Breathlessness, Anxiety, Depression, and Function–The BAD-F Study: A Cross-Sectional and Population Prevalence Study in Adults

Abstract

This study evaluated associations between chronic breathlessness and: anxiety; depression; functional status in the general population. MethodsThis cross sectional cohort of consenting adults (≥18 years) used an online survey. Quota sampling (n=3,000) was employed reflecting the 2016 national census for sex, age and place of residence. Other data included: Patient Health Questionnaire for Depression and Anxiety (PHQ-4); the modified Medical Research Council (mMRC) breathlessness scale and the Australia-modified Karnofsky Performance Scale (AKPS). Multinomial logistic regression assessed predictors. Results2977 respondents had all relevant scores; female-51.2%; median age 45.0 (range 18-92). Prevalence of breathlessness (mMRC ≥ 2) was 2.4%; anxiety 6.0%; depression 2.7%; coexisting anxiety/depression 6.1% and poorer functional status (AKPS ≤60) 1.6%.Poorest function was in the co-existing anxiety/depression group with 11.6%. The highest proportions of people with breathlessness were found in the co-existing anxiety/depression group (10.6%) and depression only (8.8%).In multinomial regression, depression only and co-existing anxiety/depression were predicted by older age, longer duration of breathlessness, and poorer functional status (AKPS ≤60). The relationship between poorer functional status and co-existing anxiety/depression was striking (OR 16.1; 95% 8.3, 31.4).Adjusted odds ratios for breathlessness and: depression only was 5.5 (95% CI 2.3,12.9); and 5.1 for co-existing anxiety/depression group (95% CI 2.7,9.7). ConclusionClinically important breathlessness (mMRC ≥2) was associated with depression only and coexisting anxiety/depression. Poorer function associated with psychological morbidity in the general population requires further research.

Prevalence and burden of breathlessness in Australian adults: The National Breathlessness Survey—a cross‐sectional web‐based population survey

“…An Australian study (n = 3000), using similar methodology to our study with a different panel (Red Planet, drawn from frequent flyers), reported that 2.4% had mMRC ≥ 2. 17 This is consistent with findings from an earlier random face-toface survey in South Australia (2.4%) in which participants were asked only about dyspnoea that had been present on 'most days for at least three of the last 6 months'. 7 Vinnikov et al 18 reported a prevalence of mMRC ≥ 2 of 9% among 1500 adults randomly selected from a large primary care facility in Kazakhstan.…”

“…A previous Australian population-based study demonstrated that anxiety and/or depression increased with increasing duration of chronic breathlessness. 17 Breathlessness has an impact on the individual's physical quality of life as well as on their emotional well-being. 25,26 Interestingly, for the same mMRC grade, people with respiratory/heart conditions rated their general health worse, and had worse Dyspnoea-12 scores, than those without such conditions.…”

The impact of unpredictability of dyspnea offset on dyspnea perception, fear, and respiratory neural gating

“…These comorbidities often contribute to a worse course of disease and reduced treatment success including greater dyspnea levels (von Leupoldt & Denutte, 2020; von Leupoldt & Kenn, 2013). For example, various studies have shown that elevated levels of state and trait anxiety are associated with greater dyspnea in everyday life settings (Currow et al., 2020; Xu et al., 2008), in rehabilitation contexts (von Leupoldt et al., 2011; Yohannes et al., 2019), and in experimental studies in patients with asthma and COPD (Livermore et al., 2008; Martínez‐Moragón et al., 2006), as well as in healthy individuals (Herzog et al., 2018; Sharma et al, 2016). Next to state/trait anxiety as rather unspecific forms of negative affect, more specific, dyspnea‐related forms such as fear of dyspnea and fear of suffocation (FoS) have previously been demonstrated to contribute even more to worse outcomes including higher dyspnea (Herigstad et al., 2017; Janssens et al., 2019; Reijnders et al., 2019; von Leupoldt & Janssens, 2016).…”

Manuscript Instrument for Fear of Driving (IFD)

“…Hence, the results should be interpreted with caution, bearing in mind the small sample size and the small numbers in each group. However, the higher proportion of females (74.1%) in the study seem to at least represent the typical gender distribution in anxiety populations (Currow et al, 2020).…”