Depression is a significant co morbidity of COPD patients and is associated with poor compliance to treatment, frequent hospitalization, prolong hospital stay, poor quality of life and increased cost of treatment. The prevalence of depression in stable COPD is widely variable. Patient Health Questionnaire (PHQ)-9 questionnaires is a standardized, validated, brief and easy diagnostic assessment tool for the depression. Hindi (local language) translation of PHQ-9 is well validated. No studies have been conducted to assess the prevalence of depression in different stages of COPD especially in India.
We investigated the prevalence of depression in eighty consecutive stable COPD patients during their routine outpatient department visit from October 2008 to December 2008. Those who were suffering from depression or other concomitant chronic systemic diseases were excluded. The spirometric measurements were performed as per American Thoracic Society guideline and severity of the disease was classified according to Global Initiative for Chronic Obstructive Lung Disease guideline. Hindi translation of PHQ-9 questionnaires was self administered. Severities of depression were classified according to the total PHQ-9 score.
All subjects were male and mean age was 60.8 ± 9.9 years. Four patients were in stage I, twenty five patients in stage II, thirty three patients in stage III and eighteen patients in stage IV. The mean ± SD score for the entire population was 14.66 ± 4.5 and in Stage I, Stage II, stage III and stage IV were 12 ± 3.7,12.88 ± 4.93,15.36 ± 3.58 and 16.44 ± 4.75 respectively (p = < 0.027). Sixteen out of the 80 patients (20%) had depression scores > 20, which indicates severe depression.
Depressive symptoms were observed in all stages of COPD and severity increases with severity of the COPD. High prevalence of depressive symptoms in Indian COPD patient may be due to other confounding factors i.e. low education, poverty etc.
Further evaluation involving large number of COPD patient is warranted. COPD patients should be screened for symptoms of depression by simple, quick and validated questionnaires during their routine visit and it may be helpful for appropriate treatment or referral.
Sajal De, No Financial Disclosure Information; No Product/Research Disclosure Information