No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Surprisingly High Prevalence of Anxiety and Depression in Chronic Breathing Disorders
Abstract
The objectives of this study were to assess the prevalence, screening, and recognition of depression and anxiety in persons with chronic breathing disorders, including COPD.
Cross-sectional study.
The Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC).
A large sample of 1,334 persons with chronic breathing disorder diagnoses who received care at the MEDVAMC.
The prevalence of anxiety and depression was measured in a large sample of persons with a chronic breathing disorder diagnosis who received care at the MEDVAMC, using the Primary Care Evaluation of Mental Disorders (PRIME-MD) screening questions. The positive predictive value of the PRIME-MD questions was then determined. The prevalence of anxiety and depressive diagnoses in patients determined to have COPD was then measured, using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID).
Of patients screened with the PRIME-MD, 80% screened positive for depression, anxiety, or both. The predictive value of a positive phone screen for either depression or anxiety was estimated to be 80%. In the subsample of patients who had COPD and received a diagnosis using the SCID, 65% received an anxiety and/or depressive disorder diagnosis. Of those patients, only 31% were receiving treatment for depression and/or anxiety.
It is troubling that a mere 31% of COPD patients with depression or anxiety are being treated, particularly given their high prevalence in this population. Practical screening instruments may help increase the recognition of anxiety and depression in medical patients, as suggested by the excellent positive predictive value of the PRIME-MD in our study.
... Although most of the participants were not suffering from anxiety (59%), 54.7% were found to have depression. The total median CAT score was 26 (range [22][23][24][25][26][27][28][29][30], reflecting high impact of COPD on patients' health and well-being. ...
... Furthermore, male participants were more likely to experience anxiety than females in the present study. Contrasting results were reported in previous studies conducted in the USA, [27,28] China, [8,29] the Nordic countries, [30] the Netherlands, [11] Jordan, [31] and Italy. [32] On the other hand, male participants in the present study had a lower likelihood of having depression than females, which was consistent with the findings reported in earlier research. ...
Objectives
This study investigated factors associated with anxiety and depression in COPD outpatients.
Methods
A cross-sectional study of 702 COPD outpatients from two major Jordanian hospitals using the Hospital Anxiety and Depression Scale (HADS) was conducted.
Results
Significant associations were found with gender (Anxiety OR: 5.29, 95%CI: 2.38–11.74; Depression OR: 0.20, 95%CI: 0.08–0.51), disease severity (Anxiety OR: 2.97, 95%CI: 1.80–4.91; Depression OR: 15.95, 95%CI: 5.32–52.63), LABA use (Anxiety OR: 16.12, 95%CI: 8.26–32.26; Depression OR: 16.95, 95%CI: 8.33–34.48), medication count (Anxiety OR: 0.73, 95%CI: 0.59–0.90; Depression OR: 0.51, 95%CI: 0.40–0.64), mMRC score (Anxiety OR: 2.41, 95%CI: 1.81–3.22; Depression OR: 2.31, 95%CI: 1.76–3.03), and inhalation technique (Anxiety OR: 0.95, 95%CI: 0.93–0.97; Depression OR: 0.92, 95%CI: 0.90–0.95). Other factors associated with anxiety included high income, urban living, diabetes, hypertension, LAMA use, and fewer COPD medications. Depression was also linked with heart disease, increased age, and longer disease duration.
Conclusion
The prevalence of anxiety and depression among COPD patients necessitates targeted interventions. Future research that recruits a more diverse sample in multiple sites and establishes the cause-effect relationship between the study predictors and outcome could provide a more robust conclusion on factors associated with anxiety and depression among COPD patients.
... Depression is common in COPD [30][31][32][33] with a prevalence of 10%-42%, which is significantly higher than that in the general population [30][31][32][33]. Moreover, depression is associated with and predictive of low levels of PA in persons with COPD [30]. ...
... Depression is common in COPD [30][31][32][33] with a prevalence of 10%-42%, which is significantly higher than that in the general population [30][31][32][33]. Moreover, depression is associated with and predictive of low levels of PA in persons with COPD [30]. ...
Background:
Depression is known to limit physical activity (PA) among individuals with chronic obstructive pulmonary disease (COPD). However, whether and how depression influences the effectiveness of PA interventions is unknown.
Purpose:
The study examined the association between baseline depression symptoms and change in daily step count and whether group assignment to a web-based, pedometer-mediated PA intervention moderated the association between baseline depression symptoms and change in daily step count.
Methods:
Secondary analysis included two cohorts of U.S. Veterans with COPD (n = 212; 97% male; mean age 69 ± 8 years) assessed at baseline and 3 months. Cohorts 1 and 2 were randomly assigned to the same PA intervention (n = 111) or a control group (n = 101). Multivariate regressions tested the main effects of baseline depression symptoms (BDI-II total and cognitive-affective and somatic subscales) on change in daily steps, as well as the interaction between baseline BDI-II and subscales and group assignment on change in daily steps.
Results:
Greater BDI-II total score (B = -31.8, SE = 14.48, p = .030) and somatic subscale scores (B = -99.82, SE = 35.76, p = .006) were associated with less improvement in daily step count. There was a significant interaction between baseline cognitive-affective subscale and the intervention predicting change in daily step count (B = -88.56, SE = 42.31, p = .038). When cognitive-affective subscale scores were ≥1 SD above the mean, the intervention was no longer associated with an increase in daily step count (p = .585).
Conclusions:
Depression should be routinely assessed and targeted as part of PA promotion efforts.
... As an extrapulmonary comorbidity, depression is important in patients with COPD [62,90], and it involves physical activity, as mentioned above. Importantly, pulmonary rehabilitation also improves anxiety and depression as examined by the Hospital Anxiety and Depression Scale [91]. ...
... Mental disorders are also associated with sedentary behavior in patients with COPD. Indeed, anxiety and depression are important comorbidities in patients with COPD, and their prevalence was 80% in patients with COPD in a US cohort [90] and 38% in Japan [115]. As mentioned above, mental disorders are known to generally contribute to increased sedentary behavior [110], meaning they are also likely associated with sedentary behavior in patients with COPD. ...
Recently, physical activity has increasingly become the focus in patients with chronic obstructive airway disease (COPD) because it is a strong predictor of COPD-related mortality. In addition, sedentary behavior, which is included as a category of physical inactivity including such behaviors as sitting or lying down, has an independent clinical impact on COPD patients. The present review examines clinical data related to physical activity, focusing on the definition, associated factors, beneficial effects, and biological mechanisms in patients with COPD and with respect to human health regardless of COPD. The data related to how sedentary behavior is associated with human health and COPD outcomes are also examined. Lastly, possible interventions to improve physical activity or sedentary behavior, such as bronchodilators and pulmonary rehabilitation with behavior modification, to ameliorate the pathophysiology of COPD patients are described. A better understanding of the clinical impact of physical activity or sedentary behavior may lead to the planning of a future intervention study to establish high-level evidence.
... The link between breathing and anxiety disorders is well established in the field, supported by decades of research on respiratory symptoms [69,70] and hypersensitivity to CO2 [71,72]. This association is bidirectional, as observed in patients with asthma [73] or chronic obstructive pulmonary disease (COPD) [74]. Individuals with respiratory dysfunction are also more susceptible to anxiety and depression [73,74]. ...
... This association is bidirectional, as observed in patients with asthma [73] or chronic obstructive pulmonary disease (COPD) [74]. Individuals with respiratory dysfunction are also more susceptible to anxiety and depression [73,74]. For instance, comorbid anxiety and depression is an independent predictor of the future risk of asthma [73,[75][76][77]. ...
Anxiety disorders are the most common group of mental disorders, but they are often underrecognized and undertreated in primary care. Dysfunctional breathing is a hallmark of anxiety disorders; however, mainstays of treatments do not tackle breathing in patients suffering anxiety. This scoping review aims to identify the nature and extent of the available research literature on the efficacy of breathwork interventions for adults with clinically diagnosed anxiety disorders using the DSM-5 classification system. Using the PRISMA extension for scoping reviews, a search of PubMed, Embase, and Scopus was conducted using terms related to anxiety disorders and breathwork interventions. Only clinical studies using breathwork (without the combination of other interventions) and performed on adult patients diagnosed with an anxiety disorder using the DSM-5 classification system were included. From 1081 articles identified across three databases, sixteen were included for the review. A range of breathwork interventions yielded significant improvements in anxiety symptoms in patients clinically diagnosed with anxiety disorders. The results around the role of hyperventilation in treatment of anxiety were contradictory in few of the examined studies. This evidence-based review supports the clinical utility of breathwork interventions and discusses effective treatment options and protocols that are feasible and accessible to patients suffering anxiety. Current gaps in knowledge for future research directions have also been identified.
... Chronic obstructive pulmonary disease (COPD) is a chronic lung disease with extrapulmonary manifestations [1]. Psychological disorders, including anxiety and depression, are among the most common comorbidities associated with COPD [2] and may have deleterious effects on patients' functional performance and health-related quality of life [3,4]. Performing routine functional activities becomes increasingly challenging for patients with COPD as the severity of the disease increases. ...
... The underlying causes of these changes in mental status have yet to be elucidated and are beyond the scope of this study. Previous studies have highlighted the impacts of long-term oxygen therapy [40], poor quality of life [17], and socioeconomic status [2,41] on psychological status. Examining general anxiety and depression in mild COPD patients to identify pathophysiological factors to explain the symptoms of general anxiety. ...
The role of anxiety and depression in functional performance during walking in patients with chronic obstructive pulmonary disease (COPD) is controversial. In this cross-sectional study, we aimed to assess the effects of anxiety, depression, and health-related quality of life (HRQOL) on the functional performance of this patient population. Seventy COPD patients aged 63 ± 11 years participated in the study. To measure their functional performance, the six-minute walk test (6MWT) was used. Anxiety and depression were assessed using two questionnaires: the Anxiety Inventory for Respiratory Disease (AIR) scale and the Hospital Anxiety and Depression Scale (HADS). The St. George's Respiratory Questionnaire (SGRQ) was used to assess HRQOL. Based on their anxiety levels, the patients were divided into a no anxiety group and a high anxiety group. There were no significant differences between the two groups in terms of pulmonary function profile or smoking status. The mean AIR and HADS (depression) scores were high (12.78 ± 4.07 and 9.90 ± 3.41, respectively). More than one-third of the patients (46%) reported high anxiety levels (above the standard cutoff score of 8). The mean score of the aggregated HADS scale was significantly higher in the high anxiety group (20.87 ± 6.13) than in the no anxiety group (9.26 ± 4.72; p = 0.01). Patients with high anxiety had poorer functional performance (6MWT: 308.75 ± 120.16 m) and HRQOL (SGRQ: 56.54 ± 22.36) than patients with no anxiety (6MWT: 373.76 ± 106.56 m; SGRQ: 42.90 ± 24.76; p < 0.01). The final multivariate model explained 33% of the variance in functional performance after controlling for COPD severity (F = 8.97). The results suggest that anxiety, depression, and poor health status are significantly associated with poor functional performance. This study highlights the need to screen patients with COPD at all stages for anxiety and depression.
... Our research revealed that for every one-point increase in lung capacity, the risk of abnormal somatization decreases by 1.8%, the risk of abnormal obsessive-compulsive disorder decreases by 2.0%, the risk of abnormal interpersonal sensitivity decreases by 1.6%, the risk of abnormal depression decreases by 5.6%, the risk of abnormal anxiety decreases by 1.9%, the risk of abnormal hostility decreases by 1.5%, the risk of abnormal paranoid ideation decreases by 1.4%, and the risk of abnormal psychoticism decreases by 1.9%. Increasing evidence in current research suggests a close association between obstructive pulmonary diseases such as asthma, chronic bronchitis, and emphysema, and psychological Table 6 Results of sport quality indicators logistic regression analysis between normal and abnormal score of psychological Test (N = 4484) B represents the non-standardized coefficient, P represents the significance, OR represents the odds ratio and 95% CI represents the 95% confidence interval health issues like depression and anxiety [37][38][39][40][41]. Previous research conducted among adult clinical and general practice populations has revealed elevated rates of anxiety and mood disorders, particularly major depression [42][43][44][45][46][47]. Community-based studies have confirmed and expanded upon the general validity of the association between asthma, chronic obstructive pulmonary disease, and mental disorders [39,[48][49][50][51][52][53][54]. ...
Background
Despite frequent discussions on the link between physical and mental health, the specific impact of physical fitness on mental well-being is yet to be fully established.
Method
This study, carried out between January 2022 and August 2023, involved 4,484 Chinese University students from eight universities located in various regions of China. It aimed to examine the association between physical fitness on psychological well-being. Descriptive statistics, t-tests, and logistic regression were used to analyze the association between physical fitness indicators (e.g., Body Mass Index (BMI), vital capacity, and endurance running) and mental health, assessed using Symptom Checklist-90 (SCL-90). All procedures were ethically approved, and participants consented to take part in.
Results
Our analysis revealed that BMI, vital capacity, and endurance running scores significantly influence mental health indicators. Specifically, a 1-point increase in BMI increases the likelihood of an abnormal psychological state by 10.9%, while a similar increase in vital capacity and endurance running decreases the risk by 2.1% and 4.1%, respectively. In contrast, reaction time, lower limb explosiveness, flexibility, and muscle strength showed no significant effects on psychological states (p > 0.05).
Conclusion
Improvements in BMI, vital capacity, and endurance running capabilities are associated with better mental health outcomes, highlighting their potential importance in enhancing overall well-being.
... EILO is frequently mistaken for asthma, especially exercise-induced asthma, and the two conditions can co-occur (Benninger et al., 2011;Jain et al., 2006;Lee et al., 2020). Additionally, the condition may be associated with other comorbidities such as gastroesophageal reflux disease, allergies, or behavioral health diagnoses-particularly anxiety (Benestad et al., 2021;Forrest et al., 2012;Fujiki et al., 2024a;Gavin et al., 1998;Husein et al., 2008;Kunik et al., 2005;Røksund et al., 2017). Accurate identification of EILO often involves multiple providers and may require considerable time and financial resources (Lunga et al., 2022). ...
Purpose
The purpose of this study was to examine the influence of exercise-induced laryngeal obstruction (EILO) on adolescents.
Method
Twenty patients (< 17 years) diagnosed with EILO participated in this study. Patients completed semistructured interviews examining their experience with the health care system, treatment, and the effects of EILO symptoms on quality of life. Interviews were analyzed using a combination of directed and conventional content analyses. Researchers identified seven overarching themes either prior to or during analysis, and 24 subthemes were inductively identified from patient interviews using open, axial, and selective coding.
Results
On average, patients went 1.9 years between symptom onset and EILO diagnosis. Patients described symptom onset as frightening and confusing. Even after initially reporting symptoms to a medical provider, patients went an average of 10.5 months before diagnosis. Patients perceived that delays in diagnosis prevented efficient management and allowed symptoms to escalate. Patients reported that EILO detrimentally influenced athletic performance, forcing them to pace themselves or cease participation altogether. Social and academic effects of EILO included missed classes, difficulty in physical education courses, and resentment from teammates if athletic performance declined. Both athletes and nonathletes indicated that EILO elicited feelings of fear, frustration, dread, guilt, and embarrassment. Patients reported that therapy with a speech-language pathologist (SLP) effectively addressed symptoms; however, employing rescue breathing techniques was often more difficult than anticipated.
Conclusions
Physical and emotional sequelae associated with EILO may have widespread influence on patient quality of life. Therapy with an SLP reportedly ameliorated EILO symptoms; however, patients indicated that delayed diagnosis allowed negative effects to intensify prior to treatment.
... Patients with COPD often experience poor mental health and older COPD patients are more likely to develop mental health especially anxiety (10). There are many risk factors for anxiety in COPD patients, such as continued smoking, poor knowledge, loneliness, and low social status (11,12). ...
Background
Anxiety is common in patients with chronic obstructive pulmonary disease (COPD), especially in older patients with the definition of age over 60 years old. Few studies have focused on anxiety in older COPD patients. This study aimed to analyze the risk factors of anxiety in older COPD patients and the impacts of anxiety on future acute exacerbation.
Methods
The general information, questionnaire data, previous acute exacerbation and pulmonary function were collected. Hamilton Anxiety Rating Scale (HAMA) was used to evaluate the anxiety of older COPD patients. The patients were followed up for one year, the number and the degrees of acute exacerbations of COPD were recorded.
Results
A total of 424 older COPD patients were included in the analysis. 19.81% (N = 84) had anxiety symptoms, and 80.19% (N = 340) had no anxiety symptoms. There were increased pack-years, more comorbidities, and more previous acute exacerbations in older COPD patients with anxiety compared to those without anxiety (P < 0.05). Meanwhile, a higher modified Medical Research Council (mMRC), a higher COPD assessment test (CAT) score and a shorter six-minute walking distance (6MWD) were found in older COPD patients with anxiety (P < 0.05). The BODE index, mMRC, CAT score, comorbidities and acute exacerbations were associated with anxiety. Eventually, anxiety will increase the risk of future acute exacerbation in older COPD patients (OR = 4.250, 95% CI: 2.369–7.626).
Conclusion
Older COPD patients with anxiety had worsening symptoms, more comorbidities and frequent acute exacerbation. Meanwhile, anxiety may increase the risk of acute exacerbation in the future. Therefore, interventions should be provided to reduce the risk of anxiety in older COPD patients at an early stage.
... Our research revealed that for every one-point increase in lung capacity, the risk of abnormal somatization decreases by 1.8%, the risk of abnormal obsessivecompulsive disorder decreases by 2.0%, the risk of abnormal interpersonal sensitivity decreases by 1.6%, the risk of abnormal depression decreases by 5.6%, the risk of abnormal anxiety decreases by 1.9%, the risk of abnormal hostility decreases by 1.5%, the risk of abnormal paranoid ideation decreases by 1.4%, and the risk of abnormal psychoticism decreases by 1.9%. Increasing evidence in current research suggests a close association between obstructive pulmonary diseases such as asthma, chronic bronchitis, and emphysema, and psychological health issues like depression and anxiety [35][36][37][38][39]. Previous research conducted among adult clinical and general practice populations has revealed elevated rates of anxiety and mood disorders, particularly major depression [40][41][42][43][44][45]. Community-based studies have con rmed and expanded upon the general validity of the association between asthma, chronic obstructive pulmonary disease (COPD), and mental disorders [37,[46][47][48][49][50][51][52]. ...
Objective
The connection between physical and mental health is frequently discussed, yet the influence of physical fitness on mental well-being remains to be definitively established.
Method
This study conducted descriptive statistics analysis on the total score of Sport Quality test and SCL-90 scale test results of the total sample, respectively. Then the independent sample t test was used to compare differences between psychological state among seven Sport Quality indicators. Logistic regression analysis was used to assess the impacts of scores of sport quality indicators on students' psychological state. The dependent variable is divided into two categories: normal (record as 1) and abnormal (record as 2), this study uses the binary logistic regression model to explore the impacts of scores of sport quality indicators on students' psychological state.
Results
BMI, vital capacity, and endurance running scores impact indicators of mental health, while scores for reaction time, lower limb explosiveness, flexibility, and muscle strength have no effect on mental health indicators.
Conclusion
Lowering BMI, increasing vital capacity, and enhancing endurance running have demonstrated promising effects on multiple aspects of mental health, suggesting their potential value in promoting overall well-being.
... Andersherum kann offenbar aber auch die psychische Befindlichkeit durch eine pathologische Veränderung der Atmung beeinflusst werden. So findet man bei Patienten mit chronischen Atemwegserkrankungen eine doppelt so hohe Prävalenz von Depression und Angst als bei Patienten mit anderen, nicht die Atmung betreffenden, schweren chronischen Erkrankungen [16][17][18]. ...
Das bewusste Atemtraining (BAT; breathing apperception training)
bietet Menschen mit ungünstig veränderten Atemmustern die
Möglichkeit, sich zunächst bewusster mit ihrer Atmung
auseinanderzusetzen. Dies ebnet diesen Menschen im späteren
Verlauf den Weg im täglichen Leben wieder unbewusst zu einer
natürlicheren Atmung zurückzufinden.
... COPD-Patient:innen erleben zunehmende Atemnot, eine verringerte körperliche Leistungsfähigkeit und benötigen oft intensive medizinische Betreuung, einschließlich stationärer Aufenthalte [2,3]. Die Prävalenz von psychischen Komorbiditäten bei Patient:innen mit COPD ist stark erhöht und hat bedeutende Auswirkungen auf die Lebensqualität und den Krankheitsverlauf [4]. So lassen sich höhere Hospitalisierungsraten, häufigere Krankheitsexazerbationen und eine höhere Mortalitätsrate bei COPD-Patient:innen mit klinisch relevanten Angst-und Depressionssymptomen finden [5,6]. ...
Zusammenfassung
Dem umfassenden Verständnis von krankheitsauslösenden und -aufrechterhaltenden Faktoren kommt im Hinblick auf die Ausprägung psychischer Komorbidität bei COPD eine große Bedeutung zu. In der vorliegenden Mixed-Methods-Studie wurden qualitative Interviewdaten zu Belastungen und Krankheitsverarbeitung mit psychischer Komorbidität (mittels PHQ-D) sowie Lebenszufriedenheitsvariablen (Positive Affect Negative Affect Schedulde, PANAS und Satisfaction with Life Scale, SWLS) in Beziehung gesetzt und um den Freiburger Fragebogen zur Krankheitsverarbeitung (FKV-LIS) ergänzt. Die beiden erzählanregenden Interviewfragen lauteten: 1.) „Was beschäftigt Sie zur Zeit am meisten?“; 2.) „Wie gehen Sie im Alltag mit Ihrer chronischen Erkrankung um?“ Insgesamt 62 aufgrund von COPD hospitalisierte Patient:innen nahmen teil. Die Schwere der körperlichen Beeinträchtigung wurde mittels GOLD-Stadium und Charlson-Komorbiditätsindex (CCI) bewertet. Die durchgeführten Interviews wurden inhaltsanalytisch ausgewertet und anschließend quantitativ erfasst. Die erhobenen Daten wurden anschließend zwischen zwei Gruppen hinsichtlich psychischer Belastung verglichen. Es wurden 13 Belastungsthemen und 11 Copingstrategien inhaltsanalytisch identifiziert. Insgesamt 42 Patient:innen zeigten Anzeichen von psychosozialer Belastung, während 20 Patient:innen keine derartigen Belastungen aufwiesen. Es gab keine signifikanten Unterschiede zwischen den beiden Gruppen hinsichtlich soziodemografischer Merkmale und der Schwere ihrer körperlichen Symptome. Bei der ersten Interviewfrage thematisierte die belastete Gruppe häufiger Themen im Zusammenhang mit dem Tod (35,7% gegenüber 15,0%) und sozialen Belastungen (21,4% gegenüber 0,0%). In der nicht-belasteten Gruppe wurden in Bezug auf die zweite Interviewfrage signifikant häufiger Strategien zur bewussten Betonung positiver Emotionen genannt (70,0% gegenüber 31,0%). Darüber hinaus zeigten sich höhere Werte in den FKV-Skalen für depressive Verarbeitung sowie Bagatellisierung und Wunschdenken in der belasteten Gruppe. In der klinischen Betreuung bei COPD sollten Lebensqualität und psychische Belastung berücksichtigt werden, wobei Maßnahmen zur Beeinflussung der Krankheitswahrnehmung und der damit zusammenhängenden Copingstile, insbesondere im Hinblick auf die Entwicklung einer realistischen und optimistischen Sichtweise auf die Lebens- und Erkrankungssituation sowie der Einbezug von Gruppen- und familientherapeutischen Interventionen von Bedeutung sind.
... With the rapidly aging population, high prevalence of smoking, and high levels of air pollution, the clinical burden of COPD in China is expected to continue to increase. Individuals with chronic conditions often experience poor mental health (1); older adult COPD patients are more likely to develop mental illnesses, specifically anxiety and depression (2,3). In a previous study, we also found that 13.93% of patients with stable COPD reported anxious symptoms, and 23.37% experienced depression (4). ...
Background
Anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), especially older adult patients. This can complicate the disease progression and lead to increased clinical and economic burden. We sought to investigate the clinical and economic burdens associated with the presence of anxious and/or depressive symptoms among older adult COPD patients.
Methods
We screened 579 patients aged over 60 years and diagnosed with COPD via a lung function test following the 2017 Global Initiative Chronic Obstructive Lung Disease (GOLD) guidelines. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) through face-to-face interviews at admission. Follow-up was conducted by telephone calls at 6, 12, 18, 24, and 36 months after discharge to assess clinical and economic burden. COPD-anxiety and/or depression patients were matched to patients without anxiety and depression (COPD-only) using propensity scores. Multivariate regression models were used to compare clinical and economic burden between COPD-anxiety and/or depression and COPD-only groups.
Results
Compared with COPD-only patients, COPD patients complicated with anxiety and/or depression had increased clinical burden, including higher COPD-related outpatient visits, COPD-related hospitalizations, and length of COPD-related hospitalizations (p < 0.001). Moreover, they also had an increased economic burden, including higher annual total healthcare costs, medical costs, and pharmacy costs (p < 0.001).
Conclusion
Older adult COPD patients with anxiety or depression had significantly higher clinical and economic burdens than patients without these comorbidities. These findings deserve further exploration and may be useful for the formulation of relevant healthcare policies.
... [4][5][6] Of these conditions, anxiety and depression are common, and the prevalence of clinically relevant anxiety and depression symptoms in patients with COPD is estimated to range for both from 22% to 48%. [7][8][9] Underlying anxiety and/or depression symptoms are often underreported, underdiagnosed and undertreated, and can predict severe respiratory exacerbations and severity of COPD and asthma, 10-12 which can result in impaired QOL and increased healthcare utilization compared to patients without these symptoms. Untreated anxiety and/or depression compounds patients' COPD by worsening several outcomes, including increased physical disability, elevated dyspnea, early dropout from pulmonary rehabilitation programs, increased exacerbation risk, increased episodes of hospital readmissions, and poor adherence to COPD therapies. ...
Background:
Revefenacin, a once-daily, nebulized, long-acting muscarinic antagonist approved in the US for the maintenance of chronic obstructive pulmonary disease (COPD), significantly improves lung function and quality of life versus placebo in patients with moderate-to-very severe COPD. Comorbid anxiety and/or depression may alter patients' symptom perception and response to bronchodilators. The impact of revefenacin in patients with COPD with comorbid anxiety and/or depression has not been previously investigated.
Methods:
This post hoc subgroup analysis examined data from two 12-week, randomized, Phase 3 trials in patients with moderate-to-very severe COPD with the following self-reported subgroups: anxiety only (A), depression only (D), anxiety and depression (+A/+D), and neither anxiety nor depression (-A/-D). We assessed change from baseline in trough forced expiratory volume in 1 second (FEV1) at Day 85 and health status by the St. George's Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT).
Results:
Of 812 patients, 90 (11%), 110 (14%), 141 (17%), and 471 (58%) had A, D, +A/+D, and -A/-D. Revefenacin versus placebo significantly improved from baseline trough FEV1 at Day 85 across all subgroups as well as SGRQ and CAT scores in patients with A, +A/+D, and -A/-D. Revefenacin was well tolerated regardless of A/D status, with a minimal incidence of treatment-emergent antimuscarinic adverse events across subgroups.
Conclusion:
In this analysis, revefenacin versus placebo significantly improved health outcomes in patients with moderate-to-very severe COPD with A, +A/+D, and -A/-D, but not in patients with D. The safety profile of revefenacin was not affected by comorbid anxiety/depression status.
... Following numerous studies, in 2017 it was observed that over 67 million healthy children have latent infection, who are at risk of developing the disease in the future (Kunik et al., 2005) and approximately 300,000 children under 5 years of age have initiated preventive measures not to develop TB (Bass et al., 1994). Globally, it is responsible for more than three million deaths each year and one of the leading causes of mortality worldwide (Lupu et al., 2017;Joshi et al., 2006) TB is particularly common among individuals with mood disorders, for example, anxiety and depression (Schenker et al., 2022). ...
Specialized studies conducted in the last decade have shown that the therapeutic success of specific treatment with tuberculostatic drugs, along with the decrease in the risk of relapse are elements that can only be achieved by increasing patients’ adherence to treatment. This is of paramount importance, especially for pediatric populations, as they are subject to a higher rate of therapeutic dropout, dependent on a number of individual particularities (from socio-demographic characteristics, to the incidence of depressive disorders, to pathological personal history, etc.). When we talk about patient behavior, we refer to how he/she complies with the specialist’s recommendation regarding: medication administration; following a diet; lifestyle changes.
... Depression and anxiety have reported prevalence rates of approximately 25% and 40% in COPD, and prevalence may be associated with younger age, female sex, current smoking, poor lung function, and reduced healthrelated quality of life (QOL) in COPD patients. [11][12][13][14][15][16][17] The prevalence of depression is also high in patients who have recently experienced exacerbations, and the presence of depression can influence patient mortality. 16 Depression and anxiety are associated with poor lung function and reduced health-related QOL in COPD patients. ...
Background
Comorbidities of chronic obstructive pulmonary disease (COPD) influence clinical characteristics and prognosis.
