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

David C Currow; Sungwon Chang; Helen K Reddel; Slavica Kochovska; Diana Ferreira; Irina Kinchin; Miriam Johnson; Magnus Ekström

doi:10.1016/j.jpainsymman.2019.09.021

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

J Pain Symptom Manage. 2020 Feb;59(2):197-205.e2. doi: 10.1016/j.jpainsymman.2019.09.021. Epub 2019 Oct 22.

Authors

David C Currow¹, Sungwon Chang², Helen K Reddel³, Slavica Kochovska², Diana Ferreira⁴, Irina Kinchin⁵, Miriam Johnson⁶, Magnus Ekström⁷

Affiliations

¹ IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia; Wolfson Palliative Care Research Centre, University of Hull, Hull, England; Australian National Palliative Clinical Studies Collaborative, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia. Electronic address: david.currow@uts.edu.au.
² IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia; Australian National Palliative Clinical Studies Collaborative, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.
³ Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia.
⁴ Flinders University, Flinders Drive, Bedford Park, South Australia, Australia.
⁵ IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.
⁶ Wolfson Palliative Care Research Centre, University of Hull, Hull, England.
⁷ Division of Respiratory Medicine & Allergology, Department of Clinical Sciences, Lund University, Lund, Sweden.

PMID: 31654741
DOI: 10.1016/j.jpainsymman.2019.09.021

Abstract

Context: Breathlessness is associated with depression, but its relationship to anxiety or impaired function is less clear.

Objectives: This study evaluated associations between chronic breathlessness and anxiety, depression, and functional status in the general population.

Methods: This cross-sectional study of consenting adults (18 years and older) used an online survey. Quota sampling (n = 3000) was used reflecting the 2016 national census for sex, age, and place of residence. Other data included Four-Item Patient Health Questionnaire for depression and anxiety, the modified Medical Research Council (mMRC) Breathlessness Scale, and the Australia-modified Karnofsky Performance Scale. Multinomial logistic regression assessed predictors.

Results: About 2977 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 (Australia-modified Karnofsky Performance Scale ≤60) 1.6%. In multinomial regression, depression, anxiety, and coexisting anxiety/depression were predicted by younger age, longer duration of breathlessness, and poorer functional status. The highest proportions of people with breathlessness were found in the coexisting anxiety/depression group (10.6%) and depression only group (8.8%). Poorest function was in the coexisting anxiety/depression group with 11.6%. The relationship between poorer functional status and coexisting anxiety/depression was significant (odds ratio 0.90; 95% CI 0.89, 0.92). Adjusted odds ratio for breathlessness and depression only was 3.0 (95% CI 1.2, 7.8).

Conclusion: Clinically important breathlessness (mMRC ≥2) was associated with depression, anxiety, and coexisting anxiety/depression. Poorer function that is associated with psychological morbidity in the general population requires further research.

Keywords: Chronic breathlessness; anxiety; depression; population survey; prevalence study.

MeSH terms

Adult
Anxiety / epidemiology
Cross-Sectional Studies
Depression* / epidemiology
Dyspnea* / epidemiology
Female
Humans
Middle Aged
Prevalence