Risk factors for depression in patients with chronic obstructive pulmonary disease

Global prevalence and risk factors of depression in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis from 2000 to 2022

OBJECTIVE

This study aims to assess the global and regional prevalence and the potential risk factors for depression among COPD patients.

METHODS

Web of Science, EMBASE, PubMed, and PsycINFO databases were searched for the literature related to the prevalence and risk factors of depression in COPD. Random-effect models were performed to pool the global prevalence. Sub-group analysis and meta-regression were conducted to investigate the potential heterogeneity. Meta-analysis was performed only on the risk factors that have been reported in a minimum of three studies.

RESULTS

A total of 79 studies from 25 countries were included. The pooled global prevalence of variably defined depression among COPD patients was 34.5% (95% CI: 30.9-38.1). The odds of depression in COPD patients were 3.53 times higher than in non-COPD participants (95% CI: 2.35-5.29). Meta-regression results showed that region, income level, and research setting are the main sources of heterogeneity. Female sex (OR=1.92), living alone (OR=2.29), BODE index (OR=1.48), dyspnea (OR=3.02), impaired quality of life (OR=1.26), and GOLD stage III∼IV (OR=1.96) were found to be significant risk factors for depression in meta-analyses.

CONCLUSIONS

More than one-third of COPD patients experience depression, with marked variations in prevalence across countries and regions. This study further highlights the need for the consolidation of mental health considerations into COPD treatments. High-quality, longitudinal studies and further research are needed to gain a better understanding of risk and protective factors.

Risk Factors for Depression in Patients with Chronic Obstructive Pulmonary Disease

Depression, anxiety, and panic disorders are common in chronic obstructive pulmonary disease (COPD) and important for the further course of the disease, as they are associated with increased hospital admissions, longer hospital stays, more frequent doctor visits, and a worsened quality of life. There are also indications of premature death in affected patients. Therefore, knowledge of the risk factors for depression in COPD patients is all the more important for early detection and treatment. Hence, Embase, the Cochrane Library, and the MEDLINE/PubMed databases were analyzed for studies on these risk factors. The main factors are as follows: female gender; older/younger age; living alone; higher education; unemployment; retirement; a low quality of life; social isolation; high/low income; high cigarette and alcohol consumption; poor physical fitness; severe respiratory symptoms; high/low body mass index, airway obstruction, dyspnea, exercise capacity index scores; and comorbidities (mainly heart disease, cancer, diabetes, and stroke). This article presents the analyzed medical literature.

Association Among Chronic Obstructive Pulmonary Disease Severity, Exacerbation Risk, and Anxiety and Depression Symptoms in the SPIROMICS Cohort

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a common, progressive lung disease that often manifests with psychiatric symptoms. Despite this, patients with COPD are not routinely screened for anxiety and depression, which substantially contribute to COPD-related morbidity.

OBJECTIVE

To determine the relationship among COPD symptom severity, exacerbation risk, and clinically significant anxiety and depression symptoms in ever smokers with COPD.

METHODS

We used baseline data from the Subpopulations and Intermediate Outcome Measures In COPD Study (SPIROMICS) cohort to examine ever smokers with COPD across Global Initiative for Obstructive Lung Disease (GOLD) disease severity groups. Multivariable logistic regression models were used to calculate odds ratios for clinically significant anxiety and depression for each GOLD group, which was compared to the control group of ever smokers without COPD. Odds ratios were adjusted for subject demographics, medical comorbidities, and substance use covariates, and comparisons were completed using 2-tailed tests.

RESULTS

Of the 2664 subjects studied, 784 (29.4%) had clinically significant anxiety, and 497 (18.7%) had clinically significant depression. In the multivariable analysis, high pulmonary symptom groups, groups B and D, had increased adjusted odds of clinically significant anxiety (group B: adjusted odds ratios [AOR] 1.28, P = 0.03; group D: AOR 1.95, P < 0.0001) and depression (group B: AOR 2.09, P < 0.0001; group D: AOR 3.04, P < 0.0001). GOLD group D, the group with high pulmonary symptoms and high COPD exacerbation risk, had the greatest risk of both anxiety and depression among the GOLD groups.

CONCLUSIONS

High COPD symptom severity, even in the absence of elevated COPD exacerbation risk, is associated with clinically significant anxiety and depression. Our separate analyses of anxiety and depression symptoms in a large, multisite, national cohort are unique within the literature and have important treatment implications for COPD patients. Our findings also highlight the utility of screening patients with high COPD symptom severity for anxiety and depression.

