Long-term Course of Depression Trajectories in Patients With COPD: A 3-Year Follow-up Analysis of the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints Cohort

Chest. 2016 Apr;149(4):916-26. doi: 10.1016/j.chest.2015.10.081. Epub 2016 Jan 5.


Background: There is insufficient evidence about the long-term course of depressive symptom trajectories and their impact among patients with COPD.

Methods: We analysed 3-year data obtained from patients with COPD participating in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints study. Patients were split into four groups on the basis of Center for Epidemiologic Studies Depression Scale score (< 16 vs ≥ 16) and antidepressant use (yes vs no) at baseline and at 3 years: never depressed, new onset, remittent, and persistent depression. Baseline characteristics were used to assess factors associated with the group by using logistic regression.

Results: A total of 1,589 patients with COPD completed the 3-year follow-up. Of these, 55% (n = 869) were classified as never depressed, 24% (n = 377) were classified as persistently depressed, 14% (n = 226) developed new onset of depression, and 7% (n = 117) had depression that remitted. Female sex and history of stroke were associated with substantial increases in the odds of persistent depression (OR, 2.95; 95% CI, 2.05-4.24 and OR, 3.09; 95% CI, 1.43-6.67, respectively). Odds of new onset depression increased with worse health status (OR, 1.10; 95% CI, 1.04-1.17 per 4-point increase in St. George's Respiratory Questionnaire score) and moderate to severe dyspnea (OR, 1.57; 95% CI, 1.07-2.31 for modified Medical Research Council score ≥ 2 vs 0 or 1). During follow-up, patients with persistent or new-onset depression experienced more exacerbations and more pronounced loss in performance as assessed by reduction in the 6-min walk distance (6MWD) test score.

Conclusions: About one in four patients with COPD had persistent depressive symptoms over 3 years. Clinicians should be aware of the characteristics of persistent and new onset depressive symptoms, which are associated with risk of exacerbations and loss of performance on the 6MWD test. Interventions that ameliorate the course of depression are needed.

Trial registry: ClinicalTrials.gov; No.: NCT00292552; URL: www.clinicaltrials.gov.

Keywords: COPD; depression; dyspnea; long-term follow-up; new onset; persistent; remittent.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biomarkers / metabolism
  • C-Reactive Protein / metabolism
  • Chemokines, CC / metabolism
  • Cohort Studies
  • Depression / epidemiology
  • Depression / physiopathology
  • Depression / psychology*
  • Depressive Disorder / epidemiology
  • Depressive Disorder / physiopathology
  • Depressive Disorder / psychology*
  • Disease Progression
  • Dyspnea / physiopathology
  • Exercise Test
  • Fatigue / physiopathology
  • Female
  • Fibrinogen / metabolism
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Odds Ratio
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / metabolism
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / psychology*
  • Pulmonary Surfactant-Associated Protein D / metabolism
  • Sex Factors
  • Stroke / epidemiology
  • Stroke / psychology
  • Uteroglobin / metabolism


  • Biomarkers
  • CCL18 protein, human
  • Chemokines, CC
  • Pulmonary Surfactant-Associated Protein D
  • SCGB1A1 protein, human
  • Fibrinogen
  • C-Reactive Protein
  • Uteroglobin

Associated data

  • ClinicalTrials.gov/NCT00292552