title: Dyspnea in relation to symptoms of anxiety and depression: A prospective population study.
abstract: BACKGROUND
  Respiratory symptoms are related to anxiety and depression in several cross-sectional studies but the association has not been explored in longitudinal studies.
  
  
  OBJECTIVE
  To prospectively study the change in dyspnea in relation to symptoms of anxiety and depression over a 9-year time period.
  
  
  METHODS
  The study comprised of 515 adults from a population sample who had participated in the European Commission Respiratory Health Survey (ECRHS) I in 1991-1992 and in the ECRHS II in 1999-2000. The questionnaire included a modified British Medical Research Council Scale for dyspnea grading and the Hospital Anxiety and Depression scale questionnaire.
  
  
  RESULTS
  The prevalence of dyspnea was 10.7% in the first and 12.6% in the second survey. Symptoms of depression was an independent determinants for dyspnea in both surveys (OR (95% CI) 3.72 (1.51-9.17) and 3.40 (1.49-7.80), respectively). In subjects that did not have dyspnea at the first survey onset of symptoms of anxiety (OR 3.53 (1.03-12.1)) and depression (OR 12.2 (3.97-37.5)) were significantly related to having dyspnea at the second survey, whereas onset of dyspnea was not significantly associated with developing symptoms of anxiety or depression when each disorder was entered separately.
  
  
  CONCLUSIONS
  Our data indicates that there is a causal relationship between development of symptoms of anxiety and depression and dyspnea. Psychological status is therefore an important factor to consider both when evaluating the results of epidemiological respiratory studies and in clinical settings when treating patients that have dyspnea.
authors.affiliation: Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University, Akademiska sjukhuset, SE 751 85 Uppsala, Sweden.
authors.forename: Asa
authors.initials: A
authors.lastname: Neuman
authors.forename: María
authors.initials: M
authors.lastname: Gunnbjörnsdottir
authors.forename: Alf
authors.initials: A
authors.lastname: Tunsäter
authors.forename: Lennarth
authors.initials: L
authors.lastname: Nyström
authors.forename: Karl A
authors.initials: KA
authors.lastname: Franklin
authors.forename: Eva
authors.initials: E
authors.lastname: Norrman
authors.forename: Christer
authors.initials: C
authors.lastname: Janson
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000150:complications*; D001249:Asthma / Q000150:complications; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000150:complications*; D004417:Dyspnea / Q000523:psychology*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects