Anxiety and Depression in Patients with Chronic Obstructive Pulmonary Disease in China: Results from the China Pulmonary Health [CPH] Study

Ke Huang; Kewu Huang; Jianying Xu; Lan Yang; Jianping Zhao; Xiangyan Zhang; Chunxue Bai; Jian Kang; Pixin Ran; Huahao Shen; Fuqiang Wen; Yahong Chen; Tieying Sun; Guangliang Shan; Yingxiang Lin; Sinan Wu; Ting Yang; Chen Wang

doi:10.2147/COPD.S328617

Anxiety and Depression in Patients with Chronic Obstructive Pulmonary Disease in China: Results from the China Pulmonary Health [CPH] Study

Int J Chron Obstruct Pulmon Dis. 2021 Dec 17:16:3387-3396. doi: 10.2147/COPD.S328617. eCollection 2021.

Authors

Ke Huang^{1

2}, Kewu Huang³, Jianying Xu⁴, Lan Yang⁵, Jianping Zhao⁶, Xiangyan Zhang⁷, Chunxue Bai⁸, Jian Kang⁹, Pixin Ran¹⁰, Huahao Shen¹¹, Fuqiang Wen¹², Yahong Chen¹³, Tieying Sun¹⁴, Guangliang Shan¹⁵, Yingxiang Lin³, Sinan Wu^{2

16}, Ting Yang^{1

2

17}, Chen Wang^{1

2

17

18}

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.
² Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China.
³ Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.
⁴ Department of Pulmonary and Critical Care Medicine, Shanxi Dayi Hospital, Taiyuan, People's Republic of China.
⁵ Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.
⁶ Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
⁷ Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, People's Republic of China.
⁸ Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
⁹ Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, People's Republic of China.
¹⁰ State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China.
¹¹ Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, People's Republic of China.
¹² State Key Laboratory of Biotherapy of China and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
¹³ Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People's Republic of China.
¹⁴ Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing, People's Republic of China.
¹⁵ Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, People's Republic of China.
¹⁶ Institute of Clinical Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.
¹⁷ Department of Respiratory Medicine, Capital Medical University, Beijing, People's Republic of China.
¹⁸ Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.

Abstract

Purpose: Anxiety and depression are often underdiagnosed and affect the prognosis of patients with chronic obstructive pulmonary disease (COPD). We analyzed data from the China Pulmonary Health (CPH) study to assess the prevalence of anxiety and depression in COPD patients and their relationship with disease severity.

Patients and methods: A total of 57,779 subjects aged 20 years or older were recruited in the CPH study. All participants were assessed using a standard questionnaire and underwent pulmonary function tests before and after the use of a bronchodilator in local health centers. The Hospital Anxiety and Depression Scale (HADS) questionnaire with a cutoff score of 8 was used to define anxiety and depression. The prevalence of anxiety and depression in patients of COPD were investigated. Multivariate logistic regression was used to investigate the effects of COPD and lung function on anxiety and depression.

Results: A total of 49,053 participants (20,661 men and 28,392 women) completed the questionnaire with reliable post-bronchodilator pulmonary function test results and were included in the final analysis, of which 4686 (9.55%) were diagnosed with COPD. Of the patients with COPD, 10.79% had anxiety, 13.65% had depression, and 7.08% had anxiety and depression concomitantly. In the multivariate logistic regression analysis, COPD was not significantly associated with anxiety, depression, or both. After adjusting for confounders in model 1, patients in the GOLD III-IV group had a significantly higher risk of anxiety, depression, and their coincidence. After further adjusting for respiratory symptoms in model 2, lung function impairment in the GOLD III-IV group was only significantly associated with a higher risk of depression or at least one of anxiety and depression.

Conclusion: Anxiety and depression are prevalent in patients with COPD in China. More severe lung function impairment is significantly associated with a higher risk of depression.

Keywords: COPD; HADS; Hospital Anxiety and Depression Scale; anxiety; depression.

MeSH terms

Adult
Anxiety / diagnosis
Anxiety / epidemiology
Bronchodilator Agents / therapeutic use
China / epidemiology
Depression* / diagnosis
Depression* / epidemiology
Depression* / etiology
Female
Humans
Male
Pulmonary Disease, Chronic Obstructive* / diagnosis
Pulmonary Disease, Chronic Obstructive* / epidemiology
Quality of Life
Surveys and Questionnaires
Young Adult

Substances

Bronchodilator Agents