Anxiety and depression in end-stage COPD

Abstract

Although feelings of anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), estimates of their prevalence vary considerably. This probably reflects the variety of scales and methods used to measure such symptoms. Regardless of whether anxiety and depression are considered separately or as a single construct, their impact on COPD patients is important.A heightened experience of dyspnoea is likely to be a contributing factor to anxiety. Feelings of depression may be precipitated by the loss and grief associated with the disability of COPD. Smoking has been associated with nicotine addiction, and the factors that contribute to smoking may also predispose to anxiety and depressive disorders.Randomised controlled trials indicate that exercise training and carefully selected pharmacological therapy are often effective in ameliorating anxiety and depression. Most medical illnesses are influenced by the psychological responses and coping mechanisms that patients use. However, anxiety and depression are associated with dyspnoea, fatigue and altered sleep, all of which also occur in COPD.An understanding of the psychological history and coping mechanisms of patients and the role of anxiety and depressive reactions to illness may enable clinicians to reduce these symptoms and improve quality of life among patients with chronic obstructive pulmonary disease.KEYWORDS: Anxiety, chronic obstructive pulmonary disease, depression C hronic obstructive pulmonary disease (COPD) is characterised by airflow obstruction that is not fully reversible [1]. In addition to the primary pulmonary pathology, the impact of secondary skeletal muscle dysfunction on exercise capacity and survival is well established [2,3]. Psychological impairments, ranging from feelings of depression and anxiety to full diagnostic mental disorders, although prevalent in this population, have received less interest. As COPD is incurable, therapeutic interventions aim to optimise function and slow disease progression [4]. Attention has focused predominantly on the effectiveness of strategies such as smoking cessation [5], longterm oxygen therapy (LTOT) [6,7], influenza vaccines [8], respiratory-specific pharmacological management [9], surgical options [10], conditioning of the peripheral muscles with graduated exercise training [11] and chronic disease selfmanagement strategies [12].Despite the prevalence of depression and anxiety and their impact on the morbidity associated with COPD, these psychological consequences of the disease are rarely addressed, at least in the respiratory medicine community. The purpose of the present review is to raise awareness among pulmonologists, general practitioners and allied health professionals to the secondary psychological impairment associated with COPD. Although anxiety and depression often coexist, they represent separate constructs [13]. Broader reviews of the psychological characteristics of patients with COPD are available [14]. ANXIETY Classification and diagnostic cr...

Effects of Smoking, Depression, and Anxiety on Mortality in COPD Patients: A Prospective Study

“…They may feel useless, experience reduced sexual activity, depend on others for their personal care, and lose interest in future projects. 38 Tobacco may provide psychological relief for some individuals. 39 Continuing smokers with COPD are more at risk of depression than those who quit.…”

Systemic manifestations and comorbidities of COPD

“…Depressive symptoms that are clinically relevant are estimated to occur in 10-80% of all patients. Conversely, in clinically stable outpatients with COPD, the prevalence of major depression (that requires medical intervention) ranges 19-42% [132,133]. There is no standardised approach for the diagnosis of depression in patients with COPD because of the differences in methodology and variability of the screening questionnaires in cut-off points to determine a diagnosis of depression.…”

“…Whatever the cause, untreated depression increases the length of hospital stay, frequency of hospital admissions, and leads to impaired quality of life and premature death [133]. However, depression often remains untreated in COPD patients.…”

Anxiety and Depression Among Chronic Obstructive Pulmonary Disease Patients in A Tertiary Care Hospital, Nepal

“…Experience of severe shortness of breath is likely to contribute anxiety whereas loss and grief related with the disability due to COPD may lead to depression 2 . Studies have even suggested that the presence of shortness of breath and exacerbation of symptoms contributes to depression, which is the most important determinant to impair health related quality of life 3 .…”