
Revised: February 26, 2020
Accepted: March 12, 2020
Article in press: March 12, 2020
Published online: April 19, 2020
Processing time: 164 Days and 19.5 Hours
The reported prevalence of depression in patients with chronic obstructive pulmonary disease (COPD) ranges from 10% to 42%, a proportion much higher than that in the general population. Certain interventions such as antidepressants, pulmonary rehabilitation, and counseling may improve health outcomes, but the diagnosis of depression in patients with COPD is often unrecognized and untreated in primary and specialty care. Unrecognized depression has major implications for compliance with medical treatment, prolonged lengths of stay, increased frequency of hospital admissions, and increased consultations with primary care physicians, all of which could decrease quality of life in patients.
Many studies have attempted to identify risk factors for progression, prognosis and response to therapy in patients with depression. However, few studies have examined the risk factors for depression in patients with COPD, and some results remain controversial.
The main objective of the current study is to investigate the correlation between clinical parameters and the symptoms of depression, and to identify independent risk factors to define patients with COPD at “high risk” of depression.
The Hospital Anxiety and Depression Rating Scale (HADS) is one of the most commonly used instruments for depression in the literature. A series of consecutive patients newly diagnosed with COPD were included in this study. The diagnosis of depression mainly relied on the HADS, and the HADS scale was carried out by an experienced psychiatrist when the patients were stable. We used a cutoff of 8 or more on the HADS to dichotomize the HADS scores for the purposes of the regression analyses. The correlation between clinical parameters and depression was analyzed, and the risk factors for depression in patients with COPD were identified.
Multivariate logistic regression analysis was carried out to identify the potential risk factors for depression in patients with COPD. Low body mass index (BMI), low forced expiratory volume in 1 s (FEV1), and high COPD assessment test (CAT) score were independent risk factors for depression. BMI had the highest diagnostic accuracy for predicting the risk of depression. Additionally, combined BMI and FEV1 with CAT score had a higher area under curve than that of one single factor.
Approximately one-fifth of patients with COPD developed depression. Additionally, we identified low BMI, low FEV1, and high CAT score as risk factors for depression in COPD patients. Combining these factors predicted the highest risk of developing depression.
Some variables, such as the time to depression and follow up, were not reported, which may have resulted in bias during analysis of the results. A prospective study with a large sample size and multicenter analysis is needed to prove the conclusions of our study.