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Anxiety, Depression Common, Yet Often Overlooked in People With COPD


A risk prediction model may offer insight in evaluating depression and anxiety in patients with chronic obstructive pulmonary disease (COPD).

Chronic obstructive pulmonary disease (COPD) is predicted to be the third leading cause of death globally by 2030.

This study, published in Annals of Medicine, used a prediction model to screen for anxiety and depression in patients with COPD in order to better predict a patient’s psychological state.

“In addition, data collected in clinical practice are rarely used for prognosis prediction of anxiety and depression in COPD patients. Furthermore, studies on prediction models for anxiety and depression in patients with COPD are limited. In view of this, a risk prediction model for anxiety and depression in COPD patients was developed and validated,” wrote the authors of this study.

Anxiety and depression are common diagnoses in people with COPD, which researchers have associated with higher morbidity and mortality, increased exacerbations, functional limitations, and longer hospital stays. An estimated 16% to 31% of people with COPD also suffer with anxiety, states another study.

However, anxiety and depression in patients with COPD often go undiagnosed or untreated, according to the researchers. Screening for depression and anxiety as well as implementing preventive measures may help lower the high morbidity and mortality rates associated with depression and anxiety in people living with COPD.

A total of 375 patients with COPD were enrolled in this study between 2018 and 2020. Sixty-seven of those patients did not have anxiety or depression and 308 had anxiety or depression.

The prediction model accounted for 13 variables: gender, age, marital status, education level, long-term residence, per capital annual household income, payment method of medical expense, direct economic costs of treating COPD in the past year, smoking, COPD progression, number of acute exacerbations of COPD in the last year, regular treatment with inhalants, and family oxygen therapy. These indicators “may serve as an instrument for clinical decision-making for COPD patients who may have anxiety or depression,” stated the authors.

According to findings based on the prediction model, evidence suggests men and adults 80 years or older were more likely to experience anxiety and depression. It was also reported that marital status, education level, and long-term residence may be potential predictive clinical indicators for depression and anxiety in patients with COPD.

Additionally, patients living in low-income households were found more likely to suffer from anxiety and depression. Lastly, the researchers found supporting evidence that there is an association between depression and anxiety in patients with COPD, and smoking.

“Screening COPD patients for concomitant psychological distress is important as it is found to contribute to poorer health outcomes across a number of domains, including general greater economic burden,” found a study published in Respiratory Care. Additionally, “anxiety and depression interact with smoking produces stronger combined effects on mortality risk in patients with COPD,” stated another study.

There were several limitations to this study, which include the following:

  • The prediction model needs to be evaluated in large and independent populations
  • The prediction model needs to be evaluated in independent populations from geographically different areas
  • The researchers acknowledge that more pertinent medical information probably contributes to anxiety and depression
  • Specific age groups and specific areas of study may be more meaningful in the prediction model, further research may identify these areas

Despite the mentioned limitations, “the model’s prediction capability is satisfactory in terms of screening anxiety or depression individuals from COPD patients. The prediction model may be used as a tool to help clinical doctors identify anxiety or depression patients and take a modulated approach to disease treatment,” concluded the researchers.


Tang T, Li Z, Lu X, Du J. Development and validation of a risk prediction model for anxiety or depression among patients with chronic obstructive pulmonary disease between 2018 and 2020. Ann Med. 2022;54(1):2181-2190. doi:10.1080/07853890.2022.2105394

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