The utility of somatic symptoms as indicators of depression and anxiety in military veterans with chronic obstructive pulmonary disease

Depression Symptoms and Physical Activity in Veterans With COPD: Insights From a Web-Based, Pedometer-Mediated Physical Activity Intervention

BACKGROUND

Depression is known to limit physical activity (PA) among individuals with chronic obstructive pulmonary disease (COPD). However, whether and how depression influences the effectiveness of PA interventions is unknown.

PURPOSE

The study examined the association between baseline depression symptoms and change in daily step count and whether group assignment to a web-based, pedometer-mediated PA intervention moderated the association between baseline depression symptoms and change in daily step count.

METHODS

Secondary analysis included two cohorts of U.S. Veterans with COPD (n = 212; 97% male; mean age 69 ± 8 years) assessed at baseline and 3 months. Cohorts 1 and 2 were randomly assigned to the same PA intervention (n = 111) or a control group (n = 101). Multivariate regressions tested the main effects of baseline depression symptoms (BDI-II total and cognitive-affective and somatic subscales) on change in daily steps, as well as the interaction between baseline BDI-II and subscales and group assignment on change in daily steps.

RESULTS

Greater BDI-II total score (B = -31.8, SE = 14.48, p = .030) and somatic subscale scores (B = -99.82, SE = 35.76, p = .006) were associated with less improvement in daily step count. There was a significant interaction between baseline cognitive-affective subscale and the intervention predicting change in daily step count (B = -88.56, SE = 42.31, p = .038). When cognitive-affective subscale scores were ≥1 SD above the mean, the intervention was no longer associated with an increase in daily step count (p = .585).

CONCLUSIONS

Depression should be routinely assessed and targeted as part of PA promotion efforts.

Neurological and Psychiatric Comorbidities in Chronic Obstructive Pulmonary Disease

Background and Purpose

Chronic obstructive pulmonary disease (COPD) is often accompanied by different neurological and psychiatric comorbidities. The purpose of this study was to examine which of them are the most frequent and to explore whether their manifestation can be explained by underlying latent variables.

Methods

Data about patients with COPD and their neurological and psychiatric comorbidities were extracted from an electronic database of the National Health Insurance Fund of Lithuania for the period between January 1, 2012, and June 30, 2014. Exploratory factor analysis (EFA) was used to investigate comorbidity patterns.

Results

A study sample of 4834 patients with COPD was obtained from the database, 3338 (69.1%) of who were male. The most frequent neurological and psychiatric comorbidities were nerve, nerve root and plexus disorders (n=1439, 29.8%), sleep disorders (n=666, 13.8%), transient ischemic attack (n=545, 11.3%), depression (n=364, 7.5%) and ischemic stroke (n=349, 7.2%). The prevalence of ischemic stroke, transient ischemic attack, Parkinson’s disease, dementia and sleep disorders increased with age. One latent variable outlined during EFA grouped neurological disorders, namely ischemic stroke, transient ischemic attack, epilepsy, dementia and Parkinson’s disease. The second encompassed depression, anxiety, somatoform and sleep disorders. While similar patterns emerged in data from male patients, no clear comorbidity profiles among women with COPD were obtained.

Conclusion

Our study provides novel insights into the neurological and psychiatric comorbidities in COPD by outlining an association among cerebrovascular, neurodegenerative disorders and epilepsy, and psychiatric and sleep disorders. Future studies could substantiate the discrete pathological mechanism that underlie these comorbidity groups.

Nurse-led cognitive behavioural therapy for treatment of anxiety in COPD

Anxiety disorders are common and debilitating conditions that significantly impair the physical functioning and quality of life (QoL) of patients with chronic obstructive pulmonary disease (COPD). A recent systematic review identified the high prevalence of these disorders in patients with COPD, ranging 6–33% for generalised anxiety, 0–44% for panic disorder, 10–27% for specific phobias, and 5–11% for social phobias [1]. Furthermore, under-recognised or untreated anxiety disorders in COPD patients may reduce the QoL of their caregivers and increase emergency care visits and hospital admissions [1–5]. In 2004, in the European Union, the estimated direct (e.g. hospital admissions and medications) and indirect (e.g. loss of productivity due to absence from work) cost of anxiety disorders exceeded €41 billion per annum [2].

