Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Apr 19, 2020; 10(4): 59-70
Published online Apr 19, 2020. doi: 10.5498/wjp.v10.i4.59
Risk factors for depression in patients with chronic obstructive pulmonary disease
Hui-Ming Yao, Ren-Sen Xiao, Ping-Liang Cao, Xiao-Lei Wang, Wei Zuo, Wei Zhang
Hui-Ming Yao, Ren-Sen Xiao, Wei Zuo, Wei Zhang, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Ping-Liang Cao, Xiao-Lei Wang, Second Department of Cardiovascular Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: All authors helped to perform the research; Yao HM manuscript writing, performing procedures and data analysis; Xiao RS manuscript writing, drafting conception and design, performing experiments, and data analysis; Cao PL, Wang XL and Zuo W contributed to writing the manuscript; Zhang W contributed to writing the manuscript, drafting conception and design.
Supported by Horizontal Projects of National Key Research and Development Plan Projects, No. 1210053010.
Institutional review board statement: Ethical permission for this study was waived by the Ethics Committee of The First Affiliated Hospital of Nanchang University.
Informed consent statement: Patients were not required to give informed consent to the study as the analysis used clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei Zhang, MD, PhD, Professor, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang 330006, Jiangxi Province, China. weizhang1963@163.com
Received: November 4, 2019
Peer-review started: November 4, 2019
First decision: December 26, 2019
Revised: February 26, 2020
Accepted: March 12, 2020
Article in press: March 12, 2020
Published online: April 19, 2020
ARTICLE HIGHLIGHTS
Research background

The reported prevalence of depression in patients with chronic obstructive pulmonary disease (COPD) ranges from 10% to 42%, a proportion much higher than that in the general population. Certain interventions such as antidepressants, pulmonary rehabilitation, and counseling may improve health outcomes, but the diagnosis of depression in patients with COPD is often unrecognized and untreated in primary and specialty care. Unrecognized depression has major implications for compliance with medical treatment, prolonged lengths of stay, increased frequency of hospital admissions, and increased consultations with primary care physicians, all of which could decrease quality of life in patients.

Research motivation

Many studies have attempted to identify risk factors for progression, prognosis and response to therapy in patients with depression. However, few studies have examined the risk factors for depression in patients with COPD, and some results remain controversial.

Research objectives

The main objective of the current study is to investigate the correlation between clinical parameters and the symptoms of depression, and to identify independent risk factors to define patients with COPD at “high risk” of depression.

Research methods

The Hospital Anxiety and Depression Rating Scale (HADS) is one of the most commonly used instruments for depression in the literature. A series of consecutive patients newly diagnosed with COPD were included in this study. The diagnosis of depression mainly relied on the HADS, and the HADS scale was carried out by an experienced psychiatrist when the patients were stable. We used a cutoff of 8 or more on the HADS to dichotomize the HADS scores for the purposes of the regression analyses. The correlation between clinical parameters and depression was analyzed, and the risk factors for depression in patients with COPD were identified.

Research results

Multivariate logistic regression analysis was carried out to identify the potential risk factors for depression in patients with COPD. Low body mass index (BMI), low forced expiratory volume in 1 s (FEV1), and high COPD assessment test (CAT) score were independent risk factors for depression. BMI had the highest diagnostic accuracy for predicting the risk of depression. Additionally, combined BMI and FEV1 with CAT score had a higher area under curve than that of one single factor.

Research conclusions

Approximately one-fifth of patients with COPD developed depression. Additionally, we identified low BMI, low FEV1, and high CAT score as risk factors for depression in COPD patients. Combining these factors predicted the highest risk of developing depression.

Research perspectives

Some variables, such as the time to depression and follow up, were not reported, which may have resulted in bias during analysis of the results. A prospective study with a large sample size and multicenter analysis is needed to prove the conclusions of our study.