The Difficulty Of Improving Quality Of Life In COPD Patients With Depression And Associated Factors

• Published in: International journal of chronic obstructive pulmonary disease Vol. 14; pp. 2331 - 2341
• Main Authors: Lim, Jeong Uk, Park, Chan Kwon, Kim, Tae-Hyung, Jang, An-Soo, Park, Yong Bum, Rhee, Chin Kook, Jung, Ki Suck, Yoo, Kwang Ha, Lee, Won-Yeon, Yoon, Hyoung Kyu
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.10.2019; Dove Medical Press Ltd; Dove; Dove Medical Press
• Subjects: Aged; Analysis; Association; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Cohort Studies; Comorbidity; COPD Assessment Test; depression; Depression (Mood disorder); Depression - etiology; Dyspnea; Ethics; Female; Humans; Lung diseases; Male; Medical research; Medical societies; Mental depression; Middle Aged; Mortality; Original Research; Patients; Physicians; Psychologists; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - psychology; Pulmonary function tests; Quality of Life; Questionnaires; Sleep; South Korea; Spirometry; St. George’s Respiratory Questionnaire; Statistical analysis; South Korea; United States > US; COPD Assessment Test; association; depression; St. George’s Respiratory Questionnaire
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S216746

Depression is a major comorbidity that affects clinical outcomes in patients with chronic obstructive pulmonary disease (COPD). COPD patients with depression are hospitalized more frequently, and show more acute exacerbations, decreased physical and social activities, and higher mortality compared to their non-depressed counterparts. In the present study, we investigated the clinical impact of depressive symptoms and associated clinical factors in Korean patients with COPD by evaluating multicenter cohort data. Patients with COPD enrolled in the Korean COPD Subtype Study, a multicenter observational study, from December 2011 to October 2014 were selected for evaluation. The initial evaluation of all patients included pulmonary function tests, 6 min walk distance (6MWD), the COPD Assessment Test (CAT), and the COPD-specific version of the St. George's Respiratory Questionnaire (SGRQ-C). Significant depression was defined as a Beck Depression Inventory-II (BDI-II) score ≥17. Among the 270 study patients, 19.6% had significant depression. The depressed group showed a higher proportion of females (41.4%), lower body mass index (BMI), and lower education level compared to the non-depressed group ( 0.002, = 0.008, and = 0.019, respectively). The depressed group had significantly higher CAT and SGRQ-C scores, as well as a lower 6MWD, compared to the non-depressed group based on 6 month-interval serial measurements over 3 years. The total SGRQ-C score and the symptoms, activity, and impact domain scores were significant predictors of depression (area under curves [AUCs] of 0.699 [0.613-0.786], 0.670 [0.581-0.758], 0.680 [0.589-0.770], and 0.689 [0.603-0.776], respectively). From CAT score domains, sleep and energy scores were significant predictors of depression (AUCs of 0.619 [0.522-0.715] and 0.595 [0.504-0.685], respectively). SGRQ-C score, low BMI, and decreased 6MWD were significantly associated with depression in a multivariable analysis. A considerable proportion of patients with COPD had depression, and a high SGRQ-C score, low BMI, and low 6MWD were significantly associated with depression. As improving quality of life in this subgroup is difficult, physicians should be more active in screening patients with significant depression.