Obstructive Lung Diseases: COPD Comorbidities |

Association of Depression and COPD in Indian Patients FREE TO VIEW

Chandramani Panjabi, MD; Arvind Kumar, MBBS; V.S. Isser, MD; G.S. Kochhar, MD
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Mata Chanan Devi Hospital, New Delhi, India

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

Chest. 2016;150(4_S):897A. doi:10.1016/j.chest.2016.08.997
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 24, 2016 at 04:30 PM - 05:30 PM

PURPOSE: To establish the association between depression and severity of airways obstruction in patients with COPD

METHODS: 230 patients with stable COPD, diagnosed as per GOLD guidelines on the basis of clinical presentation and spirometry, were recruited. The COPD Assessment Test (CAT) and the Personal Health Questionnaire Depression Scale (PHQ-9) were administered to these patients. The results of both the questionnaires were analysed, compared and correlated with spirometry findings.

RESULTS: A majority of the patients (181 out of 230, 78.7%) were in the 50-80 years age group, and only 29 (12.6%) patients were below the age of 50 years. Approximately two-thirds were males. when classified according to the GOLD stage severity of COPD, 16 (7%) had mild (stage I) disease, 74 (32.2%) had moderate (stage II) COPD, 90 (39.1%) had severe (stage III) disease and 50 (21.7%) were diadgnosed with very severe (stage IV) COPD. There was a statistically significant negative correlation between the cumulative CAT score and post bronchodilator FEV1 (r=-0.973, P<0.001). Distribution of the study subjects according to severity of depression, as calculated by the PHQ-9 scores, revealed that mild depression (PHQ-9 score = 5-9) was the commonest, seen in 74 (32.2%) of patients; while almost a fifth (45, 19.6%) did not have any (PHQ-9 score = 1-4) depression. Moderate (PHQ-9 score = 10-14) depression was found in 30 (13%), moderately severe (PHQ-9 score = 15-19) depression in 43 (18.7%) and severe (PHQ-9 score = 20-27) depression in 38 (16.5%) of our COPD patients. A positive correlation between the CAT score and the PHQ-9 score (r=0.699, P<0.001) was observed. As the post bronchodilator FEV1 and CAT scores worsened, there was a statistically significant increase in the severity of depression. A CAT score of 24 or higher was more commonly associated with moderately severe as well as severe depression. When an item analysis of the CAT questionnaire was performed, it was seen that all patients who had ascribed the maximum score of 5 to any of the last two items viz. “I sleep soundly” and “I have lots of energy” had ‘severe’ depression. This was irrespective of the severity classification of COPD as deduced by the GOLD criteria. Out of the 45 patients with ‘none’ depression, 10 had ‘severe’ COPD and one had ‘very severe’ COPD. All these 11 patients scored either 0 or 1 on the last two afore-mentioned items of the CAT questionnaire. 108 (47%) of our COPD patients were currently working while the remaining 122 (53%) were not presently working. Most of the working subjects had either mild depression or no depression at all. This again did not depend on the severity of COPD. On the contrary, moderately severe and severe depression was very common among the non working subjects.

CONCLUSIONS: There is a positive correlation between CAT and PHQ-9 scores in stable COPD patients. Both these questionnaires are useful tools to assess the impact of COPD on patients' health status.

CLINICAL IMPLICATIONS: CAT scores can point towards the possible presence of depression in stable COPD. In order to decrease the burden of disability in the community, such patients can be evaluated using the disease-specific PHQ-9 questionnaire so as to initiate early treatment for depression also.

DISCLOSURE: The following authors have nothing to disclose: Chandramani Panjabi, Arvind Kumar, V.S. Isser, G.S. Kochhar

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