Chest
Volume 137, Issue 4, April 2010, Pages 838-845
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Original Research
COPD
The Impact of Disability on Depression Among Individuals With COPD

https://doi.org/10.1378/chest.09-1939Get rights and content

Background

Both disability and depression are common in COPD, but limited information is available on the time-ordered relationship between increases in disability and depression onset.

Methods

Subjects were members of a longitudinal cohort with self-reported physician-diagnosed COPD, emphysema, or chronic bronchitis. Data were collected through three annual structured telephone interviews (T1, T2, and T3). Depression was defined as a score ≥ 4 on the Geriatric Depression Scale Short Form (S-GDS). Disability was measured with the Valued Life Activities (VLA) scale; three disability scores were calculated: percent of VLAs unable to perform, percent of VLAs affected (unable to perform or with some degree of difficulty), and mean VLA difficulty rating. Disability increases were defined as a 0.5 SD increase in disability score between T1 and T2. Multiple logistic regression analyses estimated the risk of T3 depression following a T1 to T2 disability increase for the total cohort and then excluding individuals who met the depression criterion at T1 or T2.

Results

Approximately 30% of subjects met the depression criterion each year. Eight percent to 19% experienced a T1 to T2 disability increase, depending on the disability measure. Including all cohort members and controlling for baseline S-GDS scores, T1 to T2 increases in disability yielded a significantly elevated risk of T3 depression (% affected odds ratio [OR] =3.6; 95% CI, [1.7, 7.7]; % unable OR = 6.1 [17, 21.8]; mean difficulty OR= 3.6 [1.7, 8.0]). Omitting individuals depressed at T1 or T2 yielded even stronger risk estimates for % unable (OR = 13.4 [2.0, 91.4]) and mean difficulty (OR = 3.9 [1.3, 11.8]).

Conclusions

Increases in VLA disability are strongly predictive of the onset of depression.

Section snippets

Sample

We used data from three waves of a population-based, longitudinal cohort study of US adults with various airways diseases, aged 55 to 75 years at recruitment.17, 31 During recruitment, subjects were asked if they had been diagnosed by a medical doctor with chronic bronchitis, emphysema, COPD, or asthma; if so, they were included in the airways disease cohort. Annual retention among the original sample averaged approximately 80% through 2006, over five follow-up telephone interviews (2002-2006).

Subject Characteristics

The majority of the sample was aged 66 years and older, women, and past or current smokers. Additional sample characteristics are presented in Table 1. The COPD group was older, more likely to be current or former smokers, and had higher disease severity scores.

Nearly one-third of those studied (34.5%, n = 186) met the depression criterion at T1. Individuals who were depressed were more likely to have less than high school education, be current smokers, have more comorbid conditions, and have

Discussion

Depression was common in this cohort of individuals with COPD and CB; approximately one-third of the cohort met the screening criterion each year. Previous studies have estimated the prevalence of depression in COPD at 7% to 60%,2, 5, 7, 50 with the broad range of estimates perhaps attributable to the wide variability in the number and characteristics of subjects and method of estimating depression.

In our analyses, crude depression rates were higher for individuals reporting a diagnosis of COPD

Acknowledgments

Author contributions: Dr Katz: contributed to planning this study, overseeing data collection, analyzing the data, and writing the manuscript.

Dr Julian: contributed to planning and conducting the study, and assisted with writing the manuscript.

Dr Omachi: contributed to conducting the study and assisted with writing the manuscript.

Dr Gregorich: contributed to conducting the study, analyzing the data, and writing the manuscript.

Dr Eisner: contributed to planning and conducting the study, and

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Funding/Support: This study was supported by the National Institutes of Health [National Heart, Lung and Blood Institute Grant R01 HL067438].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).

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