Objectives
This study compared the clinical characteristics and exacerbation rate of COPD according to the presence of depression or anxiety.
Design
This study used data from The Korea COPD Subgroup Study (KOCOSS) cohort, a nationwide prospective cohort from 54 medical centers, between April 2012 and 2019.
Methods
Depression and anxiety were diagnosed with the Beck Depression Inventory and Beck Anxiety Inventory. Negative binomial regression analysis was performed to analyze the frequency of exacerbations in depressed patients and anxiety. Differences in lung function trajectory according to presence of depression/anxiety were analyzed using a linear mixed model.
Results
In all, 2147 patients were enrolled. Depressed patients or anxiety had lower lung function, higher modified Medical Research Council (mMRC) grade, St. George Respiratory Questionnaire (SGRQ) score, and COPD assessment test score, and higher rates of exacerbation in the past year than those without depression/anxiety. Depressed patients had a higher frequency of moderate to severe exacerbations [Incidence Rate Ratio (IRR): 1.57, CI: 1.17–2.11, p = 0.002] and those with anxiety had higher frequencies of moderate to severe (IRR: 1.52, CI: 1.03–2.27, p = 0.038) and severe exacerbations (IRR: 2.13, CI: 1.09–4.15, p = 0.025) during 1-year follow-up compared to those without these comorbidities. The differences in the change in annual forced expiratory volume in 1 seconds (FEV1) over 3 years according to the presence of depression or anxiety were not statistically significant.
Conclusion
Depressed and anxious patients showed increased respiratory symptoms and exacerbation rate as well as reduced health-related quality of life, whereas there were no significant differences in changes in lung function between groups with and without depression/anxiety.
... Anxiety and depression are common comorbidities in patients with chronic diseases including chronic airway lung diseases 12 . Notably, anxiety and depressive symptoms are often overlooked by physicians and have been associated with worse adherence to treatment and overall increased morbidity in patients with chronic airway lung diseases [13][14][15] . The findings in this study are consistent with the findings of previous studies done on this topic that anxiety and depression are common among patients with bronchiectasis. ...
Bronchiectasis is a chronic lung disease characterized by recurrent respiratory symptoms. Several studies demonstrated that psychological comorbidities are common in patients with bronchiectasis. The aim of this study is to investigate the prevalence of anxiety and depression in bronchiectasis patients and assess their association with disease severity. In this cross-sectional study, we included patients diagnosed with bronchiectasis. The study was conducted using an interviewer-administered questionnaire via phone calls and data collected from the electronic medical records at JUH. The questionnaire included patients’ demographics and disease characteristics. Anxiety and depression were assessed using GAD7 and PHQ9 respectively. Bronchiectasis disease severity was assessed using BSI and FACED score. The total number of included patients was 133. Moreover, 53.4% of the participants were females while the rest were males (46.6%). PHQ9 demonstrated that 65.4% of the patients had depression. Regarding anxiety, GAD7 scale showed that 54.1% of the patients had anxiety. Pearson correlation showed that bronchiectasis severity index was significantly associated only with PHQ9 depression scores (r = 0.212, P value = 0.014). The prevalence of depression and anxiety is high among patients with bronchiectasis. We believe that patients affected with bronchiectasis should be screened for depression to improve their quality of life.
... Studies have shown that psychiatric well-being influences lung function response and lung health [9]. A cross-sectional study of anxiety and depression in patients with CRDs revealed a high prevalence of anxiety and depression using the PRIME-MD (80%) [10]. Furthermore, according to the results of a 2014 survey in Egypt, 61.5% of a group of patients who suffered from CRDs had an anxiety disorder, and 58% had a depressive disorder [11]. ...
Background
Chronic respiratory diseases (CRDs) are a major public health problem in Morocco. Several studies have shown that anxiety and depression are important comorbidities of CRDs and are often associated with CRDs. This study aimed to estimate the prevalence of depression and anxiety and identify their determinants in patients with CRDs.
Methodology
A cross-sectional study was conducted in the Pneumology Department at the Hassan II University Hospital in Fez in 2021. An anonymous questionnaire was used to collect sociodemographic, clinical, and therapeutic data. The Moroccan version of the Hospital Anxiety and Depression Scale (HADS) was used to measure depression and anxiety. A descriptive analysis was performed, followed by a bivariate analysis to investigate the association between anxiety and depression and other factors using tests appropriate to the types of variables studied. A p-value ≤0.05 was considered significant. Data entry was performed in Excel 2013 (Microsoft Corp., Redmond, WA, USA), and data analysis was done using SPSS software version 26 (IBM Corp., Armonk, NY, USA).
Results
The study included 209 patients, 50.7% (n = 106) of whom were female, with an average age of 57.84 ± 15.36 years. Chronic obstructive bronchopneumopathy was the most represented CRD (43.1%; n = 90), followed by asthma (32.2%; n = 67). The prevalence of depression and anxiety was 46.4% (n = 97) (95% confidence interval (CI) = 39.2-52.8) and 57.4 % (n = 120) (95% CI = 50.3-63.7), respectively. In the univariate analysis, depression was associated with the presence of dyspnea (51.3% vs. 32.7%; p = 0.018), the presence of asthenia (56.5% vs. 38.5%; p = 0.009), the use of oxygen therapy (66.7% vs. 42.7%; p = 0.015), and a higher number of hospitalizations (76.9% vs. 44.4%; p = 0.023). Moreover, 87.6% of patients with depression also had anxiety (p < 0.001). Anxiety was associated with a history of surgery (37.2% vs. 62.4%; p = 0.003) and with the presence of chronic obstructive pulmonary disease (66.7% vs. 50.4%; p = 0.019).
Conclusions
The results reveal the importance of screening for anxiety-depressive disorders in patients with CRDs and taking into account psychological aspects in the management of the disease to improve quality of life.
... Depression often occurs in patients with chronic obstructive pulmonary disease (COPD) [1]. In stable COPD, the prevalence of clinical depression ranges between 10 and 42%. ...
Background
Depression often occurs in patients with chronic obstructive pulmonary disease (COPD). In stable COPD, the prevalence of clinical depression ranges between 10 and 42%. The risk of depression is higher in patients with severe COPD, compared with control participants, reaching up to 62%, in oxygen-dependent patients.
Aim
The aim of this work was to study the prevalence of depression in COPD patients.
Patients and methods
The present study was carried out on 100 male COPD patients and 10 female COPD patients admitted to Mansoura Chest Hospital and the chest department of Benha University Hospital during the period from 2014 to 2016. All participants were submitted to Beck’s depression Inventory questionnaire.
Results
The degree of depression assessed by Beck’s score increased significantly with the degree of COPD, use of long-term oxygen therapy, and low BMI.
Conclusion
The prevalence and severity of depression increase with increasing severity of COPD.
... Breathing patterns become dysregulated, and recovery is inefficient [2]. It is therefore not surprising that COPD is accompanied by a high prevalence of anxiety symptoms (with estimates of 32-80%) [3]. Anxiety contributes to dysfunction of interoception ("processing of internal bodily stimuli") [4] and amplified dyspnea disproportionate to lung function. ...
Background
Although dyspnea is a primary symptom of chronic obstructive pulmonary disease (COPD), its treatment is suboptimal. In both COPD and acute anxiety, breathing patterns become dysregulated, contributing to abnormal CO2, dyspnea, and inefficient recovery from breathing challenges. While pulmonary rehabilitation (PR) improves dyspnea, only 1–2% of patients access it. Individuals with anxiety who use PR have worse outcomes.
Methods
We present the protocol of a randomized controlled trial designed to determine the feasibility and acceptability of a new, four-week mind-body intervention that we developed, called “Capnography-Assisted Learned, Monitored (CALM) Breathing,” as an adjunct to PR. Eligible participants are randomized in a 1:1 ratio to either CALM Breathing program or Usual Care. CALM Breathing consists of 10 core, slow breathing exercises combined with real time biofeedback (of end-tidal CO2, respiratory rate, and airflow) and motivational interviewing. CALM Breathing promotes self-regulated breathing, linking CO2 changes to dyspnea and anxiety symptoms and targeting breathing efficiency and self-efficacy in COPD. Participants are randomized to CALM Breathing or a Usual Care control group.
Results
Primary outcomes include feasibility and acceptability metrics of recruitment efficiency, participant retention, intervention adherence and fidelity, PR facilitation, patient satisfaction, and favorable themes from interviews. Secondary outcomes include breathing biomarkers, symptoms, health-related quality of life, six-minute walk distance, lung function, mood, physical activity, and PR utilization and engagement.
Conclusion
By disrupting the cycle of dyspnea and anxiety, and providing a needed bridge to PR, CALM Breathing may address a substantive gap in healthcare and optimize treatment for patients with COPD.
... Furthering the physiological detrimental effects and morbidity of chronic respiratory disease is the added burden of psychological comorbidities. Depression and anxiety are comorbidities frequently associated with COPD (Kunik et al., 2005), with prevalence estimates generally higher than other advanced chronic diseases (Maurer et al., 2008). These psychological comorbidities associated with COPD are often left untreated or under-treated (Cully et al., 2006), leading to decreased QOL, increased rates of hospitalization, and reductions in treatment adherence (Stapleton et al., 2005). ...
The purpose of this article is to describe the
psychophysiology of dyspnea in chronic obstructive pulmonary
disease (COPD), identify the unique impact of respiratory
disease on the female patient, and discuss the relationship of
anxiety and depression in disease manifestation. Current COPD
assessment and treatment guidelines published by the United
States Department of Health and Human Services, the World
Health Organization as well as the National Institute for Health
and Care Experience (NICE) will be presented along with implications
for the Advanced Practice Nurse (APN). Practitioners
treat COPD patients with advanced physiological complications
along with psychological comorbidities that worsen the disease
perception and progression. Therefore, a recommendation will
be made to integrate assessment and evaluation of psychological
comorbidities in COPD patients, with particular consideration
given to the female patient. Utilizing a holistic, int egrated
treatment plan will serve to enhance patient care, alleviate
disease burden and impact overall quality of life in the patient
with COPD.
Keywords chronic obstructive pulmonary disease (COPD), dyspnea,
psychophysiology, depression, anxiety, gender
... Breathlessness, a common symptom of COPD, causes tremendous distress to patients and caregivers [28], and acute exacerbations of breathlessness may result in emergency room visits or costly hospital stays [29,30]. Individuals living with COPD also experience decreased everyday activity [31,32], social isolation [33][34][35], depression and anxiety [36][37][38], feelings of guilt and self-blame [39], and distress about the future [40][41][42]. A growing chorus of voices in the academic, clinician, and patient advocate communities has been calling for implementation of a person-centered approach wherein the clinical team empowers and supports the individual with COPD to pursue a better quality of life and a sustained sense of well-being, in line with this individual's values, goals, and preferences [43][44][45]. ...
Background:
The largest nationally integrated health system in the United States, the Veterans Health Administration (VHA), has been undergoing a transformation toward a Whole Health (WH) System of Care. WH Clinical Care, a component of this system, includes holistically assessing the Veteran's life context, identifying what really matters to the Veteran, collaboratively setting and monitoring personal health and well-being goals, and equipping the Veteran with access to conventional and complementary and integrative health resources. Implementation of WH Clinical Care has been challenging. Understanding healthcare professionals' perspectives on the value of and barriers and facilitators to practicing WH Clinical Care holds relevance for not only VHA's efforts but also other health systems, in the U.S. and internationally, that are engaged in person-centered care implementation.
Objectives:
We sought to understand perspectives of healthcare professionals at VHA on providing WH Clinical Care to Veterans with COPD, as a lens to understand the broader issue of WH Clinical Care for Veterans living with complex chronic conditions.
Design:
We interviewed 25 healthcare professionals across disciplines and services at a VA Medical Center in 2020-2021, including primary care providers, pulmonologists, palliative care providers, and chaplains. Interview transcripts were analyzed using qualitative content analysis.
Key results:
Each element of WH Clinical Care raised complex questions and/or concerns, including: (1) the appropriate depth/breadth of inquiry in person-centered assessment; (2) the rationale for elicitation of what really matters; (3) the feasibility and appropriate division of labor in personal health goal setting and planning; and (4) challenges related to referring Veterans to a broad spectrum of supportive services.
Conclusions:
Efforts to promote person-centered care must account for healthcare professionals' existing comfort with its elements, advocate for a team-based approach, and continue to grapple with the conflicting structural conditions and organizational imperatives.
... 25 Psychological disturbances are underreported and undertreated in COPD. 26 Depression in COPD is associated with a worse quality of life, 5 and the present analysis extends such findings to reveal an association between depression (as assessed by CES-D score) and the impact of COPD. Using DSM IV criteria to define depression, a previous study reported that a total CAT score >20 was associated with major depression, 11 which is in concordance with the present analysis where patients with symptoms of depression had a mean CAT score >20. ...
Purpose
Chronic obstructive pulmonary disease (COPD) is multifaceted, with some patients experiencing anxiety and depression. Depression in COPD has been associated with worse total scores for the COPD assessment test (CAT). Also, CAT score worsening has been observed during the COVID-19 pandemic. The relationship between the Center for Epidemiologic Studies Depression Scale (CES-D) score and CAT sub-component scores has not been evaluated. We investigated the relationship between CES-D score and CAT component scores during the COVD-19 pandemic.
Patients and Methods
Sixty-five patients were recruited. Pre-pandemic (baseline) was defined as 23rd March 2019–23rd March 2020, CAT scores and information related to exacerbations were collected via telephone at 8-week intervals between 23rd March 2020–23rd March 2021.
Results
There were no differences in CAT scores pre- compared to during the pandemic (ANOVA p = 0.97). Total CAT scores were higher in patients with symptoms of depression compared to those without both pre- (p < 0.001) and during-pandemic (eg, at 12 months 21.2 versus 12.9, mean difference = 8.3 (95% CI = 2.3–14.2), p = 0.02). Individual CAT component scores showed significantly higher chest tightness, breathlessness, activity limitation, confidence, sleep and energy scores in patients with symptoms of depression at most time points (p < 0.05). Significantly fewer exacerbations were observed during- compared to pre-pandemic (p = 0.04). We observed that COPD patients with symptoms of depression had higher CAT scores both pre- and during the COVID-19 pandemic.
Conclusion
Presence of depressive symptoms was selectively associated with individual component scores. Symptoms of depression may potentially influence total CAT scores.
... Current literature suggests that the diagnosis of depression is missed in up to 50% of patients with physical illnesses, 10 leading to under or even untreated depression. In patients with COPD, it has been reported that more than 60% of patients with depression receive no treatments, 11 despite more than one-third experiencing depressive symptoms. Multiple factors may contribute to unrecognised and thus unmanaged depression in patients with COPD; such includes poor training, time constrain, patients' reluctance to discuss their mental health, lack of confidence to address psychological issues in the presence of COPD, and low uptake for treatment even if depression is identified. ...
Objective
To investigate physicians’ perceptions and current practices of identifying and managing depression in patients with chronic obstructive pulmonary disease (COPD).
Design
A cross-sectional online survey was employed between March and September 2022.
Settings
Saudi Arabia.
Participants
1015 physicians, including general practitioners and family, internal and pulmonary medicine specialists.
Primary outcome measures
Physicians’ perceptions, confidence, practices and barriers to recognising and managing depression in patients with COPD.
Results
A total of 1015 physicians completed to the online survey. Only 31% of study participants received adequate training for managing depression. While 60% of physicians reported that depression interferes with self-management and worsens COPD symptoms, less than 50% viewed the importance of regular screening for depression. Only 414 (41%) physicians aim to identify depression. Of whom, 29% use depression screening tools, and 38% feel confident in discussing patients’ feelings. Having adequate training to manage depression (OR: 2.89; 95% CI: 2.02 to 3.81; p<0.001) and more years of experience (OR: 1.25; 95% CI: 1.08 to 1.45; p=0.002) were associated with the intention to detect depression in COPD patients. The most common barriers linked to recognising depression are poor training (54%), absence of standard procedures (54%) and limited knowledge about depression (53%).
Conclusion
The prevalence of identifying and confidently managing depression in patients with COPD is suboptimal, owing to poor training, the absence of a standardised protocol and inadequate knowledge. Psychiatric training should be supported in addition to adopting a systematic approach to detect depression in clinical practice.
... Depression and anxiety correlate with COPD severity [37,38]. The rate of depression in stable COPD individuals in outpatient clinics ranges from 10% to 57% [37,[39][40][41], while anxiety prevalence ranges from 7% to 50% [39,42]. A meta-analysis reported a higher rate of depression among COPD patients (27.1%) compared with controls (10.0%) ...
Chronic obstructive pulmonary disease (COPD) is the third-leading cause of mortality globally, significantly affecting people over 40 years old. COPD is often comorbid with mood disorders; however, they are frequently neglected or undiagnosed in COPD management, thus resulting in unintended treatment outcomes and higher mortality associated with the disease. Although the exact link between COPD and mood disorders remains to be ascertained, there is a broader opinion that inflammatory reactions in the lungs, blood, and inflammation-induced changes in the brain could orchestrate the onset of mood disorders in COPD. Although the current management of mood disorders such as depression in COPD involves using antidepressants, their use has been limited due to tolerability issues. On the other hand, as omega-3 polyunsaturated fatty acids (n-3 PUFAs) play a vital role in regulating inflammatory responses, they could be promising alternatives in managing mood disorders in COPD. This review discusses comorbid mood disorders in COPD as well as their influence on the progression and management of COPD. The underlying mechanisms of comorbid mood disorders in COPD will also be discussed, along with the potential role of n-3 PUFAs in
managing these conditions.
... Although psychological distress is prevalent in COPD and associated with a substantial individual [38] and socio-economic burden [183,184], it often remains undetected and untreated [185,186]. Studies reported that in less than 44% of people with COPD, clinically relevant increased levels of depression and/or anxiety were adequately diagnosed and that only 31% of them had received any treatment for these comorbid psychological conditions [187]. These data have been subsequently confirmed [7], stressing that less than one-third of people with COPD and mental health problems receive adequate management, despite the recommendations of the Global Initiative for Chronic Obstructive Lung Disease guidelines to actively screen for and manage psychological comorbidities [188]. ...
Psychological distress is prevalent in people with COPD and relates to a worse course of disease. It often remains unrecognised and untreated, intensifying the burden on patients, carers and healthcare systems. Nonpharmacological management strategies have been suggested as important elements to manage psychological distress in COPD. Therefore, this review presents instruments for detecting psychological distress in COPD and provides an overview of available nonpharmacological management strategies together with available scientific evidence for their presumed benefits in COPD. Several instruments are available for detecting psychological distress in COPD, including simple questions, questionnaires and clinical diagnostic interviews, but their implementation in clinical practice is limited and heterogeneous. Moreover, various nonpharmacological management options are available for COPD, ranging from specific cognitive behavioural therapy (CBT) to multi-component pulmonary rehabilitation (PR) programmes. These interventions vary substantially in their specific content, intensity and duration across studies. Similarly, available evidence regarding their efficacy varies significantly, with the strongest evidence currently for CBT or PR. Further randomised controlled trials are needed with larger, culturally diverse samples and long-term follow-ups. Moreover, effective nonpharmacological interventions should be implemented more in the clinical routine. Respective barriers for patients, caregivers, clinicians, healthcare systems and research need to be overcome.
... Mental health Anxiety and depression are important and underdiagnosed comorbidities in COPD [179][180][181][182] . Both are associated with poor prognosis [181,183] , younger age, female sex, smoking, lower FEV1, cough, higher SGRQ score, and a previous history of cardiovascular disease [179,182,184] . ...
... Anxiety and depression are important and underdiagnosed comorbidities in COPD (179)(180)(181)(182). Both are associated with poor prognosis (181,183), younger age, female sex, smoking, lower FEV 1 , cough, higher SGRQ score, and a previous history of cardiovascular disease (179,182,184). ...
... Anxiety and depression are important and underdiagnosed comorbidities in COPD (179)(180)(181)(182). Both are associated with poor prognosis (181,183), younger age, female sex, smoking, lower FEV1, cough, higher SGRQ score, and a previous history of cardiovascular disease (179,182,184). ...
Executive summary of the Global Strategy for Prevention, Diagnosis and Management of COPD 2023: the latest evidence-based strategy document from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) https://bit.ly/3KCaTGe
... KOAH hastaları, özellikle ileri aşamalarda benlik saygısı, duygusal işlevsellik ve yaşam kalitesinde önemli bir değişiklik yaşadıkları için psikolojik desteğe ihtiyaç duymaktadır. 34 Yapılan metaanaliz çalışmasında KOAH olan bireylerde, anksiyetinin yaşam kalitesini olumsuz etkilediğini gösteren birçok çalışmanın olduğu belirtilmiştir. 35 Araştırmaya katılan bireylerin süreklilik kaygı durumunun, yaşam kalitesi fiziksel sorunlara bağlı rol kısıtlılıkları alt boyutu hariç diğer tüm alt boyut puan ortalamalarını negatif yönde etkilediği bulunmuştur. ...
Chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) are characterized by symptoms such as dyspnea and cough, which significantly impair the quality of life. Psychological comorbidities, particularly anxiety and depression, are frequent in patients with COPD but are often underestimated in the clinical practice. This article highlights the central role of pulmonary rehabilitation (PR) in the management of COPD as a multimodal intervention aimed at improving both physical and psychological health. Despite the recognized benefits of PR on physical symptoms and quality of life, less is known about its specific effects on anxiety and depression; however, initial studies show positive effects. The article emphasizes the need for a holistic approach to therapy that includes both respiratory physiotherapy/exercise therapy techniques and also specialized psychological interventions, to break the cycle of dyspnea, anxiety and deconditioning. It also highlights the importance of further research to develop personalized therapies that improve both the physical and psychological health of those affected.
(1) Background: A healthy lifestyle has a protective role against the onset and management of asthma and chronic obstructive pulmonary disease (COPD). Therefore, combined lifestyle interventions (CLIs) are a potentially valuable prevention approach. This review aims to provide an overview of existing CLIs for the prevention and management of asthma or COPD. (2) Methods: A systematic literature search was conducted using PubMed, EMBASE, and PsycInfo. Studies were included if CLIs targeted at least two lifestyle factors. (3) Results: Among the 56 included studies, 9 addressed asthma and 47 addressed COPD management, with no studies focusing on prevention. For both conditions, the most prevalent combination of lifestyle targets was diet and physical activity (PA), often combined with smoking cessation in COPD. The studied CLIs led to improvements in quality of life, respiratory symptoms, body mass index/weight, and exercise capacity. Behavioural changes were only measured in a limited number of studies and mainly showed improvements in dietary intake and PA level. (4) Conclusions: CLIs are effective within asthma and COPD management. Next to optimising the content and implementation of CLIs, these positive results warrant paying more attention to CLIs for persons with an increased risk profile for these chronic respiratory diseases.
Background
Not all hypercapnic COPD patients benefit from home non-invasive ventilation (NIV), and mechanisms through which NIV improves clinical outcomes remain uncertain. We aimed to identify “responders” to home NIV, denoted by a beneficial effect of NIV on PaCO 2 , health related quality of life (HRQL) and survival, and investigated whether NIV achieves its beneficial effect through an improved PaCO 2 .
Methods
We used individual patient data from previous published trials collated for a systematic review. Linear mixed effect models were conducted to compare the effect of NIV on PaCO 2 , HRQL and survival, within subgroups defined by patient and treatment characteristics. Secondly, we conducted a causal mediation analysis to investigate whether the effect of NIV is mediated by a change in PaCO 2 .
Findings
Data of 1142 participants from 16 studies were used. Participants treated with lower pressure support (PS <14 versus ≥14 cmH 2 O) and with lower adherence (<5 versus ≥5 h·day ⁻¹ ) had less improvement in PaCO 2 (mean difference (MD) −0.30 kPa, p<0.001 and −0.29 kPa, p<0.001 respectively) and HRQL (standardised MD 0.10, p=0.002 and 0.11, p=0.02 respectively), but this effect did not persist to survival. PaCO 2 improved more in patients with severe dyspnoea (MD −0.30, p=0.02), and HRQL improved only in participants with <3 exacerbations (SMD 0.52, p=0.03). The results of the mediation analysis showed that the effect on HRQL is mediated partially (23%) by a change in PaCO 2 .
Interpretation
With greater PS and better daily NIV usage, a larger improvement in PaCO 2 and HRQL is achieved. Importantly, we demonstrated that the beneficial effect of home NIV on HRQL is only partially mediated through a reduction in diurnal PaCO 2 .
Importance
Many patients with chronic obstructive pulmonary disease (COPD), heart failure (HF), and interstitial lung disease (ILD) endure poor quality of life despite conventional therapy. Palliative care approaches may benefit this population prior to end of life.
Objective
Determine the effect of a nurse and social worker palliative telecare team on quality of life in outpatients with COPD, HF, or ILD compared with usual care.
Design, Setting, and Participants
Single-blind, 2-group, multisite randomized clinical trial with accrual between October 27, 2016, and April 2, 2020, in 2 Veterans Administration health care systems (Colorado and Washington), and including community-based outpatient clinics. Outpatients with COPD, HF, or ILD at high risk of hospitalization or death who reported poor quality of life participated.
Intervention
The intervention involved 6 phone calls with a nurse to help with symptom management and 6 phone calls with a social worker to provide psychosocial care. The nurse and social worker met weekly with a study primary care and palliative care physician and as needed, a pulmonologist, and cardiologist. Usual care included an educational handout developed for the study that outlined self-care for COPD, ILD, or HF. Patients in both groups received care at the discretion of their clinicians, which could include care from nurses and social workers, and specialists in cardiology, pulmonology, palliative care, and mental health.
Main Outcomes and Measures
The primary outcome was difference in change in quality of life from baseline to 6 months between the intervention and usual care groups (FACT-G score range, 0-100, with higher scores indicating better quality of life, clinically meaningful change ≥4 points). Secondary quality-of-life outcomes at 6 months included disease-specific health status (Clinical COPD Questionnaire; Kansas City Cardiomyopathy Questionnaire-12), depression (Patient Health Questionnaire-8) and anxiety (Generalized Anxiety Disorder-7) symptoms.
Results
Among 306 randomized patients (mean [SD] age, 68.9 [7.7] years; 276 male [90.2%], 30 female [9.8%]; 245 White [80.1%]), 177 (57.8%) had COPD, 67 (21.9%) HF, 49 (16%) both COPD and HF, and 13 (4.2%) ILD. Baseline FACT-G scores were similar (intervention, 52.9; usual care, 52.7). FACT-G completion was 76% (intervention, 117 of 154; usual care, 116 of 152) at 6 months for both groups. Mean (SD) length of intervention was 115.1 (33.4) days and included a mean of 10.4 (3.3) intervention calls per patient. In the intervention group, 112 of 154 (73%) patients received the intervention as randomized. At 6 months, mean FACT-G score improved 6.0 points in the intervention group and 1.4 points in the usual care group (difference, 4.6 points [95% CI, 1.8-7.4]; P = .001; standardized mean difference, 0.41). The intervention also improved COPD health status (standardized mean difference, 0.44; P = .04), HF health status (standardized mean difference, 0.41; P = .01), depression (standardized mean difference, −0.50; P < .001), and anxiety (standardized mean difference, −0.51; P < .001) at 6 months.
Conclusions and Relevance
For adults with COPD, HF, or ILD who were at high risk of death and had poor quality of life, a nurse and social worker palliative telecare team produced clinically meaningful improvements in quality of life at 6 months compared with usual care.
Trial Registration
ClinicalTrials.gov Identifier: NCT02713347
Context: Anxietyand depression and in patients with chronic lung diseases complicates the disease effects.The prevalence of depression in COPD patients ranged from 37% to 71%. Exacerbation and death rate of depressed patients with chronic lung disease are increased. This study aims to study the frequency of depression and anxiety and to detect their impact on quality of life in patients with chronic pulmonary diseases. Settings and Design: This is a cross sectional observational study on patients taken from chest and cardiothoracic hospital of Minia university, Egypt in the period from Septemper,2017 to Septemper,2018 Methods and Material: full history ,examination , mMRC , chest X ray ,HRCT was done whenever needed), The Hamilton Anxiety Rating Scale (HAMA). Beck Depression Inventory (BDI-II)'' questionnaire and SGRQ were done Statistical analysis: Statistical analysis was performed using SPSS software (χ2 test and independent sample t-test). Results: The frequency of depression and anxiety in all patient groups was 78.7% and 16.4% respectively.Both depression and anxiety scores were positively correlated with age , dyspnea scale,FVC and HRQL score(P 0.001). Conclusion:IPF and bronchiectasis had the higher frequency of depression among chronic pulmonary diseases ,depression and anxiety scores were positively correlated with age , functional state and HRQL scores .
Objective:
Suicide risk in bipolar disorder (BD) is estimated to be up to 20 times higher than in the general population. While there is a large body of evidence suggesting that increased sympathetic activation is associated with disease and death, there is a paucity of research on the role of autonomic nervous system (ANS) dysfunction in patients with BD who have attempted suicide.
