title: Risk of depression and anxiety in employees with chronic bronchitis: the modifying effect of cigarette smoking.
abstract: OBJECTIVE
  The present study evaluates whether smoking status modifies the association between chronic bronchitis and depression or anxiety in a population-based sample. Furthermore, we tested whether these associations are different in people without any respiratory complaints and those with asthma.
  
  
  METHODS
  For this study, we used cross-sectional data form the Maastricht Cohort Study, a population-based cohort study among Dutch employees.
  
  
  RESULTS
  In total, 7482 employees completed and returned the questionnaire (92.7%). In employees with chronic bronchitis, the prevalence of depression and anxiety was significantly higher compared with healthy employees and employees with asthma. Results indicate that the odds of having comorbid depression or anxiety for employees with chronic bronchitis compared with healthy employees is highest in current and past smokers, indicating that smoking status modifies this association.
  
  
  CONCLUSIONS
  Chronic bronchitis is strongly associated with depression and anxiety. Because depression and/or anxiety may not only interfere with an attempt to stop smoking but also contribute significantly to experiencing low quality of life, it is important to consider these disorders and chronic bronchitis as different disease entities. Prospective longitudinal studies are needed to elucidate the mechanisms underlying the association among chronic bronchitis, psychiatric disorders, and cigarette smoking.
authors.affiliation: Department of General Practice, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands. edwinwageha@proteion.nl
authors.forename: Edwin J
authors.initials: EJ
authors.lastname: Wagena
authors.forename: Ijmert
authors.initials: I
authors.lastname: Kant
authors.forename: Ludovic G P M
authors.initials: LG
authors.lastname: van Amelsvoort
authors.forename: Emiel F M
authors.initials: EF
authors.lastname: Wouters
authors.forename: Constant P
authors.initials: CP
authors.lastname: van Schayck
authors.forename: Gerard M H
authors.initials: GM
authors.lastname: Swaen
mesh_terms: D000041:Absenteeism; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology*; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D029481:Bronchitis, Chronic / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016272:Occupational Health; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000523:psychology; D011788:Quality of Life; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires