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Weiss JR, Serdenes R, Madtha U, Zhao H, Kim V, Lopez-Pastrana J, Eakin MN, O'Toole J, Cooper CB, Woodruff P, Kanner RE, Krishnan JA, Iyer AS, Couper D, Morrison MF. Association Among Chronic Obstructive Pulmonary Disease Severity, Exacerbation Risk, and Anxiety and Depression Symptoms in the SPIROMICS Cohort. J Acad Consult Liaison Psychiatry 2023; 64:45-57. [PMID: 35948252 DOI: 10.1016/j.jaclp.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 01/23/2023]
Abstract
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.
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Affiliation(s)
- Jacob R Weiss
- Department of Psychiatry and Behavioral Science, Temple University Hospital, Philadelphia, PA.
| | - Ryan Serdenes
- Department of Psychiatry and Behavioral Science, Temple University Hospital, Philadelphia, PA
| | - Uchechukwu Madtha
- Department of Psychiatry and Behavioral Science, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Huaqing Zhao
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine, Philadelphia, PA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA
| | - Jahaira Lopez-Pastrana
- Department of Psychiatry and Human Behavior, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jacqueline O'Toole
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher B Cooper
- Departments of Medicine and Physiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Prescott Woodruff
- Division of Pulmonary, Critical Care and Sleep, University of California San Francisco, San Francisco, CA
| | - Richard E Kanner
- Division of Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, UT
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL
| | - Anand S Iyer
- Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - David Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mary F Morrison
- Department of Psychiatry and Behavioral Science, Temple University Hospital, Philadelphia, PA
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