Study Underscores Importance of Depression Screening, Treatment in COPD

Results of a longitudinal study outline the relationship between depression and patients reported outcomes among those with chronic obstructive pulmonary disease (COPD).

Among individuals with chronic obstructive pulmonary disease (COPD), depression was more strongly associated with several patient-reported outcomes (PROs) at baseline and their change over time compared with forced expiratory volume in one second (FEV1%), according to results of a longitudinal study. Findings were published in Annals of the American Thoracic Society.

Prevalence of depression among patients with COPD ranges from 23% to 40% compared with just 8% to 17% in the general population, researchers explained. In addition, “depression has been shown to be associated with increased risk for severe COPD exacerbations requiring hospitalizations, a longer hospital length of stay for COPD exacerbations and increased risk for readmissions,” they wrote.

In an effort to better understand the association between depression and changes in COPD morbidity over time, investigators analyzed data from 1830 Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) participants.

Information was obtained from 12 sites across the United States between 2010 and 2014, and all participants were between the ages of 40 and 80. Researchers collected data during in-person baseline visits and up to 3 follow-up visits.

The Hospital Anxiety and Depression Scale (HADS) was used to measure depression symptoms and spirometry was used to measure lung function. Mean (SD) participant age was 65.1 (8.1) years and the majority of patients (57%) were male.

“Participants had a mean smoking history of 52.7(27.5) pack years and mean comorbidities of 2 (1.4). The mean FEV1% predicted was 60.9% (23), with the within- person average of 60.3% (22.9),” authors wrote. Of those included, 20% had clinically significant depressive symptoms at baseline.

Adjusted models showed:

  • Higher HADS scores and lower FEV1% each were associated with worse PROs at baseline (P ≤ .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% to 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% to 32% of heterogeneity
  • Depressive symptoms accounted for 3% to 17% variance in change over time in PROs
  • FEV1% accounted for 1% to 4% variance over time in PROs

Overall, results demonstrated “individuals with COPD and depressive symptoms had worse PROs, including worse quality of life and respiratory symptoms; and worse functional status, compared with their counterparts without depressive symptoms,” researchers said.

Furthermore, compared with spirometry, findings showed depressive symptoms are an important driver of COPD morbidity. “When depressive symptoms go unrecognized, patients may be experiencing a worse disease trajectory overtime,” authors stressed. “This could translate into increased health care utilization and increased prescribing of inhaled medications with little symptomatic benefit in the absence of addressing underlying depression.”

Future investigations aimed at better understanding how depression as a major comorbidity of COPD impacts PROs ought to be carried out.


O’Toole J, Woo H, Putcha N, et al. Comparative impact of depressive symptoms and FEV1% on chronic obstructive pulmonary disease. Ann Am Thorac Soc. Published online August 16, 2021. doi:10.1513/AnnalsATS.202009-1187OC