Depression Increases Exacerbations, Hospitalisations in Patients With COPD

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Title: Depression Increases Exacerbations, Hospitalisations in Patients With COPD
URL: http://www.pslgroup.com/dg/231542.htm
Doctor's Guide
October 24, 2008

NEW YORK -- October 24, 2008 -- Depression and anxiety may cause increased hospitalisations and exacerbations in patients with chronic obstructive pulmonary disease (COPD), according to a study in the November issue of American Journal of Respiratory and Critical Care Medicine.

"This is an important and revealing finding, indicating that for COPD patients, depression and anxiety must be treated as potential clinically important risk factors, rather than simple comorbidities that are caused by COPD," said principle investigator Jean Bourbeau, MD, Respiratory Epidemiology and Clinical Research Unit, McGill University, Montreal, Quebec.

To determine whether depression and anxiety were independent risk factors for COPD exacerbations and hospitalisations, the researchers prospectively recruited nearly 500 patients with stable COPD from 10 hospitals in Beijing, China.

Each patient was assessed at baseline for anxiety and depression as well as disease severity. They were contacted monthly by telephone for 1 year to determine whether they had experienced any exacerbations or hospitalisations.

"Almost a quarter of the patients we monitored were suspected of having depression at baseline, and nearly 1 in 10 were suspected of having anxiety," said Dr. Bourbeau.

Depressed patients had a higher proportion of concurrent anxiety than non-depressed patients. They also had higher mortality, more symptom- and event-based exacerbations and hospitalizations, and longer hospital stays than non-depressed patients.

Anxiety was also associated with a greater risk of exacerbations and longer hospital stays. Overall, among patients with anxiety who had at least one exacerbation, the exacerbation lasted nearly twice as long as those without anxiety, but there was no support for previous findings that hospitalisations were affected by anxiety in length or frequency.

Because these effects were evident after adjustments for all known confounding factors using a causal diagram, and because the outcomes were measured after psychological exposures, the researchers assert that not only is depression linked to greater risk of more and lengthier COPD exacerbations and hospitalisations, but that their findings suggest a causal relationship.

"To our knowledge this is the first report of the possible causal association between depressive symptoms and exacerbations and hospitalisations in stable COPD. However, people have to realise that the causal relationship is a complicated issue and will require further evaluation as part of other properly designed longitudinal studies," said Dr. Bourbeau.

While they acknowledge that there may have been a differential loss of depressed/non-depressed patients in follow up, because patients who withdrew earlier had more severe COPD and were more depressed than those who completed follow-up, it is likely that the association was underestimated than anything. "Similarly, the association between anxiety and exacerbations may have been underestimated due to the differential attrition," he said.

"The results of this study can guide researchers and clinicians to evaluate in COPD patients with depression the effectiveness of antidepressants and psychotherapies on reducing exacerbations and related complications such as hospital admissions," concluded Dr. Bourbeau.

SOURCE: American Thoracic Society

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