Chest
Volume 135, Issue 3, March 2009, Pages 619-625
Journal home page for Chest

Original Research
COPD
Depressive Symptoms as Predictors of Mortality in Patients With COPD

https://doi.org/10.1378/chest.08-0078Get rights and content

Objective

Prognostic studies of mortality in patients with COPD have mostly focused on physiologic variables, with little attention to depressive symptoms. This stands in sharp contrast to the attention that depressive symptoms have been given in the outcomes of patients with other chronic health conditions. The present study investigated the independent association of depressive symptoms in stable patients with COPD with all-cause mortality.

Methods

The baseline characteristics of 121 COPD patients (78 men and 43 women; mean [± SD] age, 61.5 ± 9.1 years; and mean FEV1, 36.9 ± 15.5% predicted) were collected on hospital admission to a pulmonary rehabilitation center. The data included demographic variables, body mass index (BMI), post-bronchodilator therapy FEV1, and Wpeak (peak workload [Wpeak]). Depressive symptoms were assessed using the Beck depression inventory. The vital status was ascertained using municipal registrations. In 8.5 years of follow-up, 76 deaths occurred (mortality rate, 63%). Survival time ranged from 88 days to 8.5 years (median survival time, 5.3 years). The Cox proportional hazard model was used to quantify the association of the baseline characteristics (ie, age, sex, marital status, smoking behavior, FEV1, BMI, Wpeak, and depressive symptoms) with mortality.

Results

Depressive symptoms (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.12 to 3.33) were associated with mortality in patients with COPD, independent of other factors including male sex (OR, 1.73; 95% CI, 1.03 to 2.92), older age (OR, 1.05; 95% CI, 1.02 to 1.08), and lower Wpeak (OR, 0.98; 95% CI, 0.97 to 0.99).

Conclusions

This study provides evidence that depressive symptoms assessed in stable patients with COPD are associated with their subsequent all-cause mortality.

Section snippets

Subjects

Our study sample consisted of 121 consecutive stable patients, all with COPD (FEV1 < 80% predicted) that had been diagnosed according to the American Thoracic Society guidelines,28 who were referred for pulmonary rehabilitation between September 1998 and March 2000. All patients had been clinically stable for at least 6 weeks and did not require an increase in medication or hospitalization. Exclusion criteria were the inability to perform lung function tests and/or ergometry, refusal to fill

Results

The characteristics of the patients (78 men and 43 women) are presented in Table 1. The mean age was 61.5 ± 9.1 years. Their post-bronchodilator therapy FEV1 was 36.9 ± 15.5% predicted. With regard to depression, 19.8% of patients tested above the standard cutoff score of ≥ 19 and were classified as having moderate-to-severe depressive symptoms.

Of the 121 patients who participated in the study, 76 (63%) had died at the end of the study. The median survival time for all patients was 5.3 years.

Discussion

This study provides preliminary evidence that depressive symptoms are an independent prognostic factor for mortality among stable COPD patients, even when adjustments are made for risk factors such as age, sex, and Wpeak. The association of depressive symptoms and mortality has been demonstrated in COPD patients assessed during or shortly after hospitalization for an exacerbation. However, to our knowledge, this is one of the first studies demonstrating that there is an association even in

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    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    The preparation of this article was funded by the Beatrixoord Foundation, Haren, the Netherlands.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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