title: Added burden of mental disorders on health status among patients with chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Patients with chronic obstructive pulmonary disease (COPD) and comorbid mental disorders are known to have worse health status. The association between these variables remains complex and poorly understood. We sought to better understand the association between COPD severity, mental disorders (depression/anxiety), and health status.
  
  
  METHODS
  This cross-sectional study compared participants without COPD or with mild COPD (n = 162) to those with moderate (n = 25), severe (n = 38), and very severe (n = 26) COPD. We recruited participants from a primary care and a pulmonary clinic at a veterans affairs medical center between July 2001 until September 2002. We used the Patient Health Questionnaire to screen for depression and anxiety and the Posttraumatic Stress Disorder Checklist to screen for posttraumatic stress disorder. Health status was assessed with the veteran's version of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) and the Shortness of Breath Questionnaire (SOBQ).
  
  
  RESULTS
  COPD severity was associated with worse physical status and dyspnea as measured by the SF-36 physical component summary and the SOBQ but was not associated with worse mental status as measured by the SF-36 mental component summary. At each level of COPD severity, participants with mental disorders had worse health status and dyspnea as measured by the SF-36 physical component summary, mental component summary, and SOBQ. Significant linear trends with COPD severity were associated with increased prevalence of any depressive disorder, major depressive disorder, and nonpanic/non-PTSD anxiety disorders (all tests for linear trend, P < .01).
  
  
  CONCLUSIONS
  Independent of COPD severity, comorbid mental disorders were associated with worse health status and dyspnea. Studies are needed to determine whether patients with comorbid mental disorders may have more significant improvement in physical symptoms and functioning if providers focus more on psychiatric conditions.
authors.affiliation: VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA. Bradford.Felker@va.gov
authors.forename: Bradford
authors.initials: B
authors.lastname: Felker
authors.forename: Kristen R
authors.initials: KR
authors.lastname: Bush
authors.forename: Ofer
authors.initials: O
authors.lastname: Harel
authors.forename: Jane B
authors.initials: JB
authors.lastname: Shofer
authors.forename: Molly M
authors.initials: MM
authors.lastname: Shores
authors.forename: David H
authors.initials: DH
authors.lastname: Au