Impact of Anxiety and Depression on Chronic Obstructive Pulmonary Disease Exacerbation Risk

Laurin, Catherine; Moullec, Grégory; Bacon, Simon; Lavoie, Kim

doi:10.1164/rccm.201105-0939pp

Cited by 158 publications

(136 citation statements)

References 42 publications

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“…Patients with more than one of these coexisting psychological disorders and low socioeconomic status have even higher readmission rates, suggesting the additive effect of these factors on readmission rates, as noted in earlier studies. 9,37,38 Moreover, these factors explained a large proportion of variation in 30-day readmission rates. These psychological disorders are more likely to predict 30-day readmission than other significant factors like male sex and measures of disease severity such as length of hospital stay, ICU stay, and use of mechanical ventilation during the index hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…20 Lack of community resources to meet the transportation needs or clinic copayment may play a role in clinic absenteeism. Less than one-third of readmissions are related to acute exacerbation of COPD; the remainder are related to other comorbidities, 37,39 and the number of comorbidities correlates directly with frequency of 30-day readmission. 16,18,40,41 The complex overlap of symptoms with COPD creates challenges for the diagnosis and treatment of comorbid psychological disorders.…”

Section: Discussionmentioning

confidence: 99%

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Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

Singh

Zhang

Kuo

et al. 2016

Chest

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

Singh

Zhang

Kuo

et al. 2016

Chest

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“…Nine studies examining the prospective associations between clinical levels and symptoms of psychological distress and exacerbation risk for patients with COPD [9,10,[23][24][25][26][27][28][29] were recently evaluated in a review paper [8]. Three of those studies evaluated outpatients [23][24][25], whereas one included a cohort of elderly medical patients including non-COPD patients [29].…”

Section: Discussionmentioning

confidence: 99%

“…COPD patients often face major physical impairment and embarrassing symptoms [5], while depression by itself is also aggravated by worsening dyspnoea and fatigue, diminishing functional performance and exercise capacity, and is associated with impaired quality of life [6]. Depression is additionally related to AECOPD frequency, with frequent exacerbators presenting higher depression scores compared with infrequent exacerbators [7,8]. Although it has been reported that depressed COPD patients experience longer hospitalisations for AECOPD [9], the impact of depressive symptoms on the recovery and outcomes from an AECOPD has not been thoroughly studied.…”

mentioning

confidence: 99%

The impact of depressive symptoms on recovery and outcome of hospitalised COPD exacerbations

et al. 2012

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The impact of depressive symptoms on outcomes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has not been thoroughly evaluated in prospective studies.We prospectively enrolled 230 consecutive patients hospitalised for AECOPD, without previous diagnosis of depression. Depressive symptoms were evaluated with Beck's depression inventory. Pulmonary function tests, arterial blood gases, COPD assessment test (CAT) and Borg dyspnoea scale were recorded on admission and on days 3, 10 and 40. Patients were evaluated monthly for 1 year.Patients with depressive symptoms required longer hospitalisation (mean¡SD 11.6¡3.7 versus 5.6¡4.1 days, p,0.001). Clinical variables improved during the course of AECOPD, but depressive symptoms on admission had a significant impact on dyspnoea (p,0.001) and CAT score (p50.012) improvement. Patients with depressive symptoms presented more AECOPD (p,0.001) and more hospitalisations for AECOPD (p,0.001) in 1 year. In multivariate analysis, depressive symptoms were an independent predictor of mortality (hazard ratio 3.568, 95% CI 1.302-9.780) and risk for AECOPD (incidence rate ratio (IRR) 2.221, 95% CI 1.573-3.135) and AECOPD hospitalisations (IRR 3.589, 95% CI 2.319-5.556) in 1 year.The presence of depressive symptoms in patients admitted for AECOPD has a significant impact on recovery and is related to worse survival and increased risk for subsequent COPD exacerbations and hospitalisations in 1 year.

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“…Given that reducing 30-day readmission for acute exacerbation of COPD is now a target set forth by the Centers for Medicare and Medicaid Services, these studies, together with our data, support the need for further research, including testing of pharmacologic and behavioral interventions, to examine psychological comorbidities such as depression as potentially modifiable risk factors for readmission for acute exacerbation of COPD. Anxiety has also been linked to a worse sensation of dyspnea in COPD (47) and increased risk of acute exacerbation of COPD (36,47), but data on the risk of readmission are limited. Although we found an association between anxiety and readmissions on univariate analysis, this did not remain significant after multivariable modeling.…”

Section: Original Researchmentioning

confidence: 99%

Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

et al. 2016

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Rationale: Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and health care costs, and hospitals in the United States are now penalized by the Centers for Medicare and Medicaid Services for excessive readmissions. Identifying patients at risk of readmission is important, but modifiable risk factors have not been clearly established, and the potential contributing role of psychological disease has not been examined adequately. We hypothesized that depression and anxiety would increase the risk of both short-and long-term readmissions for acute exacerbation of COPD.Objectives: To characterize the associations between depression and anxiety and COPD readmission risk. Methods:We examined the medical records for all patients with a primary diagnosis of acute exacerbation of COPD by International Classification of Diseases, Ninth Revision codes admitted to the University of Alabama at Birmingham Hospital between November 2010 and October 2012. Those who did not meet the standardized study criteria for acute exacerbation of COPD and those with other respiratory illnesses as the primary diagnosis were excluded. Comorbidities were recorded on the basis of physician documentation of the diagnosis and/or the use of medications in the electronic medical record. Multivariable regression analyses identified factors associated with readmission for acute exacerbation of COPD at 1 year and within 30 and 90 days.Measurements and Main Results: Four hundred twenty-two patients were included, with 132 readmitted in 1 year. Mean age was 64.8 6 11.7 years, and mean percent predicted FEV 1 was 48.1 6 18.7%. On univariate analysis, readmitted patients had lower percent predicted FEV 1 (44.9 6 17.3% vs. 50.2 6 19.4%; P = 0.05) and a higher frequency of depression (47.7% vs. 23.4%; P , 0.001). On multivariable analysis, 1-year readmission was independently associated with depression (adjusted odds ratio [OR], 2.67; 95% confidence interval [CI], 1.59-4.47) and in-hospital tobacco cessation counseling (adjusted OR, 0.34; 95% CI, 0.18-0.66). Depression also predicted readmission at 30 days (adjusted OR, 3.83; 95% CI, 1.84-7.96) and 90 days (adjusted OR, 2.47; 95% CI, 1.34-4.55).Conclusions: Depression is an independent risk factor for both short-and long-term readmissions for acute exacerbation of COPD and may represent a modifiable risk factor. In-hospital tobacco cessation counseling was also associated with reduced 1-year readmission.

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Impact of Anxiety and Depression on Chronic Obstructive Pulmonary Disease Exacerbation Risk

Cited by 158 publications

References 42 publications

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

The impact of depressive symptoms on recovery and outcome of hospitalised COPD exacerbations

Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

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