Nurse-led cognitive behavioural therapy is feasible and cost-effective for the treatment of anxiety in patients with chronic obstructive pulmonary disease.http://ow.ly/QZJT30mJdXU

Depressive symptoms and antiretroviral therapy (ART) initiation among HIV-infected Russian drinkers

The impact of depressive symptoms on ART initiation among Russian HIV-infected heavy drinkers enrolled in a secondary HIV prevention trial (HERMITAGE) was examined. We assessed 133 participants eligible for ART initiation (i.e., CD4 count <350 cells/μl) who were not on ART at baseline. Depressive symptom severity and ART use were measured at baseline, 6- and 12-months. Association between depressive symptoms and subsequent ART initiation was evaluated using GEE logistic regression adjusting for gender, past ART use, injection drug use and heavy drinking. Depressive symptom severity was not significantly associated with lower odds of initiating ART. Cognitive depression symptoms were not statistically significant (global p = 0.05); however, those with the highest level of severity had an AOR of 0.25 (95 % CI 0.09-0.71) for delayed ART initiation. Although the effect of depression severity was not significant, findings suggest a potential role of cognitive depression symptoms in decisions to initiate ART in this population.

Mental health and risk of secondary medical complications in adults with pediatric-onset spinal cord injury

OBJECTIVE

To investigate mental health problems in adults with pediatric-onset spinal cord injury (SCI) and explore how these problems relate to the risk of negative outcomes over time.

METHOD

The study included 466 adults who sustained an SCI prior to age 19 years and had been injured for at least 1 year. Participants were interviewed on an approximately annual basis using a study-specific questionnaire and standardized measures of depression, anxiety, substance use, and community involvement. Generalized estimating equations were used to assess the risk of negative outcomes across time as a function of depression, anxiety, and substance misuse.

RESULTS

Of the participants who reported on each domain of mental health, 26% reported misuse of alcohol or drugs (122/466), 21% reported problems with depression (78/360), and 29% reported problems with anxiety (49/168). Depression was associated with increased odds of pressure ulcers, urinary tract infections, hospitalizations, pain, and smoking and lower levels of economic independence and mobility. Anxiety was associated with increased odds of hospitalization, pain, and smoking. Substance misuse predicted an increased risk of pressure ulcers, pain, and smoking and decreased odds of occupational involvement. When examining the effect of mental health with time, results showed that depression accelerated the risk of urinary tract infections, respiratory complications, and hospitalizations and anxiety and depression accelerated risk for lower occupational independence.

CONCLUSIONS

The added burden that mental health difficulties pose for medical and psychosocial outcomes highlight the importance of monitoring and treating mental health symptoms in pediatric-onset SCI.

Cognitive biases in patients with chronic obstructive pulmonary disease and depression--a pilot study

OBJECTIVES

Comorbid depression is highly prevalent in patients with chronic obstructive pulmonary disease (COPD) and associated with a worse course of disease; however, the exact mechanisms linking both remain unclear. In currently depressed individuals without lung disease, depression-specific biases in information processing have been suggested as risk factors for the development and maintenance of depression. We examined whether comparable biases in cognitive information processing might underlie depression in COPD.

DESIGN

Different aspects of cognitive information processing were examined with computer-based tasks measuring selective attention and memory in patients with COPD who were compared with age-matched, currently depressed patients without lung disease and healthy control participants.

METHODS

The Self-Referential Encoding and Incidental Recall Task as well as the emotion face dot-probe task was applied to 21 never-depressed COPD patients, 18 currently depressed COPD patients, 20 currently depressed patients without lung disease and 19 healthy controls to examine cognitive biases.

RESULTS

In both patients with COPD who were never and who were currently depressed, depression-like cognitive biases were observed for some attention- and memory-related tasks, but not for all tested aspects of information processing. These biases were particularly prominent in patients with COPD and current depression and comparable to those observed in currently depressed patients without lung disease.

CONCLUSIONS

The results of this pilot study suggest that patients with COPD may potentially show depression-like biases in some aspects of cognitive information processing. Future studies are required to examine whether these biases represent a vulnerability factor for the development of depression in patients with COPD.

The psychometric properties of the Brief Symptom Inventory depression and anxiety subscales in patients with heart failure and with or without renal dysfunction

More than 5 million Americans have heart failure (HF); approximately one third have concomitant renal dysfunction. Anxiety and depressive symptoms are the most common psychological responses of these individuals and may influences outcomes; thus a reliable valid instrument to measure these is needed. This article reports a psychometric evaluation of the Brief Symptom Inventory (BSI) depression and anxiety subscales in patients with HF and with or without renal dysfunction, as these scales are commonly used in this population for research studies. This rigorous psychometric analysis used existing data from 590 patients with HF with an average ejection fraction of 35% ± 15% and average age of 63 ± 13 years. Patients were categorized as normal renal function (n = 495) or renal dysfunction (n = 95), and groups were compared and analyzed separately. Cronbach's alpha for the BSI subscales was .82 for those with normal renal function and .88 for those with renal dysfunction. Factor analysis determined that the subscales evaluated one dimension, psychological distress, in both groups. Construct validity was examined using hypothesis testing, and construct validity was supported in patients with HF and with normal renal function by significant associations of the BSI subscales with another measure of depression and a measure of perceived control. Construct validity in patients with HF and renal dysfunction was not strongly supported. Only the BSI depression subscale predicted poorer outcomes in patients with HF and with normal renal function; neither subscale was associated with event-free survival at 12 months in those with renal dysfunction. The BSI anxiety and depression subscales provide reliable and valid data in patients HF and normal renal function. Although reliability is excellent, construct validity was weak in those patients with HF and with concomitant renal dysfunction, which may reduce the validity of those data.