Methods:
Fifty-three participants with BD used a wearable device to assess the association between history of suicide attempt, current suicidal ideation, and ANS dysfunction, including measures of heart rate variability (HRV) and respiratory rate. Data were analyzed in a series of unadjusted and adjusted bivariate models of association controlling for relevant variables.
Results:
A history of suicide attempts was significantly associated with an increase in respiratory rate (p < 0.01). These results remained significant after adjusting for age, BMI, and current mood state. There was no association between current suicidal ideation and heart rate or respiratory rate. In the frequency domain, HRV parameters suggest reduced parasympathetic (i.e., vagal) activity in participants with a history of suicide attempts and in those with current suicidality, suggesting changes in sympathicovagal balance in BD.
Conclusions:
Our results suggest that changes in the ANS in patients with BD and a history of suicide attempt are not restricted to pure vagally mediated HRV parameters, but rather signal a general ANS dysregulation. This ANS imbalance may be contributing to illness burden and cardiovascular disease. Further research on the relationship between ANS and suicidality in BD is needed.
Purpose of review
This brief critical review evaluates recent research on the impact of anxiety disorders and post-traumatic stress disorders (PTSD) on patients with chronic obstructive pulmonary disease (COPD) and asthma. In these patients, untreated anxiety and PTSD exacerbate acute symptoms, increase disability and impair quality of life. Therefore, effective interventions are also reviewed.
Recent findings
Anxiety disorders and PTSD are prevalent in COPD and asthma, worsen symptoms in acute exacerbations, and increase morbidity and healthcare utilization. Pulmonary rehabilitation (PR), cognitive behavioural therapy and pharmacological therapy are each effective in COPD patients with anxiety or PTSD. However, very little work examined therapy for combined anxiety and PTSD in patients with either COPD or asthma.
Summary
Despite the high prevalence of anxiety disorder or PTSD in patients with chronic respiratory diseases, a paucity of literature remains demonstrating the efficacy of pharmacological therapies for these conditions. This review highlights the promising benefits of PR on anxiety, but prospective trials are needed to demonstrate the efficacy of interventions with PTSD alone, or with concomitant anxiety.
12th International Medicine and Health Sciences Researches Congress
COPD is a chronic respiratory disease that commonly coexists with other chronic conditions. These comorbidities have been shown to influence overall disease burden and mortality in COPD, and these comorbidities have an important impact on functional status and other psychosocial factors. Mental health disorders, especially anxiety and depression are common comorbidities in COPD. However, the mechanisms and interactions of anxiety and depression in COPD are poorly understood and these conditions are often underdiagnosed. The interplay between anxiety and depression and COPD is likely multifactorial and complex. An obvious mechanism is the expected psychological consequences of having a chronic illness. However, there is increasing interest in other potential biological processes, such as systemic inflammation, smoking, hypoxia, and oxidative stress. Recognition and diagnosis of comorbid anxiety and depression in patients with COPD is often challenging because there is no consensus on the appropriate screening tools or rating scales to use in this patient population. Despite the challenges in accurate assessment of anxiety and depression, there is growing evidence to support that these comorbid mental health conditions in COPD result in worse outcomes, including poor health-related quality of life, increased exacerbations with associated health-care utilization and cost, increased functional disability, and increased mortality. There are limited data of variable quality on effective treatment and management strategies, both pharmacologic and non-pharmacologic, for anxiety and depression in COPD. However, cumulative evidence demonstrates that complex psychological and lifestyle interventions, which include a pulmonary rehabilitation component, may offer the greatest benefit. The high prevalence and negative impact of depression and anxiety highlights the need for comprehensive, innovative, and standardized chronic disease management programs for individuals with COPD.
Aging is a heterogeneous process characterized prevalently by multimorbidity. Neurocognitive disorders (NCDs) are organic brain diseases with psychiatric symptoms, often comorbid with the exacerbation of chronic physical illnesses, especially in pulmonary disease. Noninvasive mechanical ventilation (NIMV) plays a crucial role in treating patients with respiratory failure as the first choice in the elderly when physicians consider the correct selection criteria for its application. NIMV failure should be managed carefully, considering patients’ characteristics. Ageism, a tendency to systematically stereotype and discriminate against older adults just for their age, is a severe concern, in the health system. Coronavirus-19 pandemic burst this concept as age represented one of the criteria for intensive care exclusion. NCD needs to be recognized and contextualized, allowing the healthcare organization improvement in the care of people with acute disease and psychiatric manifestations. The implementation of strategies to address the cognitive and behavioural disorders management, thanks to efficient integration of geriatricians in the healthcare pathways, should break down the latent ageism in healthcare professionals. This chapter aims to illustrate the effect of ageism in the healthcare system and how NCD could represent one of its drivers.KeywordsNeurocognitive disordersNeuropsychiatric symptomsStigmatizationAgeismNoninvasive mechanical ventilation
Neuropsychiatric disorders are poorly diagnosed and rarely treated, even in patients in non-invasive ventilation (NIV). The use of the NIV involves a change of life of the patient, who must devote a time of their day, with possible reduction of compliance. The use of such instrumentation, especially in the elderly and polypathological patients, requires a multidimensional culture that cannot be lacking in those who are treating critical patients. Training is also of primary importance in this area. In light of these considerations and the increase in evidence of the positive effect of the NIV also on neuropsychiatric disorders, it is desirable to develop pathways and protocols dedicated to the correct detection and treatment of these disorders.KeywordsNeuropsychiatric disordersNIVCOPDMultidimensional culture
This study aims to compare the mental health of patients with asthma and COPD in terms of anxiety, depression, and sleep quality and to examine the factors that predict sleep disturbance, anxiety, and depressive symptoms.
Methods
This quantitative cross-sectional study employed convenience sampling to enroll 200 patients with asthma and 190 patients with COPD. Data were gathered using a standardized self-administered questionnaire that contained sections on patients’ characteristics, the Sleep Quality, Anxiety, and Depression.
Results
The prevalence of poor sleep quality was 17.5 and 32.6% among asthmatic and COPD patients, respectively. The incidence of anxiety and depression was 38 and 49.5% among the patients with asthma, respectively. Their prevalence in patients with COPD was 48.9 and 34.7%, respectively. The multivariate regression analysis showed that marital status (married), BMI, education level (pre-university level), presence of comorbid illness, and depression were significant predictors of PSQI in asthmatic patients. Moreover, age, gender (male), marital status (married), education level (pre-university level), depression, and anxiety were significant predictors of PSQI among COPD participants. According to this study, COPD, and asthma pose serious health risks, including reduced sleep quality, anxiety, and depression.
Background:
The objective of this study was to investigate whether alcohol consumption might affect the quality of life (QOL), depressive mood, and metabolic syndrome in patients with obstructive lung disease (OLD).
Methods:
Data were obtained from the Korean National Health and Nutrition Examination Survey from 2014 and 2016. OLD was defined as spirometry of forced expiratory volume in 1 second/forced vital capacity <0.7 in those aged more than 40 years. QOL was evaluated using the European Quality of Life Questionnaire-5D (EQ-5D) index. Patient Health Questionnaire-9 (PHQ-9) was used to assess the severity of depressive mood. Alcohol consumption was based on a history of alcohol ingestion during the previous month.
Results:
A total of 984 participants with OLD (695 males, 289 females, age 65.8±9.7 years) were enrolled. The EQ-5D index was significantly higher in alcohol drinkers (n=525) than in non-alcohol drinkers (n=459) (0.94±0.11 vs. 0.91±0.13, p=0.002). PHQ- 9 scores were considerably lower in alcohol drinkers than in non-alcohol drinkers (2.15±3.57 vs. 2.78±4.13, p=0.013). However, multiple logistic regression analysis showed that alcohol consumption was not associated with EQ-5D index or PHQ-9 score. Body mass index ≥25 kg/m2, triglyceride ≥150 mg/dL, high-density lipoprotein <40 mg/dL in men and <50 mg/dL in women, and blood pressure ≥130/85 mm Hg were significantly more common in alcohol drinkers than in non-alcohol drinkers (all p<0.05).
Conclusion:
Alcohol consumption did not change the QOL or depressive mood of OLD patients. However, metabolic syndrome-related factors were more common in alcohol drinkers than in non-alcohol drinkers.
Ageing is an inevitable developmental phenomenon bringing along a number of changes in the physical, psychological, hormonal and the social conditions. Define ageing in terms of the biology; referring to "the regular changes that occur in mature genetically representative organism living under reprehensive environmental conditions as they advance in chronological age." old age has been viewed, as problematic period of one's life and this is correct to same extent. The aged become increasingly dependent on others. The main purpose of this study to find out the correlation between stress and anxiety among geriatrics living in selected villages at Puducherry. The total 450 sample have been selected based on inclusion and exclusion criteria. The research tool stress (PSS) and anxiety (GAS) scale was used and test was applied to identified the correlation between stress and anxiety by correlation coefficient method. Result reveals that significance of positive correlation of stress and anxiety among geriatrics living in selected villages at Puducherry. Age is main risk factor to increase the level of stress and anxiety compare to young age group.
Context
The Primary Care Evaluation of Mental Disorders (PRIME-MD) was developed
as a screening instrument but its administration time has limited its clinical
usefulness.Objective
To determine if the self-administered PRIME-MD Patient Health Questionnaire
(PHQ) has validity and utility for diagnosing mental disorders in primary
care comparable to the original clinician-administered PRIME-MD.Design
Criterion standard study undertaken between May 1997 and November 1998.Setting
Eight primary care clinics in the United States.Participants
Of a total of 3000 adult patients (selected by site-specific methods
to avoid sampling bias) assessed by 62 primary care physicians (21 general
internal medicine, 41 family practice), 585 patients had an interview with
a mental health professional within 48 hours of completing the PHQ.Main Outcome Measures
Patient Health Questionnaire diagnoses compared with independent diagnoses
made by mental health professionals; functional status measures; disability
days; health care use; and treatment/referral decisions.Results
A total of 825 (28%) of the 3000 individuals and 170 (29%) of the 585
had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those
of independent mental health professionals (for the diagnosis of any 1 or
more PHQ disorder, κ = 0.65; overall accuracy, 85%; sensitivity, 75%;
specificity, 90%), similar to the original PRIME-MD. Patients with PHQ diagnoses
had more functional impairment, disability days, and health care use than
did patients without PHQ diagnoses (for all group main effects, P<.001). The average time required of the physician to review the
PHQ was far less than to administer the original PRIME-MD (<3 minutes for
85% vs 16% of the cases). Although 80% of the physicians reported that routine
use of the PHQ would be useful, new management actions were initiated or planned
for only 117 (32%) of the 363 patients with 1 or more PHQ diagnoses not previously
recognized.Conclusion
Our study suggests that the PHQ has diagnostic validity comparable to
the original clinician-administered PRIME-MD, and is more efficient to use.
Figures in this Article
Mental disorders in primary care are common, disabling, costly, and
treatable.1- 5
However, they are frequently unrecognized and therefore not treated.2- 6
Although there have been many screening instruments developed,7- 8
PRIME-MD (Primary Care Evaluation of Mental Disorders)5
was the first instrument designed for use in primary care that actually diagnoses
specific disorders using diagnostic criteria from the Diagnostic
and Statistical Manual of Mental Disorders, Revised Third Edition9(DSM-III-R) and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition10(DSM-IV).
PRIME-MD is a 2-stage system in which the patient first completes a
26-item self-administered questionnaire that screens for 5 of the most common
groups of disorders in primary care: depressive, anxiety, alcohol, somatoform,
and eating disorders. In the original study,5
the average amount of time spent by the physician to administer the clinician
evaluation guide to patients who scored positively on the patient questionnaire
was 8.4 minutes. However, this is still a considerable amount of time in the
primary care setting, where most visits are 15 minutes or less.11
Therefore, although PRIME-MD has been widely used in clinical research,12- 28
its use in clinical settings has apparently been limited. This article describes
the development, validation, and utility of a fully self-administered version
of the original PRIME-MD, called the PRIME-MD Patient Health Questionnaire
(henceforth referred to as the PHQ).
DESCRIPTION OF PRIME-MD PHQ
ABSTRACT
|
DESCRIPTION OF PRIME-MD PHQ
|
STUDY PURPOSE
|
METHODS
|
RESULTS
|
COMMENT
|
REFERENCES
The 2 components of the original PRIME-MD, the patient questionnaire
and the clinician evaluation guide, were combined into a single, 3-page questionnaire
that can be entirely self-administered by the patient (it can also be read
to the patient, if necessary). The clinician scans the completed questionnaire,
verifies positive responses, and applies diagnostic algorithms that are abbreviated
at the bottom of each page. In this study, the data from the questionnaire
were entered into a computer program that applied the diagnostic algorithms
(written in SPSS 8.0 for Windows [SPSS Inc, Chicago, Ill]). The computer program
does not include the diagnosis of somatoform disorder, because this diagnosis
requires a clinical judgment regarding the adequacy of a biological explanation
for physical symptoms that the patient has noted.
A fourth page has been added to the PHQ that includes questions about
menstruation, pregnancy and childbirth, and recent psychosocial stressors.
This report covers only data from the diagnostic portion (first 3 pages) of
the PHQ. Users of the PHQ have the choice of using the entire 4-page instrument,
just the 3-page diagnostic portion, a 2-page version (Brief PHQ) that covers
mood and panic disorders and the nondiagnostic information described above,
or only the first page of the 2-page version (covering only mood and panic
disorders) (Figure 1).
Figure 1. First Page of Primary Care Evaluation
of Mental Disorders Brief Patient Health QuestionnaireGrahic Jump Location+View Large |
Save Figure |
Download Slide (.ppt)
|
View in Article ContextCopyright held by Pfizer Inc, but may be photocopied ad libitum.
For office coding, see the end of the article.
The original PRIME-MD assessed 18 current mental disorders. By grouping
several specific mood, anxiety, and somatoform categories into larger rubrics,
the PHQ greatly simplifies the differential diagnosis by assessing only 8
disorders. Like the original PRIME-MD, these disorders are divided into threshold
disorders (corresponding to specific DSM-IV diagnoses,
such as major depressive disorder, panic disorder, other anxiety disorder,
and bulimia nervosa) and subthreshold disorders (in which the criteria for
disorders encompass fewer symptoms than are required for any specific DSM-IV diagnoses: other depressive disorder, probable alcohol
abuse or dependence, and somatoform and binge eating disorders).
One important modification was made in the response categories for depressive
and somatoform symptoms that, in the original PRIME-MD, were dichotomous (yes/no).
In the PHQ, response categories are expanded. Patients indicate for each of
the 9 depressive symptoms whether, during the previous 2 weeks, the symptom
has bothered them "not at all," "several days," "more than half the days,"
or "nearly every day." This change allows the PHQ to be not only a diagnostic
instrument but also to yield a measure of depression severity that can be
of aid in initial treatment decisions as well as in monitoring outcomes over
time. Patients indicate for each of the 13 physical symptoms whether, during
the previous month, they have been "not bothered," "bothered a little," or
"bothered a lot" by the symptom. Because physical symptoms are so common in
primary care, the original PRIME-MD dichotomous-response categories often
led patients to endorse physical symptoms that were not clinically significant.
An item was added to the end of the diagnostic portion of the PHQ asking
the patient if he or she had checked off any problems on the questionnaire:
"How difficult have these problems made it for you to do your work, take care
of things at home, or get along with other people?" As with the original PRIME-MD,
before making a final diagnosis, the clinician is expected to rule out physical
causes of depression, anxiety and physical symptoms, and, in the case of depression,
normal bereavement and history of a manic episode.
STUDY PURPOSE
ABSTRACT
|
DESCRIPTION OF PRIME-MD PHQ
|
STUDY PURPOSE
|
METHODS
|
RESULTS
|
COMMENT
|
REFERENCES
Our major purpose was to test the validity and utility of the PHQ in
a multisite sample of family practice and general internal medicine patients
by answering the following questions:
Are diagnoses made by the PHQ as accurate as diagnoses
made by the original PRIME-MD, using independent diagnoses made by mental
health professionals (MHPs) as the criterion standard?Are the frequencies of mental disorders found by
the PHQ comparable to those obtained in other primary care studies?Is the construct validity of the PHQ comparable
to the original PRIME-MD in terms of functional impairment and health care
use?Is the PHQ as effective as the original PRIME-MD
in increasing the recognition of mental disorders in primary care patients?How valuable do primary care physicians find the
diagnostic information in the PHQ?How comfortable are patients in answering the questions
on the PHQ, and how often do they believe that their answers will be helpful
to their physicians in understanding and treating their problems?
The assessment of anxiety disorders in late life is often hindered by the lack of measures specifically validated with older adults. Because anxiety manifestations may vary across age groups, it is important to design new instruments or validate existing measures with older adults. This study examined the psychometric properties of the Beck Anxiety Inventory (BAI) in a sample of 281 older adults who were community-dwelling (82.6%) or living in residential care facilities (17.4%). The mean total BAI score was 6.5 (SD = 7.2), indicating minimal anxiety symptomatology in this older sample. There was a trend for older subjects to score higher. Females scored higher than males, and subjects living in a residential facility scored higher than did community dwellers. Item-total correlations were in the moderate range and the internal consistency of the BAI was adequate (alpha = 0.89). A factor analysis yielded a six-factor structure accounting for 64.6% of the variance, with a somatic factor accounting for the largest portion of the variance (32.2%). Because somatic symptoms are more prevalent with aging, such symptoms should not be weighed as heavily in the total BAI score as cognitive or behavioral symptoms. The findings indicate that the BAI is a useful self-report scale for assessing anxiety symptomatology among older adults.
The purpose of this study was to examine the comorbidity of and communality of risk factors associated with major depressive disorder and anxiety disorders in later life.
A random age- and sex-stratified community-based sample (N=3,056) of the elderly (age 55-85 years) in the Netherlands was studied. A two-stage screening design was used, with the Center for Epidemiologic Studies Depression Scale as a screening instrument and the National Institute of Mental Health Diagnostic Interview Schedule as a criterion instrument. Risk factors were measured with well-validated instruments and represented a broad range of vulnerability and stress-related factors associated with anxiety and depression. Multivariate analyses examined risk factors associated with pure major depressive disorder, pure anxiety disorders, and comorbid conditions.
Comorbidity was highly prevalent: 47.5% of those with major depressive disorder also met criteria for anxiety disorders, whereas 26.1% of those with anxiety disorders also met criteria for major depressive disorder. While the only variables associated with pure major depressive disorder were younger age and external locus of control, risk factors representing a wide range of both vulnerability and stress were associated with pure anxiety disorders. External locus of control was the only common factor. The group with anxiety disorders plus major depressive disorder had a distinct risk factor profile and may represent those with a more severe disorder.
Although high levels of comorbidity between major depressive disorder and anxiety disorders were found, comparing risk factors associated with pure major depressive disorder and pure anxiety disorders revealed more differences than similarities. Anxiety disorders in later life merit separate study.
The history, rationale, and development of the Structured Clinical Interview for DSM-III-R (SCID) is described. The SCID is a semistructured interview for making the major Axis I DSM-III-R diagnoses. It is administered by a clinician and includes an introductory overview followed by nine modules, seven of which represent the major axis I diagnostic classes. Because of its modular construction, it can be adapted for use in studies in which particular diagnoses are not of interest. Using a decision tree approach, the SCID guides the clinician in testing diagnostic hypotheses as the interview is conducted. The output of the SCID is a record of the presence or absence of each of the disorders being considered, for current episode (past month) and for lifetime occurrence.
We estimated clinicians' awareness of depression for patients with current depressive disorder (N = 650) who received care in either a single-specialty solo or small group practice, a large multispecialty group practice, or a health maintenance organization in three US sites. Depressive disorder was determined by independent diagnostic assessment shortly after an office visit. Detection and treatment of depression were determined from visit-report forms completed by the treating clinician. Depending on the setting, from 78.2% to 86.9% of depressed patients who visited mental health specialists had their depression detected at the time of the visit, compared with 45.9% to 51.2% of depressed patients who visited medical clinicians, after adjusting for case-mix differences. Among patients of mental health specialists, there were no significant differences by type of payment in the likelihood of depressive disorder being detected or treated. Among patients of medical clinicians, however, those receiving care financed by prepayment were significantly less likely to have their depression detected or treated during the visit than were similar patients receiving fee-for-service care.
This field trial was designed to answer four questions. First, are patients presenting with anxious or depressed symptoms that are associated with significant impairment but do not meet DSM-III-R definitional thresholds for axis I anxiety or mood disorders? Second, is the impairment experienced by these patients simply the consequence of the severity of their medical conditions? Third, what percent of these patients present with depressive symptoms only, anxious symptoms only, and a mixture of both? Fourth, how should the operational criteria for the syndrome(s) presented by these patients be defined?
A total of 666 patients from five primary care medical sites and two outpatient mental health sites were administered a semistructured psychiatric interview.
Patients presenting with affective symptoms that did not meet definitional thresholds for DSM-III-R axis I disorders were at least as common as patients with several of the already established anxiety and mood disorders in each of the seven sites, and their disorders were associated with significant distress or impairment. A nonspecific pattern of anxious and depressed symptoms was the modal presentation among these patients with currently subdefinitional threshold disorders, and they could be significantly differentiated in terms of current symptoms from patients presenting with a principal diagnosis of generalized anxiety disorder, major depressive episode, or panic disorder with agoraphobia.
The authors recommend that a mixed anxiety-depression category be included in the DSM-IV appendix for proposed diagnostic categories that need further study. A criteria set is proposed.
In order to assess the psychometric properties and diagnostic utility of the Beck Anxiety Inventory (BAI) and the State-Trait Anxiety Inventory (STAI) with older adults, these measures were administered to 217 older adult outpatients with mixed psychiatric disorders. Both the BAI and STAI scales demonstrated high internal reliabilities. The BAI demonstrated good factorial validity, with a somatic anxiety and a subjective anxiety factor emerging. In contrast, the STAI did not evidence factorial validity, with analyses failing to support presence of state and trait anxiety factors. Both the BAI and Trait Anxiety scale of the STAI demonstrated discriminant validity in separating patients with a current anxiety disorder from patients without such a disorder. However, the State Anxiety scale of the STAI did not discriminate between these groups. When used to predict presence of an anxiety disorder, no single cutting score for either the BAI or STAI proved optimal, due to tradeoffs between sensitivity and specificity. Results suggest that both the subjective subscale and total score on the BAI can be somewhat useful as a quick screening instrument in detecting presence of a current anxiety disorder for older adult psychiatric outpatients, although results were not as strong as previous findings regarding screening tests for depression in the elderly.
Although anxiety is quite prevalent in late life, its impact on disability, well-being, and health care utilization of older persons has not been studied. Older persons are a highly relevant age group for studying the consequences of anxiety, since their increasing numbers put an extra strain on already limited health care resources.
Data of a large community-based random probability sample (N = 659) of older subjects (55-85 year) in the Netherlands were used to select three groups: subjects with a diagnosed anxiety disorder, subjects with merely anxiety symptoms and a reference group without anxiety. These groups were compared with regard to their functioning, subjective well-being, and use of health care services, while controlling for potentially confounding variables.
Anxiety was associated with increased disability and diminished well-being. Older persons with a diagnosed anxiety disorder were equally affected in their functioning as those with merely anxiety symptoms. Although use of health services was increased in anxiety sufferers, their use of appropriate care was generally low.
Anxiety has a clear negative impact on the functioning and well-being of older subjects. The similarity of participants with an anxiety disorder and those having merely anxiety symptoms regarding quality of life variables and health care use was quite striking. Finally, in spite of its grave consequences for the quality of life, appropriate care for anxiety is seldom received. Efforts to improve recognition, disseminate effective treatments in primary care, and referring to specialized care may have positive effects on the management of anxiety in late life.
Patients with chronic obstructive pulmonary disease (COPD) have repeatedly been characterised as a population of chronically ill patients with a higher than normal prevalence of depression. Susceptibility for depression has been noted in patients with certain other chronic conditions. This systematic review was conducted to achieve a more definite answer to the question: do patients with COPD show a higher than normal prevalence of depression?
Studies in English language journals were retrieved by an electronic search over the period from 1966 to December 1997 and by an extended search of reference lists, and were included or excluded according to a system of diagnostic and methodological criteria.
Ten studies were included, of which only four had a case-control design. Three of the case-control studies reported an increased prevalence of depression among patients with COPD which was statistically significant in only one. The fourth controlled study found a significantly increased depression score among COPD patients. Of the remaining six uncontrolled studies three found a high baseline prevalence of depression among their study group.
An association between COPD and depression was found in the four controlled studies. The two methodologically best conducted studies that did not detect a statistically significant higher prevalence lacked power. The two studies that did find a significant association used a questionable depression measure. The prevalence of depression was high compared with general population figures in three of six non-controlled studies. The empirical evidence for a significant risk of depression in patients with COPD remains inconclusive, due to the poor methodological quality of most of the published studies, the lack of studies with an adequate sample size, and variability in instruments and cut off scores used to measure depression.
Current US mental disorder prevalence estimates have limited usefulness for service planning and are often discrepant. Data on clinical significance from the National Institute of Mental Health Epidemiologic Catchment Area Program (ECA) and the National Comorbidity Survey (NCS) were used to produce revised estimates, for more accurate projections of treatment need and further explication of rate discrepancies.
To ascertain the prevalence of clinically significant mental disorders in each survey, responses to questions on life interference from, telling a professional about, or using medication for symptoms were applied to cases meeting symptom criteria in the ECA (n = 20,861) and NCS (n = 8098). A revised national prevalence estimate was made by selecting the lower estimate of the 2 surveys for each diagnostic category, accounting for comorbidity, and combining categories.
Using data on clinical significance lowered the past-year prevalence rates of "any disorder" among 18- to 54-year-olds by 17% in the ECA and 32% in the NCS. For adults older than 18 years, the revised estimate for any disorder was 18.5%. Using the clinical significance criterion reduced disparities between estimates in the 2 surveys. Validity of the criterion was supported by associations with disabilities and suicidal behavior.
Establishing the clinical significance of disorders in the community is crucial for estimating treatment need. More work should be done in defining and operationalizing clinical significance, and characterizing the utility of clinically significant symptoms in determining treatment need even when some criteria of the disorder are not met. Discrepancies in ECA and NCS results are largely due to methodologic differences.
To evaluate the long term effect of ongoing intervention to improve treatment of depression in primary care.
Randomised controlled trial.
Twelve primary care practices across the United States. Participants: 211 adults beginning a new treatment episode for major depression; 94% of patients assigned to ongoing intervention participated.
Practices assigned to ongoing intervention encouraged participating patients to engage in active treatment, using practice nurses to provide care management over 24 months. Main outcome measures: Patients' report of remission and functioning.
Ongoing intervention significantly improved both symptoms and functioning at 24 months, increasing remission by 33 percentage points (95% confidence interval 7% to 46%), improving emotional functioning by 24 points (11 to 38) and physical functioning by 17 points (6 to 28). By 24 months, 74% of patients in enhanced care reported remission, with emotional functioning exceeding 90% of population norms and physical functioning approaching 75% of population norms.
Ongoing intervention increased remission rates and improved indicators of emotional and physical functioning. Studies are needed to compare the cost effectiveness of ongoing depression management with other chronic disease treatment routinely undertaken by primary care.
Few depressed older adults receive effective treatment in primary care settings.
To determine the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression.
Randomized controlled trial with recruitment from July 1999 to August 2001.
Eighteen primary care clinics from 8 health care organizations in 5 states.
A total of 1801 patients aged 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%).
Patients were randomly assigned to the IMPACT intervention (n = 906) or to usual care (n = 895). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert and who offered education, care management, and support of antidepressant management by the patient's primary care physician or a brief psychotherapy for depression, Problem Solving Treatment in Primary Care.
Assessments at baseline and at 3, 6, and 12 months for depression, depression treatments, satisfaction with care, functional impairment, and quality of life.
At 12 months, 45% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline compared with 19% of usual care participants (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.71-4.38; P<.001). Intervention patients also experienced greater rates of depression treatment (OR, 2.98; 95% CI, 2.34-3.79; P<.001), more satisfaction with depression care (OR, 3.38; 95% CI, 2.66-4.30; P<.001), lower depression severity (range, 0-4; between-group difference, -0.4; 95% CI, -0.46 to -0.33; P<.001), less functional impairment (range, 0-10; between-group difference, -0.91; 95% CI, -1.19 to -0.64; P<.001), and greater quality of life (range, 0-10; between-group difference, 0.56; 95% CI, 0.32-0.79; P<.001) than participants assigned to the usual care group.
The IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices.
Older adults with generalized anxiety disorder (GAD; N = 75; M age = 67.1 years) were randomly assigned to cognitive-behavioral therapy (CBT), a discussion group (DG) organized around worry-provoking topics, or a waiting period. Participants in both active conditions improved relative to the waiting list. Although CBT participants improved on more measures than DG participants, the authors found only I significant difference immediately after treatment and no differences at 6-month follow-up. Effect sizes were smaller than in younger samples, but CBT showed large effects and DG showed medium-sized effects Overall, results indicate that brief treatment of late-life GAD is beneficial, but they provide only limited support for the superiority of CBT to a credible comparison intervention.
