Older Adults With COPD in Good Mental Health

Despite chronic obstructive pulmonary disease (COPD) being associated with poor mental health and depression, most older adults report being free of mental illness or substance abuse, a new study has found.

Of 703 individuals, more than 4 of 5 older adults with chronic obstructive pulmonary disease (COPD) were free of mental illness or any substance abuse (87%) and two-thirds (67%) were in excellent mental health, according to the findings of a recent representative-based study published in International Journal of Environmental Research and Public Health.

COPD is a leading cause of mortality and has been linked with mental health issues such as depression, anxiety, and substance abuse disorders. However, the characteristics and contributing factors among individuals who have COPD who are in complete mental health (CMH) has not been established. The authors of this new study estimated the prevalence or absence of mental illnesses among patients with COPD and aimed to identify factors and characteristics that significantly contribute to the absence of psychiatric disorders (APD) and CMH among older adults with COPD.

“This research provides a very hopeful message for individuals struggling with COPD, as well as for their families and health professionals,” said co-author Sally Abudiab, a recent graduate of the University of Toronto’s Factor-Inwentash Faculty of Social Work, in a statement. “Our findings suggest the vast majority of individuals with COPD are embracing their lives and thriving. They are in exceptionally good mental health despite the physical, mental, and economic challenges of coping with COPD.”

The data for this study came from the nationally representative 2012 Canadian Community Health Survey – Mental Health (CCHS-MH), which included 10,892 individuals 50 years or older with diagnosed COPD. Predictor variables such as demographics, socioeconomic status, social support, physical health, coping strategies, adverse childhood experiences, and lifetime mental health history were considered.

The researchers examined multiple factors associated with flourishing mental health:

  • Almost daily happiness or life satisfaction in the past month
  • High levels of social and psychological well-being in the past month
  • Freedom from generalized anxiety disorder and depressive disorders, suicidal thoughts, and substance dependence for at least the preceding full year

As a result, the unadjusted odds of APD without COPD were approximately 2 times higher compared with those with COPD (odds ratio [OR], 2.90; 95% CI = 2.23; 3.78). The unadjusted odds of CMH for those without COPD was 67% higher compared with those with COPD (OR, 1.67; 95% CI, 1.39-2.01).

Additionally, individuals with COPD who were socially isolated were found to be at higher risk of having poor mental health compared with those who had at least 1 person with whom they could talk to about important decision making.

The researchers believe that interventions that promote social support are needed to decrease social isolation and loneliness, and they stress the importance of establishing targeted and accessible mental health support for individuals with COPD who are most vulnerable to worse mental health outcomes.

The findings of this study had limitations, including its self-reported nature and its cross-sectional study design, which made it unclear if a COPD diagnosis preceded APD and CMH.

Despite these limitations, the researchers found the results of this study encouraging. And for those individuals with COPD who also have mental illness, the researchers emphasized the need for targeted interventions and further investigations of racial barriers that may contribute to an individual’s mental health.

“Our findings underline the importance of targeted outreach and referrals for those with COPD who are not flourishing,” said the study’s senior author, Esme Fuller-Thomson, PhD, University of California, Berkely, in the statement discussing the findings.


Abudiab S, Fuller-Thomson E. Flourishing despite chronic obstructive pulmonary disease (COPD): findings from a nationally representative survey of Canadians aged 50 and older. Int J Environ Res Public Health. 2022;19(23):16337. doi:10.3390/ijerph192316337

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