The Effect of Progressive Muscle Relaxation and Deep Breathing Exercises on Dyspnea and Fatigue Symptoms of COPD Patients: A Randomized Controlled Study

This study was conducted to examine the effect of progressive muscle relaxation and deep breathing exercises applied to patients diagnosed with chronic obstructive pulmonary disease (COPD) on their dyspnea and fatigue symptoms. The study was a randomized controlled experimental trial and comprised 116 COPD patients who applied to a chest diseases follow-up outpatient clinic hospital located in Gaziantep, Turkey. The data were collected using the "Patient Information Form" including sociodemographic and disease-related characteristics of the patients, COPD and Asthma Fatigue Scale (CAFS), and Dyspnea-12 Scale. Dyspnea-12 Scale and CAFS total scores of the patients in the intervention group showed a statistically significant difference before and after the Progressive Relaxation Exercise and Deep Breathing Exercise applications (P < .05). Although the Dyspnea-12 Scale and CAFS total mean scores showed an increase in the intervention group, they remained the same in the control group. In the present study, it was found that the Progressive Muscle Relaxation Exercise and Deep Breathing Exercise applied to COPD patients were effective in decreasing their dyspnea and fatigue symptoms.

Update on the Etiology, Assessment, and Management of COPD Cachexia: Considerations for the Clinician

Cachexia is a commonly observed but frequently neglected extra-pulmonary manifestation in patients with chronic obstructive pulmonary disease (COPD). Cachexia is a multifactorial syndrome characterized by severe loss of body weight, muscle, and fat, as well as increased protein catabolism. COPD cachexia places a high burden on patients (eg, increased mortality risk and disease burden, reduced exercise capacity and quality of life) and the healthcare system (eg, increased number, length, and cost of hospitalizations). The etiology of COPD cachexia involves a complex interplay of non-modifiable and modifiable factors (eg, smoking, hypoxemia, hypercapnia, physical inactivity, energy imbalance, and exacerbations). Addressing these modifiable factors is needed to prevent and treat COPD cachexia. Oral nutritional supplementation combined with exercise training should be the primary multimodal treatment approach. Adding a pharmacological agent might be considered in some, but not all, patients with COPD cachexia. Clinicians and researchers should use longitudinal measures (eg, weight loss, muscle mass loss) instead of cross-sectional measures (eg, low body mass index or fat-free mass index) where possible to evaluate patients with COPD cachexia. Lastly, in future research, more detailed phenotyping of cachectic patients to enable a better comparison of included patients between studies, prospective longitudinal studies, and more focus on the impact of exacerbations and the role of biomarkers in COPD cachexia, are highly recommended.

Epidemiological evidence relating risk factors to chronic obstructive pulmonary disease in China: A systematic review and meta-analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD), the most common chronic respiratory disease worldwide, not only leads to the decline of pulmonary function and quality of life consecutively, but also has become a major economic burden on individuals, families, and society in China. The purpose of this meta-analysis was to explore the risk factors for developing COPD in the Chinese population that resides in China and to provide a theoretical basis for the early prevention of COPD.

METHODS

A total of 2457 cross-sectional, case-control, and cohort studies published related to risk factors for COPD in China were searched. Based on the inclusion and exclusion criteria, 20 articles were selected. Stata 11.0 was used for meta-analysis. After merging the data, the pooled effect and 95% confidence intervals (CIs) were calculated to assess the association between risk factors and COPD. Heterogeneity between studies was assessed using I2 and Cochran's Q tests. Begg's test was used to assess publication bias.

RESULTS

Exposure to particulate matter less than 2.5 μm in diameter (PM2.5) (pooled effect = 1.73; 95%CI: 1.16~2.58; P <0.01), smoking history (pooled effect = 2.58; 95%CI: 2.00~3.32; P <0.01), passive smoking history (pooled effect = 1.39; 95%CI: 1.03~1.87; P = 0.03), male sex(pooled effect = 1.70; 95%CI: 1.31~2.22; P <0.01), body mass index (BMI) <18.5 kg/m2 (pooled effect = 1.73; 95%CI: 1.32~2.25; P <0.01), exposure to biomass burning emissions (pooled effect = 1.65; 95%CI: 1.32~2.06; P <0.01), childhood respiratory infections (pooled effect = 3.44; 95%CI: 1.33~8.90; P = 0.01), residence (pooled effect = 1.24; 95%CI: 1.09~1.42; P <0.01), and a family history of respiratory diseases (pooled effect = 2.04; 95%CI: 1.53~2.71; P <0.01) were risk factors for COPD in the Chinese population.