This study addressed the efficacy of cognitive-behavioral therapy (CBT), relative to minimal contact control (MCC), in a sample of 85 older adults (age 60 years and over) with generalized anxiety disorder (GAD). All participants completed measures of primary outcome (worry and anxiety), coexistent symptoms (depressive symptoms and specific fears), and quality of life. Results of both completer and intent-to-treat analyses revealed significant improvement in worry, anxiety, depression, and quality of life following CBT relative to MCC. Forty-five percent of patients in CBT were classified as responders, relative to 8% in MCC. Most gains for patients in CBT were maintained or enhanced over 1-year follow-up. However, posttreatment scores for patients in CBT failed to indicate return to normative functioning.
Aims. To investigate the use of the Hospital Anxiety and Depression Scale (HADS) with recuperating chronic obstructive pulmonary disease (COPD) patients. To study prevalence rates and changes in clinically relevant anxiety and depression during rehabilitation. Methods. Consecutive patients admitted to a non acute respiratory ward over a twelve week period were asked to complete a HADS questionnaire on three occasions. Nurses recorded basic demographic information on admission. Additional demographic, medical and psychiatric data were obtained by retrospective review of medical records. Results. Of 93 consecutive inpatients, 79 (85%) completed the admission HADS. 72 patients were eligible to complete the day three HADS and 60 the discharge HADS. Clinically relevant anxiety (HADS score of greater than or equal to8) was indicated in 39 patients (50%) and depression in 22 (28%). HADS anxiety (p=0.05) and total scores (anxiety+depression) (p=0.03) decreased between admission and discharge. A larger proportion of patients scored within the normal or mild psychopathology range by discharge. More severe COPD (FEV1% predicted) correlated with higher HADS anxiety scores (r=-0.39, p<0.001) and HADS depression scores (r=-0.34, p<0.005). Patients with a recorded history of anxiety (p<0.0001) and depression (p<0.02) had higher HADS scores. Females (n=37) when compared to males (n=42), recorded significantly higher HADS anxiety scores throughout (p<0.005). Conclusions. Clinically relevant anxiety, indicated by higher HADS scores, was more common in patients with severe COPD, a past history of anxiety or depression and females. Anxiety and total mood unproved during inpatient rehabilitation. The use of this instrument with New Zealand COPD patients may improve identification and treatment of anxious and depressed patients.
Objective:
While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity.
Measurements:
The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients.
Results:
As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples.
Conclusion:
In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
This chapter describes and evaluates the Beck Anxiety Inventory (BAI), a 21-item self-report instrument for measuring the severity of anxiety in adolescents and adults. A summary of the research investigating the reliability, internal consistency, test-retest reliability, content validity, construct and convergent validity, discriminant validity, and factorial validity is offered. Sex, age, ethnic, and diagnostic effects of the BAI are also presented. The chapter concludes with applications, benefits and limitations of the BAI. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity.
MEASUREMENTS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients.
RESULTS: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples.
CONCLUSION: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
Studies of the primary care treatment of depressed elderly patients are constrained by limited time and space and by subject burden. Research assessments must balance these constraints with the need for obtaining clinically meaningful information. Due to the wide-ranging impact of depression, assessments should also focus on suicidality, hopelessness, substance abuse, anxiety, cognitive functioning, medical comorbidity, functional disability, social support, personality, service use and satisfaction with services. This paper describes considerations concerning the assessment selection process for primary care studies, using the PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) study as an example. Strategies are discussed for ensuring that data are complete, valid and reliable. Copyright © 2001 John Wiley & Sons, Ltd.
Although recent epidemiologic studies have established that patients with chronic medical illness and depressed mood are more disabled than euthymic patients, detailed data on the benefits and risks of antidepressant treatment in medically high-risk patients have been slow to accumulate. The authors have examined multiple outcome indicators in patients with disabling chronic obstructive pulmonary disease and comorbid depression. Thirty patients completed a 12-week, randomized controlled trial of nortriptyline. Nortriptyline was clearly superior to placebo for treatment of depression. Nortriptyline treatment was accompanied by marked improvements in anxiety, certain respiratory symptoms, overall physical comfort, and day-to-day function; placebo effects were negligible. Physiological measures reflecting pulmonary insufficiency were generally unaffected by treatment. These data provide impetus for renewed efforts to improve recognition and treatment of mood disorders in even severely disabled medical patients.
In a general medical clinic setting, 880 patients were screened for depression by using the Diagnostic Interview Schedule version of the DSM-III and the Zung Self-Rating Depression Scale (SDS), as well as the Zung Self-Rating Anxiety Scale (SAS). Based on a morbidity cutoff index of 50 on the SDS and a positive DIS for depression, 112 patients (13%) were found to have a depressive disorder. The SDS showed a 97% sensitivity, a 63% specificity, and an 82% correct classification of depressed and nondepressed control patients. Based on the SDS results and SAS results when anxiety was considered present at a moderate severity level, the comorbidity of anxiety and depression was 67%. Depressed patients were followed for 1 year during which time they were retested with the SDS and SAS at five time points (6 weeks and quarterly). Fifty-one patients who met the criterion of a decrease of greater than or equal to 12 points in the SDS index were assigned to the improved group, 23 who met the criterion of an increase of greater than or equal to 12 points were assigned to the worse group, and 36 patients were assigned to the no-change group. Depressed patients who improved showed a significant decrease in anxiety based on SAS change scores; depressed patients who worsened showed a significant increase in their anxiety index. The decrease in the anxiety index of patients in the no-change group was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)
Fifty consecutive outpatients with stable chronic obstructive pulmonary disease were evaluated for lifetime prevalence of psychiatric morbidity. Eight percent had a diagnosis of panic disorder. This finding suggests that this patient population should be monitored for panic disorder.
The effects of regular aerobic exercise on state-trait anxiety (Spielberger) and Depression (Zung) were assessed for nine men and six women, 46-71 years of age, with chronic obstructive pulmonary disease (COPD). Treatment subjects (N = 9) were evaluated prior to and following 14 and 28 weeks of exercise. Control subjects (N = 6) were evaluated at the same times but did not participate in the initial 14 weeks of exercise. The exercise regime consisted of stretching before and after 30 minutes of walking at about 50% of maximal oxygen uptake. Analyses showed the exercise intervention to have little impact on state-trait anxiety or depression scores. Anecdotal remarks and perceptions of the subjects suggest that further investigation of the relationship between exercise and psychological status of COPC patients is justified.
Fifty consecutive patients with chronic airflow obstruction who were admitted to a respiratory unit were assessed medically and psychiatrically. A high rate of psychiatric morbidity (58%) was detected with panic and other anxiety disorders (34%) being particularly prevalent. Various physiological and psychological reasons for the high rate of anxiety disorders are discussed.
The objective of this study was twofold: (1) to document the prevalence of depression and anxiety in patients with moderate or severe chronic obstructive pulmonary disease; and (2) to determine whether the presence of depression or anxiety adversely affected the functional capabilities of the patient as reflected by the distance he could walk in 12 minutes. Forty-five patients with an FEV1 less than 1,250 ml underwent pulmonary function testing including spirometry, single breath diffusing capacity, and arterial blood gas determinations. The degree of depression was assessed by the Beck depression inventory, while the degree of anxiety was assessed by the State-Trait anxiety inventory. Forty-two percent of the patients had significant depression, while only 2 percent of the patients had significant anxiety. There was a highly significant correlation between the depression scores and the anxiety scores (r = 0.81, p less than 0.001). There was no significant correlation between the level of depression or anxiety and the distance that the patient could walk in 12 minutes. From this study, we conclude that the prevalence of depression in patients with moderate or severe COPD approaches 50 percent while the incidence of anxiety is much lower (2 percent).
Measures of quality of life were obtained on 985 patients with mild hypoxemia and chronic obstructive pulmonary disease (COPD). A subsample of 100 patients were also given extensive neuropsychological and personality tests. Mildly hypoxemic COPD patients showed impairment in quality-of-life activities. They showed less impairment in physical function, compared with previous studies on COPD patients with hypoxemia, but about equal impairment in psychosocial function and dysphoric mood. Nonrelated health changes in life do not seem to account for these findings. Degree of self-reported tension-anxiety was the single greatest predictor of both physical and psychosocial measures of quality of life. Level of exercise completed, forced expiratory volume in 1 s, and neuropsychological status were significantly related to physical limitations, but not psychosocial functioning. The Pao2 was not significantly related to quality-of-life measures in this patient group.
Self-assessment questionnaires which measure the functional and affective consequences of chronic obstructive pulmonary disease (COPD) give valuable information about the effects of the disease and may serve as important tools with which to evaluate treatment.
A cross sectional comparative study was performed between patients with COPD (n = 68), stratified according to pulmonary function, and a healthy control group (n = 89). A battery of well established clinical and quality of life measures (the Sickness Impact Profile (SIP), Mood Adjective Check List (MACL), and Hospital Anxiety and Depression scale (HAD)) was used to examine in which functional and affective aspects the patient group differed from the control group and how these measures related to pulmonary function and smoking habits.
Compared with the controls, COPD affected functional status in most areas, not just those requiring physical activity. Forty six patients with forced expiratory volume in one second (FEV1) below 50% predicted showed particularly high levels of dysfunction in ambulation, eating, home management, and recreation/ pastimes (SIP). Despite this, their level of psychosocial functioning and mood status was little different from that of the healthy controls. Among the patients, a subgroup reported substantial psychological distress, but mood status was only weakly, or not at all, related to pulmonary function. Smoking habits did not affect functional status or well being.
Quality of life is not significantly affected in patients with mild to moderate loss of pulmonary function, possibly due to coping and/or pulmonary reserve capacity. This suggests that generic self-assessment questionnaires are of limited value for detecting the early consequences of COPD. However, in later stages of the disease they are sensitive enough to discriminate between patients with different levels of pulmonary dysfunction. The low correlations between the indices of pulmonary function and the indices of affective status suggest that well being depends, to a large extent, on factors outside the clinical domain.
Exercise rehabilitation is recommended increasingly for patients with chronic obstructive pulmonary disease (COPD). This study examined the effect of exercise and education on 79 older adults (M age = 66.6 +/- 6.5 years; 53% female) with COPD, randomly assigned to 10 weeks of (a) exercise, education, and stress management (EXESM; n = 29); (b) education and stress management (ESM; n = 25); or (c) waiting list (WL; n = 25). EXESM included 37 sessions of exercise, 16 educational lectures, and 10 weekly stress management classes. ESM included only the 16 lectures and 10 stress management classes. Before and after the intervention, assessments were conducted of physiological functioning (pulmonary function, exercise endurance), psychological well-being (depression, anxiety, quality of life), and cognitive functioning (attention, motor speed, mental efficiency, verbal processing). Repeated measures multivariate analysis of variance indicated that EXESM participants experienced changes not observed among ESM and WL participants, including improved endurance, reduced anxiety, and improved cognitive performance (verbal fluency).
Depression is a highly prevalent, morbid, and costly illness that is often unrecognized and inadequately treated. Because depression questionnaires have the potential to improve recognition, we evaluated the accuracy and effects on primary care of two case-finding instruments compared to usual care.
The study was conducted at three university-affiliated and one community-based medical clinics. Consecutive patients were randomly assigned to be asked a single question about mood, to fill out the 20-item Center for Epidemiologic Studies Depression Screen, or to usual care. Within 72 hours, patients were assessed for Diagnostic and Statistical Manual of Mental Disorders Third Revised Edition (DSM-III-R) disorders by an assessor blinded to the screening results. Process of care was assessed using chart audit and administrative databases; patient and physician satisfaction was assessed using Likert scales. At 3 months, depressed patients and a random sample of nondepressed patients were re-assessed for DSM-III-R disorders and symptom counts.
We approached 1,083 patients, of whom 969 consented to screening and were assigned to the single question (n = 330), 20-item questionnaire (n = 323), or usual care (n = 316). The interview for DSM-III-R diagnosis was completed in 863 (89%) patients; major depression, dysthymia, or minor depression was present in 13%. Both instruments were sensitive, but the 20-item questionnaire was more specific than the single question (75% vs 66%, P = 0.03). The 20-item questionnaire was less likely to be self-administered (54% vs 90%) and took significantly more time to complete (15 vs 248 seconds). Case-finding with the 20-item questionnaire or single question modestly increased depression recognition, 30/77 (39%) compared with 11/38 (29%) in usual care (P = 0.31) but did not affect treatment (45% vs 43%, P = 0.88). Effects on DSM-III-R symptoms were mixed. Recovery from depression was more likely in the case-finding than usual care groups, 32/67 (48%) versus 8/30 (27%, P = 0.03), but the mean improvement in depression symptoms did not differ significantly (1.6 vs 1.5 symptoms, P = 0.21).
A simple question about depression has similar performance characteristics as a longer 20-item questionnaire and is more feasible because of its brevity. Case-finding leads to a modest increase in recognition rates, but does not have consistently positive effects on patient outcomes.
The authors examined the relationship between functional status and comorbid anxiety and depression and the relationship between utilization of health care resources and psychopathology in elderly patients with chronic obstructive pulmonary disease (COPD). Elderly male veterans (N = 43) with COPD completed anxiety, depression, and functional status measures. The authors constructed regression models to explore the contribution of COPD severity, medical burden, depression, and anxiety to the dependent variables of functional impairment and health care utilization. Anxiety and depression contributed significantly to the overall variance in functional status of COPD patients, over and above medical burden and COPD severity, as measured by the 8 scales of the Medical Outcomes Study (MOS) 36-item Short Form Health Survey. Surprisingly, medical burden and COPD severity did not contribute significantly to overall variance in functional status. Few patients were receiving any treatment for anxiety or depression.
Depressive and anxiety symptoms are common in elderly patients with chronic obstructive pulmonary disease (COPD). However, true prevalence of clinical depression and anxiety is uncertain. We thus aimed to assess prevalence of clinical depression and/or anxiety in elderly COPD patients using the Geriatric Mental State Schedule (GMS) and determine severity of clinical depression by the Montgomery Asberg Depression Rating Scale (MADRS). We also aimed to validate the Brief Assessment Schedule Depression Cards (BASDEC) screening test for depressive symptoms against GMS.
A university teaching hospital.
Subjects comprised 137 (69 men) outpatients with COPD, aged 60 - 89 (mean 73) years. Exclusion criteria were acute respiratory exacerbation or use of oral corticosteroid within 6 weeks, known psychosis, acute or chronic confusion.
A GMS score > or =3 is diagnostic of clinical depression, and a BASDEC score > or =7 is classed as "case". GMS was taken as gold standard. Severity of depression was assessed by the MADRS:
Mean (SD) one second forced expiratory volume was 0.89 (0.3) litres. Sixty-two subjects (46%) scored as a "case" on BASDEC and 57 subjects (42%) were identified as clinically depressed on GMS. In the depressed the prevalence of anxiety was 37% and in the non-depressed 5%. BASDEC performed well against GMS, having a sensitivity of 100%; a specificity of 93%; a positive predictive value of 91% and a negative predictive value of 100%. Assessment of severity of depression by MADRS showed that 17 subjects (30%) were mildly depressed, 39 (68%) were moderately depressed and one (2%) was severely depressed.
Clinical depression and anxiety are common in elderly patients with COPD, though clinical anxiety seems mainly confined to those who also suffer clinical depression. Of those depressed, two-thirds scored in the moderately depressed range. BASDEC is a valid screening tool in this patient group.
Late life depression can be successfully treated with antidepressant medications or psychotherapy, but few depressed older adults receive effective treatment.
A randomized controlled trial of a disease management program for late life depression.
Approximately 1,750 older adults with major depression or dysthymia are recruited from seven national study sites.
Half of the subjects are randomly assigned to a collaborative care program where a depression clinical specialist supervised by a psychiatrist and a primary care expert supports the patient's regular primary care provider to treat depression. Intervention services are provided for 12 months using antidepressant medications and Problem Solving Treatment in Primary Care according to a stepped care protocol that varies intervention intensity according to clinical needs. The other half of the subjects are assigned to care as usual.
Subjects are independently assessed at baseline, 3 months, 6 months, 12 months, 18 months, and 24 months. The evaluation assesses the incremental cost-effectiveness of the intervention compared with care as usual. Specific outcomes examined include care for depression, depressive symptoms, health-related quality of life, satisfaction with depression care, health care costs, patient time costs, market and nonmarket productivity, and household income.
The study blends methods from health services and clinical research in an effort to protect internal validity while maximizing the generalizability of results to diverse health care systems. We hope that this study will show the cost-effectiveness of a new model of care for late life depression that can be applied in a range of primary care settings.
Mental health services for older people in primary care are relatively underdeveloped. This study has sought to determine the nature and extent of mental health problems in older people presenting to primary care and to compare this with the detection and management of mental health problems by the primary health care team (PHCT).
Participants were patients aged 65 years and above attending a representative inner city general practice. Screening tools included the General Health Questionnaire (GHQ-28), Hospital Anxiety and Depression Scale (HADS), Mini Mental State Examination (MMSE). The PHCT used a brief checklist to rate participants for the presence of mental health problems. Follow-up interviews using the Geriatric Mental State (GMSA), Cambridge Examination for Mental Disorders in the Elderly (CAMDEX)-cognitive subscale (CAMCOG), National Adult Reading Test (NART), were carried out.
A high level of psychological morbidity was identified at screening (48.1%). There was a considerable degree of agreement between the HADS and GMSA, and the MMSE and GMSA at follow-up. Agreement rates between the PHCT and initial screening tools were low suggesting under-recognition of mental health problems at primary care level by the PHCT. Contributory factors included: short consultation times with a concentration on physical symptoms; few patients presenting explicitly with mental health problems; few decisions to treat or refer patients; and the general practitioners tended to monitor, or defer decisions.
This study found lower levels of severe mental health problems, especially depression, than reported elsewhere, but higher prevalence of psychological distress. High levels of physical and mental health co-morbidity were found. These findings suggest that planning for primary care services needs to adopt a flexible assessment model. The development of effective, time-limited protocols and screening tools to assist the PHCT in improving their identification rates is recommended. This needs to be supported by the availability of appropriate treatments for the psychological distress.
To examine whether feedback and treatment advice for depression presented to primary care physicians (PCPs) via an electronic medical record (EMR) system can potentially improve clinical outcomes and care processes for patients with major depression.
Randomized controlled trial.
Academically affiliated primary care practice in Pittsburgh, PA.
Two hundred primary care patients with major depression on the Primary Care Evaluation of Mental Disorders (PRIME-MD) and who met all protocol-eligibility criteria.
PCPs were randomly assigned to 1 of 3 levels of exposure to EMR feedback of guideline-based treatment advice for depression: "active care" (AC), "passive care" (PC), or "usual care" (UC).
Patients' 3- and 6-month Hamilton Rating Scale for Depression (HRS-D) score and chart review of PCP reports of depression care in the 6 months following the depression diagnosis. Only 22% of patients recovered from their depressive episode at 6 months (HRS-D </=7). Patients' mean HRS-D score decreased regardless of their PCPs' guideline-exposure condition (20.4 to 14.2 from baseline to 6-month follow-up; P <.001). However, neither continuous (HRS-D </=7: 22% AC, 23% PC, 22% UC; P =.8) nor categorical measures of recovery (P =.2) differed by EMR exposure condition upon follow-up. Care processes for depression were also similar by PCP assignment despite exposure to repeated reminders of the depression diagnosis and treatment advice (e.g., depression mentioned in >/=3 contacts with usual PCP at 6 months: 31% AC, 31% PC, 18% UC; P =.09 and antidepressant medication suggested/prescribed or baseline regimen modified at 6 months: 59% AC, 57% PC, 52% UC; P =.3).
Screening for major depression, electronically informing PCPs of the diagnosis, and then exposing them to evidence-based treatment recommendations for depression via EMR has little differential impact on patients' 3- or 6-month clinical outcomes or on process measures consistent with high-quality depression care.
The purpose of this study was to make comparisons between different types of exercise tests used in chronic obstructive pulmonary disease (COPD) to better interpret the results and to select the most suitable testing procedure. Therefore, we evaluated the relationship between exercise capacity and other clinical measures and their relative contributions to exercise capacity in patients with COPD.
We studied 36 patients with stable COPD. All patients underwent baseline pulmonary function testing. Dyspnea during activities of daily living was assessed with the Oxygen Cost Diagram (OCD). The Hospital Anxiety and Depression Scale and the St George's Respiratory Questionnaire were used to assess psychologic status and health-related quality of life, respectively. All patients performed the 6-minute walking test, progressive cycle ergometry, and the cycle endurance test.
Each exercise capacity result correlated significantly with pulmonary function, the OCD, and the Activity and Total scores of the St George's Respiratory Questionnaire. Multiple regression analyses revealed that the OCD was an important predictor of exercise capacity, especially for the walking test. Diffusing capacity was also a significant predictor on progressive cycle ergometry. Body mass index was the most significant predictor of the endurance time.
The 3 different exercise tests had similar characteristics in relation to pulmonary function, dyspnea, and health-related quality of life in patients with COPD. However, some differences were found in the aspects they evaluated.
Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and disability. Many studies have investigated factors influencing quality of life (QoL) in middle-aged COPD sufferers, but little attention has been given to elderly COPD. The aim of the present study was to investigate the impact of COPD on QoL and functional status in the elderly. Sixty COPD patients and 58 healthy controls over 65 years old were administered Pulmonary Function Tests, 6 min Walking Test (6MWD) for exercise tolerance, the Barthel Index and Mini Mental State Examination (MMSE) for functional status, the Geriatric Depression Scale (GDS) for mood, and the Saint George Respiratory Questionnaire (SGRQ) for QoL. FEV1 and PaO2 were reduced in COPD patients. Also the distance walked during 6MWD was significantly shorter for patients than controls (282.5 +/- 89.5 vs. 332.9 +/- 95.2 m; P < 0.01). Moreover, COPD patients had significantly worse outcomes for the Barthel Index, GDS and SGRQ. The logistic regression model demonstrated that a decrease in FEV1 is the factor most strictly related to the deterioration of QoL in COPD patients. Mood was also an independent factor influencing QoL. In conclusion, elderly COPD patients show a substantial impairment in QoL depending on the severity of airway obstruction; symptoms related to the disease may be exaggerated by mood deflection.
The aims of the study were to: 1) assess the validity of the mood and anxiety modules of the PRIME-MD Patient Health Questionnaire (PHQ) in otorhinolaryngology outpatients consulting with dizziness; and, 2) the prevalence of anxiety and mood disorders in these patients and in 3 subgroups based on of the cause of dizziness (Functional group, with psychogenic or hyperventilation factor; Organic group with an organic cause; Unspecified group without indication of organic or psychogenic cause). The PRIME-MD PHQ was completed by 268 consecutive outpatients. In 97 patients a psychiatric interview was performed. Operating characteristics indicated good criterion validity for the assessed modules of the PRIME-MD PHQ. Thirty five percent of the patients were diagnosed with "Any Anxiety or Depressive Disorder". In the Functional group, the prevalence of "Any Anxiety or Depressive Disorder" was significantly higher than in the Organic group (P<.0001) and than in the Unspecified group (P<.0001). In the Unspecified group, the prevalence of "Any Anxiety or Depressive Disorder" was significantly lower than in the Organic group (P =.007). Our findings support the criterion validity of the PRIME-MD PHQ for anxiety and depressive disorders in otorhinolaryngology outpatients with dizziness. Psychiatric disorders were highly prevalent and differences in psychiatric status between the different subgroups were demonstrated.
The authors reviewed the implications of the latest generation of health services research studies on primary care practice system changes for depression management, especially in the roles of care managers and mental health specialists.
Authors conducted a review of four large, related, multisite trials testing system changes in the delivery of care to depressed, mostly older, primary care patients.
These studies confirm that older patients are more likely to accept collaborative mental health treatment within primary care than within mental health specialty care. The study results published to date suggest that these system changes produce better outcomes than usual care for depression in a wide range of patients and healthcare organizations. Two key partners in implementing these system changes are a care manager to assist the primary care physician in patient education, treatment, and treatment monitoring, and a mental health specialist to provide care-manager consultation and collaborative care with the primary care physician for more complex cases.
Most patients with depression first seek attention for their symptoms in primary care, rather than in the mental health specialty sector. Since primary care visits are necessarily brief and pressured by competing demands to manage other medical problems, practice system changes are necessary. For mental health specialists, these studies emphasize the importance of joining and being integrated into primary care. Consultative and supervisory roles allow the specialist to indirectly but effectively serve a larger number of patients.
This article reviews the prevalence of anxiety disorders in patients with chronic obstructive pulmonary disease (COPD) as well as the impact of comorbid anxiety on quality of life in patients with COPD. Published studies on three types of treatments for anxiety are then reviewed: psychopharmacology, psychotherapy, and pulmonary rehabilitation programs.
A PubMed search was conducted of the literature from 1966 through 2002 using the keywords anxiety, chronic obstructive pulmonary disease, respiratory diseases, obstructive lung diseases, and pulmonary rehabilitation. Any articles that discussed the prevalence of anxiety symptoms or anxiety disorders among patients with COPD, the impact of anxiety on patients with COPD, or the treatment of anxiety in COPD patients were included in this review.
Anxiety disorders, especially generalized anxiety disorder (GAD) and panic disorder, occur at a higher rate in patients with COPD compared with the general population. Not surprisingly, anxiety has a significant and negative impact on quality of life of COPD patients. Nonetheless, few studies have examined pharmacological, psychotherapeutic, or pulmonary rehabilitation treatments for anxiety disorders in the context of COPD. Trials of nortriptyline, buspirone, and sertraline have been found to reduce symptoms of anxiety. Similarly, cognitive-behavioral programs that focus on relaxation and changes in thinking also produced declines in anxious symptoms. Finally, multicomponent pulmonary rehabilitation programs can also result in reductions in anxious symptoms.
Studies examining the treatment of anxiety disorders in patients with COPD are promising, yet their efficacy needs to be established. The long-term effects of treatment of anxiety disorders on quality of life of COPD patients have yet to be explored.
The aim of this study was to compare the validity of the Hospital Anxiety and Depression Scale (HADS), the WHO (five) Well Being Index (WBI-5), the Patient Health Questionnaire (PHQ), and physicians' recognition of depressive disorders, and to recommend specific cut-off points for clinical decision making.
A total of 501 outpatients completed each of the three depression screening questionnaires and received the Structured Clinical Interview for DSM-IV (SCID) as the criterion standard. In addition, treating physicians were asked to give their psychiatric diagnoses. Criterion validity and Receiver Operating Characteristics (ROC) were determined. Areas under the curves (AUCs) were compared statistically.
All depression scales showed excellent internal consistencies (Cronbach's alpha: 0.85-0.90). For 'major depressive disorder', the operating characteristics of the PHQ were significantly superior to both the HADS and the WBI-5. For 'any depressive disorder', the PHQ showed again the best operating characteristics but the overall difference did not reach statistical significance at the 5% level. Cut-off points that can be recommended for the screening of 'major depressive disorder' had sensitivities of 98% (PHQ), 94% (WBI-5), and 85% (HADS). Corresponding specificities were 80% (PHQ), 78% (WBI-5), and 76% (HADS). In contrast, physicians' recognition of 'major depressive disorder' was poor (sensitivity, 40%; specificity, 87%).
Our sample may not be representative of medical outpatients, but sensitivity and specificity are independent of disorder prevalence.
All three questionnaires performed well in depression screening, but significant differences in criterion validity existed. These results may be helpful in the selection of questionnaires and cut-off points.
US Preventive Services Task Force. Screening for depression: recommendations and rationale
US Preventive Services Task Force. Screening for depression:
recommendations and rationale. Ann Intern Med 2002; 136:
760 -764
Center for Health Quality OaER. Health status and outcomes of veterans: physical and mental component summary scores; Veterans SF-36 1999 large survey of veteran enrollees executive report
- Performance Office Of Quality
- Vha
Office of Quality and Performance VHA, Center for Health
Quality OaER. Health status and outcomes of veterans:
physical and mental component summary scores; Veterans
SF-36 1999 large survey of veteran enrollees executive report.
Washington, DC: Department of Veterans Affairs, 2000
Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys' estimates
- W E Narrow
- D S Rae
- L N Robins
Narrow WE, Rae DS, Robins LN, et al. Revised prevalence
estimates of mental disorders in the United States: using a
clinical significance criterion to reconcile 2 surveys' estimates.
Arch Gen Psychiatry 2002; 59:115-123
Mental disorders and mental health treatment among
- C S Hankin
- Spiro A Iii
- D R Miller
Hankin CS, Spiro A, III, Miller DR, et al. Mental disorders
and mental health treatment among U.S. Department of
34 Art: 27498 Input-cf Veterans Affairs outpatients: the Veterans Health Study
balt2/zcb-chest/zcb-chest/zcb-orig/zcb6972-04a mortonk2 S4؍ 11/12/04 5:34 Art: 27498 Input-cf
Veterans Affairs outpatients: the Veterans Health Study. Am J
Psychiatry 1999; 156:1924 -1930