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Original Research: COPD |

Predictors of All-Cause Mortality in Patients With Severe COPD and Major Depression Admitted to a Rehabilitation Hospital

Abebaw Mengistu Yohannes, PhD; Patrick J. Raue, PhD; Dora Kanellopoulos, PhD; Amanda McGovern, PhD; Jo Anne Sirey, PhD; Dimitris N. Kiosses, PhD; Samprit Banerjee, PhD; Joanna K. Seirup, BA; Richard S. Novitch, MD; George S. Alexopoulos, MD
Author and Funding Information

FUNDING/SUPPORT: This work was supported by the National Institute of Mental Health [Grants R01 HLB071992, R01 MH075897, P30 MH085943, T32 MH019132] and the Sanchez Foundation (G. S. A.).

CORRESPONDENCE TO: Abebaw Mengistu Yohannes, PhD, Department of Health Professions, Manchester Metropolitan University, Birley Campus, 53 Bonsall St, Manchester, M15 6GX, England


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(2):467-473. doi:10.1378/chest.15-0529
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Background  COPD is a major cause of all-cause mortality. We examined predictors of 1-year mortality in patients with severe COPD and major depression after inpatient treatment in a rehabilitation hospital.

Methods  We screened 898 consecutively admitted patients. Of these, 138 patients received the diagnoses of COPD according to American Thoracic Society Guidelines and major depression by Diagnostic and Statistical Manual of Mental Disorders, 4th edition and signed consent; 67 were randomized to a treatment adherence enhancement intervention and 71 to usual care. We assessed history of falls, dyspnea-related disability, severity of depression, medical burden, and cognitive functioning. Following discharge from inpatient rehabilitation, participants were prospectively followed, and mortality was ascertained over 52 weeks from hospital notes and reports of primary care physicians and relatives.

Results  One-year, all-cause mortality was 22% (31 of 138). Multivariate Cox regression analysis showed that history of falls in the 6 months preceding hospital admission was the strongest predictor of mortality (OR, 3.05; 95% CI, 1.40-6.66; P < .005). Dyspnea during activities (Pulmonary Functional Status and Dyspnea Questionnaire-Modified domain) was also associated with mortality (OR, 1.05; 95% CI, 1.02-1.08; P < .002). Depression severity, medical burden, and cognitive impairment were not predictors of mortality.

Conclusions  Recent falls and dyspnea during activities identify subgroups of depressed patients with COPD at increased risk for all-cause mortality. These subgroups are in need of clinical attention and follow-up and can serve as targets for prevention research aiming to inform clinical strategies and public health planning.

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