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Original Research: COPD |

Long-term Course of Depression Trajectories in Patients With COPD: A 3-Year Follow-up Analysis of the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints Cohort

Abebaw M. Yohannes, PhD, FCCP; Hana Müllerová, PhD; Nicola A. Hanania, MD, FCCP; Kim Lavoie, PhD; Ruth Tal-Singer, PhD; Jorgen Vestbo, MD; Steven I. Rennard, MD; Emil F.M. Wouters, MD
Author and Funding Information

FUNDING/SUPPORT: This study was funded by GlaxoSmithKline [study code SCO104960; grant NCT00292552].

CORRESPONDENCE TO: Abebaw Mengistu Yohannes, PhD, FCCP, 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(4):916-926. doi:10.1016/j.chest.2015.10.081
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Background  There is insufficient evidence about the long-term course of depressive symptom trajectories and their impact among patients with COPD.

Methods  We analysed 3-year data obtained from patients with COPD participating in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints study. Patients were split into four groups on the basis of Center for Epidemiologic Studies Depression Scale score (< 16 vs ≥ 16) and antidepressant use (yes vs no) at baseline and at 3 years: never depressed, new onset, remittent, and persistent depression. Baseline characteristics were used to assess factors associated with the group by using logistic regression.

Results  A total of 1,589 patients with COPD completed the 3-year follow-up. Of these, 55% (n = 869) were classified as never depressed, 24% (n = 377) were classified as persistently depressed, 14% (n = 226) developed new onset of depression, and 7% (n = 117) had depression that remitted. Female sex and history of stroke were associated with substantial increases in the odds of persistent depression (OR, 2.95; 95% CI, 2.05-4.24 and OR, 3.09; 95% CI, 1.43-6.67, respectively). Odds of new onset depression increased with worse health status (OR, 1.10; 95% CI, 1.04-1.17 per 4-point increase in St. George’s Respiratory Questionnaire score) and moderate to severe dyspnea (OR, 1.57; 95% CI, 1.07-2.31 for modified Medical Research Council score ≥ 2 vs 0 or 1). During follow-up, patients with persistent or new-onset depression experienced more exacerbations and more pronounced loss in performance as assessed by reduction in the 6-min walk distance (6MWD) test score.

Conclusions  About one in four patients with COPD had persistent depressive symptoms over 3 years. Clinicians should be aware of the characteristics of persistent and new onset depressive symptoms, which are associated with risk of exacerbations and loss of performance on the 6MWD test. Interventions that ameliorate the course of depression are needed.

Trial Registry  ClinicalTrials.gov; No.: NCT00292552; URL: www.clinicaltrials.gov.


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