Comparative Impact of Depressive Symptoms and FEV1% on Chronic Obstructive Pulmonary Disease

Abstract

Rationale: Individuals with chronic obstructive pulmonary disease (COPD) have a high prevalence of depression, which is associated with increased COPD hospitalizations and readmissions. Objectives: Examine the impact of depressive symptoms compared with FEV₁% on COPD morbidity. Methods: Using longitudinal data from individuals with COPD in the Subpopulations and Intermediate Outcome Measures in COPD Study, longitudinal growth analysis was performed to assess COPD morbidity by assessing differences in baseline 6-minute walk distance and patient reported outcomes (PROs) and their rate of change over time explained by depressive symptoms or lung function, as measured by Hospital Anxiety and Depression Scale or FEV₁% respectively. PROs consisted of in-person completion of St. George's Respiratory Questionnaire, COPD Assessment Test, Functional Assessment of Chronic Illness Therapy Fatigue, and Modified Medical Research Council Dyspnea Scale measures. Results: Of the individuals analyzed (n = 1,830), 43% were female, 81% Caucasian with mean ± SD age of 65.1 ± 8.1, and 52.7 ± 27.5 pack-years smoking. Mean ± SD FEV₁% was 60.9 ± 23.0% and 20% had clinically significant depressive symptoms. Adjusted models showed higher Hospital Anxiety and Depression Scale scores and lower FEV₁% each were associated with worse PROs at baseline (P ⩽ 0.001). Depression accounted for more baseline variance in St. George's Respiratory Questionnaire, COPD Assessment Test, and Functional Assessment of Chronic Illness Therapy Fatigue than FEV₁%, explaining 30-67% of heterogeneity. FEV₁% accounted for more baseline variance in Modified Medical Research Council Dyspnea Scale and 6-minute walk distance than depression, explaining 16-32% of heterogeneity. Depressive symptoms accounted for 3-17% variance in change over time in PROs. In contrast, FEV₁% accounted for 1-4% variance over time in PROs. Conclusions: Depression is more strongly associated with many PROs at baseline and their change over time compared with FEV₁%. Recognizing and incorporating the impact of depressive symptoms into individualized care may improve COPD outcomes.

Keywords: COPD; depression; patient reported outcome measures.

Figure 1.

Proportion of variance accounted for in baseline morbidity by depressive symptoms compared with FEV₁% predicted. 6MWD = 6-minute walk distance (meters); CAT = Chronic Obstructive Pulmonary Disease Assessment Test; FACIT-F = Functional Assessment of Chronic Illness Therapy Fatigue; FEV₁ = forced expiratory volume in 1 second; mMRC = modified Medical Research Council Dyspnea Scale; SGRQ = St. George's Respiratory Questionnaire.

Figure 2.

Proportion of variance accounted for in change in morbidity over time by average depressive symptoms compared with FEV₁% predicted. 6MWD = 6-minute walk distance (meters); CAT = Chronic Obstructive Pulmonary Disease Assessment Test; FACIT-F = Functional Assessment of Chronic Illness Therapy Fatigue; FEV₁ = forced expiratory volume in 1 second; mMRC = modified Medical Research Council Dyspnea Scale; SGRQ = St. George's Respiratory Questionnaire.