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Original Research: COPD |

The Impact of Disability on Depression Among Individuals With COPD

Patricia P. Katz, PhD; Laura J. Julian, PhD; Theodore A. Omachi, MD, MBA; Steven E. Gregorich, PhD; Mark D. Eisner, MD, MPH, FCCP; Edward H. Yelin, PhD; Paul D. Blanc, MD, MSPH, FCCP
Author and Funding Information

From the Department of Medicine (Drs Katz, Julian, Omachi, Gregorich, Eisner, and Yelin); the Department of Medicine, Division of Occupational and Environmental Medicine (Dr Blanc); and the Cardiovascular Research Institute (Dr Blanc), University of California, San Francisco, San Francisco, CA.

Correspondence to: Patricia P. Katz, PhD, University of California, San Francisco, 3333 California St, Ste 270, San Francisco, CA 94143-0920; e-mail: patti.katz@ucsf.edu


Funding/Support: This study was supported by the National Institutes of Health [National Heart, Lung and Blood Institute Grant R01 HL067438].

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


© 2010 American College of Chest Physicians


Chest. 2010;137(4):838-845. doi:10.1378/chest.09-1939
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Background:  Both disability and depression are common in COPD, but limited information is available on the time-ordered relationship between increases in disability and depression onset.

Methods:  Subjects were members of a longitudinal cohort with self-reported physician-diagnosed COPD, emphysema, or chronic bronchitis. Data were collected through three annual structured telephone interviews (T1, T2, and T3). Depression was defined as a score ≥ 4 on the Geriatric Depression Scale Short Form (S-GDS). Disability was measured with the Valued Life Activities (VLA) scale; three disability scores were calculated: percent of VLAs unable to perform, percent of VLAs affected (unable to perform or with some degree of difficulty), and mean VLA difficulty rating. Disability increases were defined as a 0.5 SD increase in disability score between T1 and T2. Multiple logistic regression analyses estimated the risk of T3 depression following a T1 to T2 disability increase for the total cohort and then excluding individuals who met the depression criterion at T1 or T2.

Results:  Approximately 30% of subjects met the depression criterion each year. Eight percent to 19% experienced a T1 to T2 disability increase, depending on the disability measure. Including all cohort members and controlling for baseline S-GDS scores, T1 to T2 increases in disability yielded a significantly elevated risk of T3 depression (% affected odds ratio [OR] =3.6; 95% CI, [1.7, 7.7]; % unable OR = 6.1 [17, 21.8]; mean difficulty OR= 3.6 [1.7, 8.0]). Omitting individuals depressed at T1 or T2 yielded even stronger risk estimates for % unable (OR = 13.4 [2.0, 91.4]) and mean difficulty (OR = 3.9 [1.3, 11.8]).

Conclusions:  Increases in VLA disability are strongly predictive of the onset of depression.


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