. 2019 Mar:118:18-26.

doi: 10.1016/j.jpsychores.2019.01.002. Epub 2019 Jan 7.

Symptoms of anxiety and depression and use of anxiolytic-hypnotics and antidepressants in current and former smokers with and without COPD - A cross sectional analysis of the COPDGene cohort

Anand S Iyer¹, Kristen E Holm², Surya P Bhatt³, Victor Kim⁴, Gregory L Kinney⁵, Frederick S Wamboldt⁶, Michael R Jacobs⁴, Elizabeth A Regan⁷, Hilary F Armstrong⁸, Katherine E Lowe⁵, Carlos H Martinez⁹, Mark T Dransfield¹⁰, Marilyn G Foreman¹¹, Gen Shinozaki¹², Nicola A Hanania¹³, Robert A Wise¹⁴, Barry J Make¹⁵, Karin F Hoth¹⁶; COPDGene Investigators

Affiliations

¹ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Health Services, Outcomes, and Effectiveness Research Training Program, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: aiyer@uabmc.edu.
² Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA.
³ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Department of Thoracic Medicine and Surgery, Temple University School of Medicine Philadelphia, PA, USA.
⁵ Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA.
⁶ Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA.
⁷ Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA.
⁸ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
⁹ Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.
¹⁰ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veterans Affairs Medical Center, Birmingham, AL, USA.
¹¹ Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, USA.
¹² Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
¹³ Division of Pulmonary/Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA.
¹⁴ Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
¹⁵ Department of Medicine, National Jewish Health, Denver, CO, USA.
¹⁶ Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Department of Pulmonary, Critical Care, and Sleep Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. Electronic address: karin-hoth@uiowa.edu.

PMID: 30782350
PMCID: PMC6383809
DOI: 10.1016/j.jpsychores.2019.01.002

Symptoms of anxiety and depression and use of anxiolytic-hypnotics and antidepressants in current and former smokers with and without COPD - A cross sectional analysis of the COPDGene cohort

Anand S Iyer et al. J Psychosom Res. 2019 Mar.

. 2019 Mar:118:18-26.

doi: 10.1016/j.jpsychores.2019.01.002. Epub 2019 Jan 7.

Authors

Affiliations

¹ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Health Services, Outcomes, and Effectiveness Research Training Program, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: aiyer@uabmc.edu.
² Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA.
³ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Department of Thoracic Medicine and Surgery, Temple University School of Medicine Philadelphia, PA, USA.
⁵ Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA.
⁶ Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA.
⁷ Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA.
⁸ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
⁹ Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.
¹⁰ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veterans Affairs Medical Center, Birmingham, AL, USA.
¹¹ Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, USA.
¹² Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
¹³ Division of Pulmonary/Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA.
¹⁴ Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
¹⁵ Department of Medicine, National Jewish Health, Denver, CO, USA.
¹⁶ Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Department of Pulmonary, Critical Care, and Sleep Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. Electronic address: karin-hoth@uiowa.edu.

PMID: 30782350
PMCID: PMC6383809
DOI: 10.1016/j.jpsychores.2019.01.002

Abstract

Objectives: To compare the frequency of anxiety/depressive symptoms and use of anxiolytic-hypnotics/antidepressants in smokers with and without COPD and to identify characteristics associated with having unmedicated symptoms.

Methods: Cross-sectional analysis of ambulatory, current/former smokers ≥10 pack years enrolled in the COPDGene study. We measured anxiety/depressive symptoms using the Hospital Anxiety and Depression Scale (subscales ≥8), recorded anxiolytic-hypnotic/antidepressant use, and defined unmedicated symptoms as elevated anxiety/depressive symptoms and not on medications. Regression analysis identified characteristics associated with having unmedicated symptoms.

Key results: Of 5331 current/former smokers (45% with and 55% without COPD), 1332 (25.0%) had anxiety/depressive symptoms. Anxiety symptoms were similar in frequency in smokers with and without COPD (19.7% overall), while depressive symptoms were most frequent in severe-very severe COPD at 20.7% (13.1% overall). In the entire cohort, 1135 (21.2%) were on medications. Anxiolytic-hypnotic use was highest in severe-very severe COPD (range 7.6%-12.0%), while antidepressant use showed no significant variation in smokers with and without COPD (range 14.7%-17.1%). Overall, 881 (66% of those with symptoms) had unmedicated symptoms, which was associated with African American race (adjusted OR 2.95, 95% CI 2.25-3.87), male gender (adjusted OR 1.93, 95% CI 1.57-2.36), no health insurance (adjusted OR 2.38, 95% CI 1.30-4.35), severe-very severe COPD (adjusted OR 1.48, 95% CI 1.04-2.11), and higher respiratory symptoms/exacerbation history (adjusted OR 2.21, 95% CI 1.62-3.02).

Conclusions: Significant unmet mental health care needs exist in current and former smokers with and without COPD. One in five have unmedicated symptoms, identified by key demographic and clinical characteristics.

Primary funding source: National Institutes of Health and The COPD Foundation.

Keywords: Access to care; Antianxiety agents; Antidepressive agents; Anxiety; Chronic obstructive pulmonary disease; Clinical epidemiology; Depression; Mental health; Population health; Pulmonary diseases; Smoking.

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Figures

**Figure 1.. Subjects Screened and Enrolled from the COPDGene Study.**

**Figure 2.. Symptoms of Anxiety and Depression and Use of Anxiolytic-Hypnotics and Antidepressants by GOLD Stage.**
Anxiety symptoms, depressive symptoms, anxiolytic-hypnotic use, antidepressant use, and unmedicated symptoms across GOLD severity stages using ANOVA followed by post-hoc group-by-group comparisons. *p<0.05; ^†p<0.001

**Figure 3.. Characteristics Associated with Unmedicated Anxiety or Depressive Symptoms.**
Mixed effects logistic regression model with unmedicated symptoms as the dependent variable compared to being on medications, study center as the random effect, and clinically important variables included in the full model. See Appendix 2 for full model. *Reference GOLD 0. ^†Reference GOLD Group A.

See this image and copyright information in PMC

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Symptoms of anxiety and depression and use of anxiolytic-hypnotics and antidepressants in current and former smokers with and without COPD - A cross sectional analysis of the COPDGene cohort

Affiliations

Symptoms of anxiety and depression and use of anxiolytic-hypnotics and antidepressants in current and former smokers with and without COPD - A cross sectional analysis of the COPDGene cohort

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical