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. 2025 May 27;11(3):00348-2024.
doi: 10.1183/23120541.00348-2024. eCollection 2025 May.

Anxiety, depression, physical disease parameters and health-related quality of life in the BronchUK national bronchiectasis cohort

Anthony De Soyza  1 , Tess Saunders  2 , Georgina Wild  1 , Phil Mawson  1 , Martin Kelly  3 , Stuart Elborn  4 , Adam T Hill  5 , Tim Gatheral  6 , Anita Sullivan  7 , Charles Haworth  8 , John R Hurst  9 , Jeremy Brown  9 , Mary Carroll  10 , Vidya Navaratnam  11 , Michael Loebinger  12 , Gareth Davies  13 , Henil Upadhyay  13 , Judy Bradley  4 , Paul P Walker  14 , John Steer  15 , Jamie Duckers  16 , Jennifer Pollock  17 , Megan Crichton  17 , James D Chalmers  17 , Richard McNally  1
Affiliations

Anxiety, depression, physical disease parameters and health-related quality of life in the BronchUK national bronchiectasis cohort

Anthony De Soyza et al. ERJ Open Res. .

Abstract

Background: Bronchiectasis is associated with psychological comorbidity and poor quality of life (QoL), yet guidelines lack focus on psychological morbidity. Using data obtained from the BronchUK database (1341 patients), we examined the link between anxiety/depression and physical disease severity, QoL and long-term outcomes in bronchiectasis.

Methods: Computed tomography-confirmed bronchiectasis patients enrolled in the BronchUK study with Hospital Anxiety and Depression Scale (HADS-A/D) data were studied. HADS-A/D scores ≥8 indicated anxiety/depression. QoL was measured by the St George's Respiratory Questionnaire and QoL-Bronchiectasis Questionnaire. Exacerbations during annual follow-up were analysed by negative binomial regression with time in study as an offset adjusted for age, body mass index, sex, Pseudomonas infection, diabetes and forced expiratory volume in 1 s (FEV1). Cox regression determined probability of hospitalisation using time to first exacerbation.

Results: 1341 patients were included; 418 had anxiety (31%), 269 (20%) had depression and 201 (15%) had both conditions. HADS-A/D ≥8 was associated with worse QoL (p<0.0001) and clinical severity (e.g. Bronchiectasis Severity Index, FEV1 and Medical Research Council dyspnoea score (all p<0.01). HADS-A/D ≥8 each was associated with exacerbation (rate ratio (RR) 1.42, 95% CI 1.32-1.52 for HADS-A; RR 1.45, 95% CI 1.34-1.56 for HADS-D, both p<0.0001) and hospitalisation risk (RR 1.58, 95% CI 1.29-1.92 for HADS-A; RR 1.76, 95% CI 1.43-2.17 for HADS-D, both p<0.001). HADS-A/D ≥8 each predicted future hospitalisation (HR 1.30, 95% CI 0.98-1.72, p=0.067 for HADS-A; HR 1.40 95% CI 1.04-1.88, p=0.027 for HADS-D).

Interpretation: Anxiety and depression are common in bronchiectasis, correlate with disease severity and predict poor outcomes. Consideration of psychological comorbidities should be evaluated in routine bronchiectasis care.

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Conflict of interest statement

Conflict of interest: T. Saunders, J. Brown, A. Sullivan, M. Carroll, P. Mawson, T. Gatheral, A.T. Hill, G. Davies, J. Pollock, M. Kelly, R. McNally, G. Wild, V. Navarantnam and H. Upadhyay declare no conflict of interest in relation to this manuscript. Conflict of interest: A. De Soyza reports receiving funds from AstraZeneca, Byers, Forest, Gilead, Insmed, GSK and Novartis outside of work for this manuscript. Conflict of interest: S. Elborn reports research grants from iABC outside of work for this manuscript. Conflict of interest: C. Haworth reports consulting fees from 30 Technology, Aradigm, CSL Behring, Chiesi, Gilead, Grifols, GSK, Insmed, Janssen, LifeArc, Meiji, Mylan, Novartis, Pneumagen, Shionogi, Teva, Vertex and Zambon; payment from Chiesi, Grifols, GSK, Insmed, Mylan, Novartis, Teva, Vertex and Zambon; and support for attending meetings and/or travel from Zambon outside of work for this manuscript. Conflict of interest: J.R. Hurst reports consulting fees from AstraZeneca and GSK; payments from Boehringer Ingelheim, Chiesi, Sanofi and Takeda; support for attending meetings and travel from AstraZeneca; participation on an advisory board AstraZeneca; and receipt of equipment from Nonin outside of work for this manuscript. Conflict of interest: M. Loebinger reports consulting fees from Armata, 30T, AstraZeneca, Insmed, Cheisi, Zambon, Electromed, Recode, Boehringer Ingelheim, Ethris, Mannkind and AN2 Therapeutics; and received payment or honoraria for lectures or presentations from Insmed outside of work for this manuscript. Conflict of interest: J. Bradley reports research grants from Health and Social Care (Northern Ireland), iABC, NIHR and DfE; and receipt of equipment from PARI outside of work for this manuscript. Conflict of interest: P.P. Walker reports unpaid work as Chair of the Board, British Thoracic Society, outside of work for this manuscript. Conflict of interest: J. Steer reports research grants from Chiesi and Menarini Pharmaceutica; and speaker fees and conference and travel fees from AstraZeneca outside of work for this manuscript. Conflict of interest: J. Duckers reports consulting fees from Insmed; payment received from Vertex, Chiesi and Insmed; participation on a data safety monitoring board for NOMAB study; Chair of British Thoracic Society CF Specialist advisory Group, CF Trust Registry Steering group and South-East Wales Research Ethics Committee; and receipt of medical writing from IQVIA outside of work for this manuscript. Conflict of interest: M. Crichton declares consulting fees received from Boxer Capital LLC. Conflict of interest: J.D. Chalmers reports research grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Gilead Sciences, Novartis and Insmed; and received consultancy or speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Insmed, Janssen, Novartis and Zambon outside of work for this manuscript; and is an associate editor of this journal.

Figures

FIGURE 1
FIGURE 1
Results of Mann–Whitney U-tests comparing HADS-A groups (<8 or ≥8) with a) HADS-A scores, b) BSI, c) SGRQ scores, d) FEV1 % predicted and e) QoL-B questionnaire scores. Blue represents those with HADS-D scores <8 (n=923) and red represents those with HADS-D scores ≥8 (n=418). HADS-A: Hospital Anxiety and Depression Scale – Anxiety Score; HADS-D: Hospital Anxiety and Depression Scale – Depression Score; BSI: Bronchiectasis Severity Index; FEV1: forced expiratory volume in 1 s; SGRQ: St George's Respiratory Questionnaire; QoL-B: Quality of Life in Bronchiectasis. **: p<0.01; ****: p<0.0001.
FIGURE 2
FIGURE 2
Results of Mann–Whitney U-tests comparing HADS-D groups (<8 or ≥8) with a) HADS-A scores, b) BSI, c) SGRQ scores, d) FEV1 % predicted and e) QoL-B questionnaire scores. Blue represents those with HADS-D scores <8 (n=1072). Red represents those with HADS-D scores ≥8 (n=269). HADS-A: Hospital Anxiety and Depression Scale – Anxiety Score; HADS-D: Hospital Anxiety and Depression Scale – Depression Score; BSI: Bronchiectasis Severity Index; FEV1: forced expiratory volume in 1 s; SGRQ: St George's Respiratory Questionnaire; QoL-B: Quality of Life in Bronchiectasis. ***: p<0.001; ****: p<0.0001.
FIGURE 3
FIGURE 3
a) Long-term outcomes of those with elevated HADS-A scores (≥8) and b) elevated HADS-D scores (≥8). Data are shown as incident rate ratio (RR) with 95% confidence intervals (CIs). Reference line (x=1.0) represents those individuals with HADS-D/A scores <8. A represents adjusted analysis and U represents unadjusted analysis. Data shown for frequency of exacerbation and frequency of hospitalisation have undergone adjustment for age, sex, body mass index category, diabetes, Pseudomonas aeruginosa status and bronchiectasis disease severity in the form of forced expiratory volume in 1 s Global Initiative for Chronic Obstructive Lung Disease group classification. HADS-A/D: Hospital Anxiety and Depression Scale – Anxiety/Depression Score. ***: p<0.001; ****: p<0.0001.
FIGURE 4
FIGURE 4
a) Time to first severe exacerbation requiring hospitalisation of those with elevated HADS-A scores (≥8) and b) elevated HADS-D scores (≥8), c, d) including percentage of patients hospitalised at each follow-up time point. Data are shown as hazard ratio (HR) with 95% confidence intervals (CIs). Reference line (x=1.0) represents those individuals with HADS-D/A scores <8. U represents unadjusted analysis, and A represents analysis that has undergone adjustment for age, sex, BMI category, diabetes, Pseudomonas aeruginosa status and bronchiectasis disease severity in the form of forced expiratory volume in 1 s (FEV1) % predicted classification. HADS-A/D: Hospital Anxiety and Depression Scale–Anxiety/Depression Score. *: p<0.05; **: p<0.01; ***: p<0.001.
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References

    1. Barker AF. Bronchiectasis. N Engl J Med 2002; 346: 1383–1393. doi:10.1056/NEJMra012519 - DOI - PubMed
    1. Quint JK, Millett ER, Joshi M, et al. . Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. Eur Respir J 2016; 47: 186–193. doi:10.1183/13993003.01033-2015 - DOI - PMC - PubMed
    1. Finklea JD, Khan G, Thomas S, et al. . Predictors of mortality in hospitalized patients with acute exacerbation of bronchiectasis. Respir Med 2010; 104: 816–821. doi:10.1016/j.rmed.2009.11.021 - DOI - PubMed
    1. Chalmers JD, Aliberti S, Blasi F. Management of bronchiectasis in adults. Eur Respir J 2015; 45: 1446–1462. doi:10.1183/09031936.00119114 - DOI - PubMed
    1. McDonnell MJ, Aliberti S, Goeminne PC, et al. . Multimensional severity assessment in bronchiectasis: an analysis of seven European cohorts. Thorax 2016; 71: 1110–1118. doi:10.1136/thoraxjnl-2016-208481 - DOI - PMC - PubMed

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