Examining the relationship between anxiety and depression and exacerbations of COPD which result in hospital admission: a systematic review

Abstract

Objectives: Exacerbations of chronic obstructive pulmonary disease (COPD) are the third largest cause of emergency hospital admissions in the UK. This systematic literature review explored the relationship between the hospitalization rates and the COPD comorbidities, anxiety, and depression.

Methods: The Centre for Research Dissemination's framework for systematic reviews was followed using search terms relating to COPD, anxiety, depression, and hospital admission. Papers identified were assessed for relevance and quality, using a suitable Critical Appraisal Skills Programme tool and Mixed Methods Assessment Tool.

Results: Twenty quantitative studies indicated that anxiety and depression led to a statistically significant increase in the likelihood of COPD patients being hospitalized. These comorbidities also led to an increased length of stay and a greater risk of mortality postdischarge. Other significant factors included lower Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise scores, female gender, lower socioeconomic status, poorer patient perceived quality of life, increased severity of lung function, and less improvement in dyspnea from admission to discharge. It was also highlighted that only 27%-33% of those with depression were being treated for it. Four qualitative studies revealed that patients saw anxiety and depression as a major factor that affected their ability to cope with and self-manage their condition.

Implications: Findings from the systematic review have highlighted a need for better recognition and treatment of anxiety and depression amongst individuals with COPD. Ongoing research will develop and test strategies for promoting better management and self-management as a means of reducing hospital admissions.

Keywords: COPD; anxiety; depression; exacerbations; hospital admissions.

Figure 1

Flow chart of study selection process. Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 2

Synthesis process used in the review of the literature. Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 3

Diagrammatic representation of the theoretical relationship between anxiety and depression and acute exacerbations of COPD that result in hospital admissions or readmission. Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 4

Idea webbing of factors involved in the relationship of anxiety and depression and the acute exacerbation of COPD. Abbreviation: COPD, chronic obstructive pulmonary disease.