Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations

Am J Respir Crit Care Med. 2008 Nov 1;178(9):913-20. doi: 10.1164/rccm.200804-619OC. Epub 2008 Aug 28.


Rationale: Depression and anxiety are significant comorbid and potentially modifiable conditions in chronic obstructive pulmonary disease (COPD), but their effects on exacerbations are not clear.

Objectives: To investigate the independent effect of depression and anxiety on the risk of COPD exacerbations and hospitalizations.

Methods: A multicenter prospective cohort study in 491 patients with stable COPD in China. Multivariate Poisson and linear regression analyses were used, respectively, to estimate adjusted incidence rate ratios (IRRs) and adjusted effects on duration of events.

Measurements and main results: Depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS) at baseline. Other measurements included sociodemographic, clinical, psychosocial, and treatment characteristics. Patients were then monitored monthly for 12 months to document the occurrence and characteristics of COPD exacerbations and hospitalizations. Exacerbation was determined using both symptom-based (worsening of > or =1 key symptom) and event-based definitions (> or =1 symptom worsening plus > or =1 change in regular medications). A total of 876 symptom-based and 450 event-based exacerbations were recorded, among which 183 led to hospitalization. Probable depression (HADS depression score > or = 11) was associated with an increased risk of symptom-based exacerbations (adjusted IRR, 1.51; 95% confidence interval [CI], 1.01-2.24), event-based exacerbations (adjusted IRR, 1.56; 95% CI, 1.02-2.40), and hospitalization (adjusted IRR, 1.72; 95% CI, 1.04-2.85) compared with nondepression (score < or = 7). The duration of event-based exacerbations was 1.92 (1.04-3.54) times longer for patients with probable anxiety (HADS anxiety score > or = 11) than those with no anxiety (score < or = 7).

Conclusions: This study suggests a possible causal effect of depression on COPD exacerbations and hospitalizations. Further studies are warranted to confirm this finding and to test the effectiveness of antidepressants and psychotherapies on reducing exacerbations and improving health resource utilizations.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / epidemiology*
  • Anxiety Disorders / psychology
  • Causality
  • China / epidemiology
  • Cohort Studies
  • Comorbidity
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology*
  • Depressive Disorder / psychology
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Hospitalization / statistics & numerical data*
  • Humans
  • Incidence
  • Male
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / pathology
  • Pulmonary Disease, Chronic Obstructive / psychology*
  • Risk Factors
  • Severity of Illness Index
  • Socioeconomic Factors
  • Time Factors