CONCLUSION

Early prevention of COPD could be accomplished by quitting smoking, reducing exposure to air pollutants and biomass burning emissions, maintaining body mass index between 18.5 kg/m2 and 28 kg/m2, protecting children from respiratory infections, adopting active treatments to children with respiratory diseases, and conducting regular screening for those with family history of respiratory diseases.

Developing a nomogram for predicting the depression of senior citizens living alone while focusing on perceived social support

BACKGROUND

Although the number of senior citizens living alone is increasing, only a few studies have identified factors related to the depression characteristics of senior citizens living alone by using epidemiological survey data that can represent a population group.

AIM

To evaluate prediction performance by building models for predicting the depression of senior citizens living alone that included subjective social isolation and perceived social support as well as personal characteristics such as age and drinking.

METHODS

This study analyzed 1558 senior citizens (695 males and 863 females) who were 60 years or older and completed an epidemiological survey representing the South Korean population. Depression, an outcome variable, was measured using the short form of the Korean version CES-D (short form of CES-D).

RESULTS

The prevalence of depression among the senior citizens living alone was 7.7%. The results of multiple logistic regression analysis showed that the experience of suicidal urge over the past year, subjective satisfaction with help from neighbors, subjective loneliness, age, and self-esteem were significantly related to the depression of senior citizens living alone (P < 0.05). The results of 10-fold cross validation showed that the area under the curve of the nomogram was 0.96, and the F1 score of it was 0.97.

CONCLUSION

It is necessary to strengthen the social network of senior citizens living alone with friends and neighbors based on the results of this study to protect them from depression.

Predictors of Depressive Symptoms Based on the Human Capital Model Approach: Findings From the Indonesia Family Life Survey

Depression is the leading factor of disability and the overall global burden of diseases. The human capital model provides an appropriate conceptual model for managing human health. This study aimed to determine the association between human capital (including social, emotional, physical, financial, and intellectual capital) and depressive symptoms among productive age groups in Indonesia. A cross-sectional study was conducted by analyzing data of 9,858 respondents aged 15-59 years that were obtained from the Indonesia Family Life Survey 5 (IFLS 5). Multivariate logistic regression was used to assess the association between human capital components and depressive symptoms. Among respondents, 23.65% had higher depressive symptoms. Social trust and social networks (part of social capital) were significantly related to depressive symptoms. Self-reported satisfaction (part of emotional capital) were also related to depressive symptoms, as well as self-rated health, sleep quality, a number of chronic disease, body mass index (BMI), and physical functioning (part of physical capital). Log income (part of financial capital) and education level (part of intellectual capital) were related to depressive symptoms after controlling for other variables. Of all the components of human capital, physical capital has the most attributes associated with the risk of depressive symptoms. Therefore, depression prevention programs can be prioritized on attributes related to physical capital.

Common Mental Disorders, Functional Limitation and Diet Quality Trends and Related Factors among COPD Patients in Spain, 2006-2017: Evidence from Spanish National Health Surveys

Certain conditions such as common mental disorders (CMDs), functional limitation (FL) and poor diet quality may affect the lives of individuals who suffer from chronic obstructive pulmonary disease (COPD). This study sought to examine time trends in the prevalence of CMDs, FL and diet quality among male and female COPD patients living in Spain from 2006 to 2017 and to identify which factors were related to CMDs, FL and a poor/improvable diet quality in these patients. We performed a cross-sectional study among COPD patients aged ≥ 40 years old using data from the Spanish National Health Surveys conducted in 2006, 2011 and 2017, identifying a total of 2572 COPD patients. Binary logistic regressions were performed to determine the characteristics related to CMDs, FL and poor/improvable diet quality. Over the years of the study, the prevalence of FL among female COPD patients increased (p for trend <0.001). In addition, CMDs were associated to body mass index (BMI), educational level, physical activity, smoking status, occupation, chronic conditions and alcohol consumption; FL was related to age, living with a partner, educational level, physical activity and chronic conditions; and poor/improvable diet quality was associated to age, smoking status, BMI and physical activity.