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Original Research: COPD |

Effect of Depression Care on Outcomes in COPD Patients With Depression

Neil Jordan, PhD; Todd A. Lee, PharmD, PhD; Marcia Valenstein, MD, MS; Paul A. Pirraglia, MD, MPH; Kevin B. Weiss, MD, MPH
Author and Funding Information

*From the Center for Management of Complex Chronic Care (Drs. Jordan and Lee), Edward Hines, Jr. VA Hospital, Hines, IL; the Institute for Healthcare Studies (Dr. Weiss), Feinberg School of Medicine, Northwestern University, Chicago, IL; Serious Mental Illness Treatment Research and Evaluation Center (Dr. Valenstein), VA Center for Practice Management & Outcomes Research, Ann Arbor VA Hospital, Ann Arbor, MI; and the Providence VA Medical Center (Dr. Pirraglia), Providence, RI.

Correspondence to: Neil Jordan, PhD, Northwestern University, 710 N Lake Shore Dr, Suite 904, Chicago, IL 60611; e-mail: neil-jordan@northwestern.edu


The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

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

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


Chest. 2009;135(3):626-632. doi:10.1378/chest.08-0839
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Background:  Although depression among COPD patients is a common problem with important consequences for the management of COPD and overall outcomes, the proportion of those who receive guideline-concordant depression care is low. Guideline-concordant depression care is associated with fewer depressive symptoms and lower risk for psychiatric hospitalization; however, it is unknown whether guideline-concordant depression care favorably impacts COPD-related outcomes for patients with both conditions.

Methods:  This retrospective cohort study investigated 5,517 veterans with COPD who experienced a new treatment episode for depression. Guideline-concordant depression care was defined as having an adequate supply of antidepressant medication and sufficient follow-up care. Multivariate methods were used to examine the relationship between the receipt of guideline-concordant depression care and (1) COPD-related hospitalization and (2) all-cause mortality 2 years after the depression episode, while controlling for care setting and other covariates.

Results:  There was no association between the receipt of guideline-concordant depression care and COPD-related hospitalization (odds ratio [OR], 0.98) or all-cause mortality (OR, 0.95). However, patients seen in mental health settings during their depressive episode had 30% lower odds of 2-year mortality than patients seen in primary care.

Conclusions:  For patients with COPD and depression, interacting with a mental health professional may be an important intervention. However, receiving guideline-concordant depression care, as outlined in common quality monitors, was not significantly associated with decreased hospitalization or mortality. These findings suggest that more referrals to specialty care or better care coordination with mental health specialty care may lead to a significant reduction in mortality risk for these patients.


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