Depressive symptoms as predictors of mortality in patients with COPD.
OBJECTIVE
Prognostic studies of mortality in patients with COPD have mostly focused on physiologic variables, with little attention to depressive symptoms. This stands in sharp contrast to the attention that depressive symptoms have been given in the outcomes of patients with other chronic health conditions. The present study investigated the independent association of depressive symptoms in stable patients with COPD with all-cause mortality.


METHODS
The baseline characteristics of 121 COPD patients (78 men and 43 women; mean [+/- SD] age, 61.5 +/- 9.1 years; and mean FEV(1), 36.9 +/- 15.5% predicted) were collected on hospital admission to a pulmonary rehabilitation center. The data included demographic variables, body mass index (BMI), post-bronchodilator therapy FEV(1), and Wpeak (peak workload [Wpeak]). Depressive symptoms were assessed using the Beck depression inventory. The vital status was ascertained using municipal registrations. In 8.5 years of follow-up, 76 deaths occurred (mortality rate, 63%). Survival time ranged from 88 days to 8.5 years (median survival time, 5.3 years). The Cox proportional hazard model was used to quantify the association of the baseline characteristics (ie, age, sex, marital status, smoking behavior, FEV(1), BMI, Wpeak, and depressive symptoms) with mortality.


RESULTS
Depressive symptoms (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.12 to 3.33) were associated with mortality in patients with COPD, independent of other factors including male sex (OR, 1.73; 95% CI, 1.03 to 2.92), older age (OR, 1.05; 95% CI, 1.02 to 1.08), and lower Wpeak (OR, 0.98; 95% CI, 0.97 to 0.99).


CONCLUSIONS
This study provides evidence that depressive symptoms assessed in stable patients with COPD are associated with their subsequent all-cause mortality.
de Voogd
Jacob N
JN
Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Electronic address: j.n.de.voogd@cvr.umcg.nl.
Wempe
Johan B
JB
Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Koëter
Gerard H
GH
Department of Pulmonary Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Postema
Klaas
K
Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
van Sonderen
Eric
E
Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Ranchor
Adelita V
AV
Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Coyne
James C
JC
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA.
Sanderman
Robbert
R
Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
D003863:Depression / Q000150:complications* / Q000628:therapy; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000503:physiopathology / Q000523:psychology; D012307:Risk Factors; D015996:Survival Rate