Patients With COPD Developed Depression During Early Pandemic Stages, Study Says

All patients with chronic obstructive pulmonary disease (COPD), whether they have a history of depression or not, require screening and interventions to potentially mitigate the mental health effects of the COVID-19 pandemic, according to a study published in International Journal of Chronic Obstructive Pulmonary Disease.

Research has found that older adults with COPD have a higher risk of depression than those without COPD. A recent study showed that exercise in patients with COPD helps improve physical and depression symptoms, emphasizing “the importance of exercise-based interventions to support the mental well-being of individuals with COPD.”

The researchers explained that the COVID-19 pandemic lockdown prevented people from adequately exercising daily. They hypothesized that this lack of physical activity contributed to the worsening physical and mental health among older adults with COPD, as they are more likely to experience severe symptoms and mortality from COVID-19.

To address the unknown mental effects of COVID-19, the researchers conducted a study to identify in those without a history of depression the prevalence of, and factors associated with, first-onset depression during the pandemic. They also analyzed the prevalence and factors associated with the recurrence and/or continuation of depression during the pandemic in patients with COPD with a history of depression.

The study population was created using the Canadian Longitudinal Study on Aging (CLSA), “a large national study that recruited Canadian older adults aged 45 to 85 years.” The researchers noted their analysis was limited to CLSA respondents with COPD during the baseline (conducted between 2011-2015) or follow-up 1 (conducted 2015-2018) waves; the population consisted of 875 respondents. Data were also analyzed for relevant respondents from the COVID-19 spring 2020 wave (conducted April 15-May 30, 2020) and the COVID-19 autumn 2020 wave (conducted September 29-December 29, 2020).

The researchers diagnosed COPD in respondents through their answers to the question, “Has a doctor told you that you have/had any of the following: emphysema, chronic bronchitis, COPD, or chronic changes in lungs due to smoking?” Those who answered with 1 were given a COPD diagnosis, while those who answered with 0 were not.

Also, they measured first-onset depression during the pandemic with the Center for Epidemiologic Studies Short Scale of Depression (CES-D-10) as part of the autumn 2020 questionnaire. CES-D-10 used 10 items to measure depressive symptoms experienced in the last 7 days, with the total score ranging from 0 to 30. Those with a score of 10 or more receivbe ed a depression diagnosis, with higher scores indicating higher severity.

The researchers identified lifelong depression through 4 measures, one being CES-D-10 scores from the baseline and follow-up 1 waves where participants were asked, “Did your doctor ever tell you that you had clinical depression?” Those with scores below 10 and who answered "No" to the question in both waves were classified as not having prepandemic depression. However, if at least 1 of 4 outcomes indicated depression at baseline or follow-up 1, the researchers classified the respondent as having prepandemic depression.

Depressed woman | Image credit: Kittiphan - stock.adobe.com

Study findings showed that approximately 1 in 6 (17%) respondents with COPD and no lifetime history of depression developed depression during the early stages of the pandemic. Additionally, approximately 1 in 2 (52%) respondents with COPD and a history of depression experienced a recurrence of depressive symptoms during the study period.

They associated functional limitations (odds ratio [OR], 3.38; 95% CI, 1.70-6.72; P < .001), difficulties accessing health care (OR, 2.14; 95% CI, 1.17-3.89; P = .013), and increased family conflict during the pandemic (OR, 2.68; 95% CI, 1.17-6.14; P = .019) with a higher risk of incident depression. On the other hand, the researchers noted that women had a higher risk of recurrent depressive symptoms than men (OR, 1.88; 95% CI, 1.06-3.34; P = .033), and respondents who often felt lonely during the first few months of the pandemic were more likely to have recurrent depressive symptoms (OR, 3.26; 95% CI 1.83-5.83; P < .001).

The researchers also found that those with a post-secondary degree (OR, 3.00; 95% CI, 1.12-8.05; P = .029) and older respondents with higher adverse childhood experiences (OR, 1.44; 95% CI, 1.03-2.02; P = .033) were more likely to be depressed during the pandemic.

They acknowledged that their study had limitations, one being that the analysis relied on self-reported COPD, which may not be considered a definitive medical diagnosis. Also, self-reported COPD data were only taken during the follow-up 1 questionnaire, meaning that any patients who developed COPD after would be misclassified.

The researchers noted that these limitations did not diminish their findings, as they helped them “to better understand the effects of the COVID-19 pandemic on the mental health of this population.”

“The findings indicate a heightened risk for both incident and recurring depression among older adults with COPD during the pandemic,” the authors concluded. “Health care professionals should be aware of the mental health impacts of COVID-19 on individuals with COPD and continue to screen their COPD patients for depression to support their mental well-being.”

Reference
Taunque A, Li G, MacNeil A, et al. Breathless and blue in the Canadian longitudinal study on aging: incident and recurrent depression among older adults with COPD during the COVID-19 pandemic. Int J Chron Obstruct Pulmon Dis. 2023;18:1975-1993. doi:10.2147/COPD.S417218