title: The association between depressive symptoms and acute exacerbations of COPD.
abstract: BACKGROUND
  Depression is an important comorbidity for patients with chronic obstructive pulmonary disease (COPD). The association between depression and acute exacerbations of COPD is unknown. This study was designed to determine the frequency of COPD exacerbations in outpatients with and without depressive symptoms.
  
  
  METHODS
  In this retrospective cohort study, patients with a primary diagnosis of COPD were followed for 1 year after discharge from a pulmonary rehabilitation program and the frequency of exacerbations was recorded. Upon completion of the program, all patients were administered the Short-Form 36 Health Survey (SF-36), which contains a mental health domain. Patients were classified as having depressive symptoms based on their domain score, which was separately validated in a second population of patients.
  
  
  RESULTS
  Of the 194 patients with COPD who completed the pulmonary rehabilitation program, 32 (16.5%) had depressive symptoms. There were no differences in terms of age, race, pack-years, forced expiratory volume in 1 second (FEV(1)), 6-minute walk distance, body mass index, use of supplemental oxygen, use of inhaled steroids, or the Charlson Comorbidity Index between patients with and without depressive symptoms. Patients with depressive symptoms had more exacerbations in the following year (1.91 vs. 1.36; p = 0.02), were 2.8 times more likely to have ever had an exacerbation (95% confidence interval (CI), 1.1-7.3; p = 0.03), and suffered a first exacerbation earlier (148 days compared with 266 days; p = 0.04) than nondepressed patients.
  
  
  CONCLUSIONS
  COPD patients with depressive symptoms have a significantly higher risk for exacerbations. Early screening for depression in patients with COPD may help identify those patients at higher risk for subsequent exacerbations.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, K-17, 2799 W. Grand Blvd, Detroit, MI 48202, USA. jjennin2@hfhs.org
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Jennings
authors.forename: Bruno
authors.initials: B
authors.lastname: Digiovine
authors.forename: Dany
authors.initials: D
authors.lastname: Obeid
authors.forename: Cathy
authors.initials: C
authors.lastname: Frank
mesh_terms: D000368:Aged; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome