Depression and Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease
Abstract
Background
Prior research on the risk of depression in chronic obstructive pulmonary disease (COPD) has yielded conflicting results. Furthermore, we have an incomplete understanding of how much depression versus respiratory factors contributes to poor health-related quality of life.
Methods
Among 1202 adults with COPD and 302 demographically matched referents without COPD, depressive symptoms were assessed using the 15-item Geriatric Depression Score. We measured COPD severity using a multifaceted approach, including spirometry, dyspnea, and exercise capacity. We used the Airway Questionnaire 20 and the Physical Component Summary Score to assess respiratory-specific and overall physical quality of life, respectively.
Results
In multivariate analysis adjusting for potential confounders including sociodemographics and all examined comorbidities, COPD subjects were at higher risk for depressive symptoms (Geriatric Depression Score ≥6) than referents (odds ratio [OR] 3.6; 95% confidence interval [CI], 2.1-6.1; P <.001). Stratifying COPD subjects by degree of obstruction on spirometry, all subgroups were at increased risk of depressive symptoms relative to referents (P <.001 for all). In multivariate analysis controlling for COPD severity as well as sociodemographics and comorbidities, depressive symptoms were strongly associated with worse respiratory-specific quality of life (OR 3.6; 95% CI, 2.7-4.8; P <.001) and worse overall physical quality of life (OR 2.4; 95% CI, 1.8-3.2; P <.001).
Conclusions
Patients with COPD are at significantly higher risk of having depressive symptoms than referents. Such symptoms are strongly associated with worse respiratory-specific and overall physical health-related quality of life, even after taking COPD severity into account.
aDivision of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco
bInstitute for Health Policy Studies, University of California, San Francisco
cDivision of Rheumatology, Department of Medicine, University of California, San Francisco
dDivision of General Internal Medicine, Department of Medicine, University of California, San Francisco
eDivision of Research, Kaiser Permanente, Oakland, Calif
fDivision of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco
Requests for reprints should be addressed to Theodore A. Omachi, MD, MBA, Department of Medicine, University of California, San Francisco, Box 0111, 505 Parnassus Avenue, San Francisco, CA 94143-0111
Funding: Dr. Omachi was supported by the Agency for Healthcare Research and Quality, Grant number F32 HS017664. Dr. Eisner was supported by R01HL077618 from the National Heart, Lung, and Blood Institute, National Institutes of Health, and UCSF Bland Lane FAMRI Center of Excellence on Secondhand Smoke CoE2007.
Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing the manuscript.
ABSTRACT