Anxiety, depression, and quality of life in primary care patients

BACKGROUND

Anxiety and depressive disorders have a significant and negative impact on quality of life. However, less is known about the effects of anxiety and depressive symptoms on quality of life. The purpose of this study was to examine the impact of anxiety and depressive symptoms on emotional and physical functioning, the effects of anxiety symptoms on functioning independent of depressive symptoms, and the effects of depressive symptoms on functioning independent of anxiety symptoms.

METHOD

Participants included 919 patients, recruited from 2 university-affiliated primary care clinics between May 2004 and September 2006, who completed self-report measures of anxiety symptoms, depressive symptoms, and quality of life.

RESULTS

Almost 40% of the sample reported anxiety symptoms and 30% reported depressive symptoms. In both unadjusted and adjusted models, anxiety and depressive symptoms were significantly associated with all domains of quality of life. When anxiety and depressive symptoms were added simultaneously, both remained significant. As the severity of anxiety or depressive symptoms increased, quality of life decreased. Furthermore, patients with moderate to severe anxiety or depressive symptoms had greater impairments in most quality of life domains than patients with acute myocardial infarction, congestive heart failure, or diabetes.

CONCLUSION

Detection and treatment of anxiety and depressive symptoms in the primary care setting should be emphasized.

Determinants of depression in the ECLIPSE chronic obstructive pulmonary disease cohort

RATIONALE

Depression is prevalent in patients with chronic obstructive pulmonary disease (COPD); however, its etiology and relationship to the clinical features of COPD are not well understood.

OBJECTIVES

Using data from a large cohort, we explored prevalence and determinants of depression in subjects with COPD.

METHODS

The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints study is an observational 3-year multicenter study that enrolled smokers with and without COPD and nonsmoker controls. At baseline, several patient-reported outcomes were measured including the Center for Epidemiologic Studies of Depression Scale. For the purposes of this analysis, depression was defined as a score of 16 and higher on this scale, which reflects a high load of depressive symptoms and has a good correspondence with a clinical diagnosis of major depression.

MEASUREMENTS AND MAIN RESULTS

The study cohort consisted of 2,118 subjects with COPD; 335 smokers without COPD (smokers); and 243 nonsmokers without COPD (nonsmokers). A total of 26%, 12%, and 7% of COPD, smokers, and nonsmokers, respectively, suffered from depression. In subjects with COPD, higher depression prevalence was seen in females, current smokers, and those with severe disease (Global Initiative for Obstructive Lung Disease [GOLD]-defined). Multivariate modeling of depression determinants in subjects with COPD revealed that increased fatigue, higher St. George's Respiratory Questionnaire for COPD patients score, younger age, female sex, history of cardiovascular disease, and current smoking status were all significantly associated with depression; physiologic and biologic measures were weak or nonsignificant descriptors.

CONCLUSIONS

Depression is more prevalent in subjects with COPD compared with smokers and nonsmokers without COPD. Clinical and biologic measures were less important determinants of depression in COPD than disease symptoms and quality-of-life. Clinical trial registered with www.clinicaltrials.gov (NCT 00292552).

Challenges associated with the recognition and treatment of depression in older recipients of home care services

BACKGROUND

Home care for older adults is a common phenomenon worldwide because it allows older adults to remain in their home environment. Research has shown that depression is frequently found in older recipients of home care services. Nonetheless, it is often poorly recognized and treated. Untreated or poorly treated depression in older home care recipients has been associated with a variety of negative outcomes, including increased morbidity and mortality, greater likelihood of nursing home institutionalization and higher caregiver distress.

METHODS

The present review outlines some of the challenges associated with appropriate recognition and treatment of depression in older home care recipients.

RESULTS

Our review demonstrates that more aggressive management of depressive symptoms and the employment of an interdiciplinary team can result in beneficial outcomes.

CONCLUSIONS

Further research is needed, especially in the area of psychotherapeutic interventions as these should be flexible enough to meet the unique and evolving needs of this frail population of older adults.