The Impact of Depression and Anxiety on Chronic Obstructive Pulmonary Disease Acute Exacerbations: A prospective cohort study

Background: To explore the impact of anxiety and depression in chronic obstructive pulmonary disease(COPD) patients on the risk of acute exacerbation. Methods: 600 COPD patients were recruited and followed in Beijing, China. The demographic data, medical history, smoking history, therapy, assessments for anxiety and depression were completed by our physicians by face-to-face interview. Then the acute exacerbation events during the past one year was derived from their case record. Results: 504 people (295 men and 209 women) were thus included in the final analyses.The patients with anxiety scored more than 50 showed higher risk of acute exacerbation(54.1%) than those who scoring less than 50 (39.8%). Similarly, the patients with depression scored more than 53 showed higher risk of acute exacerbation (52.1%) than those who scoring less than 53(40.4%). Eventually, Anxiety and/or depression will increase the risk of acute exacerbation in chronic obstructive pulmonary disease patients(AECOPD) (adjusted OR = 1.60, 95%CI: 1.10-2.31), after adjusting the influence of family history, duration of disease, BMI index and other factors. Besides, the prevalence of acute exacerbation in patients with anxiety and/or depression was higher than those without acute exacerbation (P<0.05). Limitations: The frequency of AECOPD was limited to self-reported data, recall bias should be reconsidered, and it also may underestimate the association between anxiety and/or depression and AECOPD. Anxiety and depression were assessed by questionnaires rather than by a clinical diagnosis. Conclusion: Anxiety and/or depression in stable COPD patients were significantly associated with a higher risk of acute exacerbation. Mental health care should be paid more attention, to decrease the risk of acute exacerbation in COPD patients.