title: The impact of anxiety and depression on outcomes of pulmonary rehabilitation in patients with COPD.
abstract: BACKGROUND
  Anxiety and depression are prevalent comorbidities in COPD and are related to a worse course of disease. The present study examined the impact of anxiety and depression on functional performance, dyspnea, and quality of life (QoL) in patients with COPD at the start and end of an outpatient pulmonary rehabilitation (PR) program.
  
  
  METHODS
  Before and after PR, 238 patients with COPD (mean FEV(1) % predicted = 54, mean age = 62 years) underwent a 6-min walking test (6MWT). In addition, anxiety, depression, QoL, and dyspnea at rest, after the 6MWT, and during activities were measured.
  
  
  RESULTS
  Except for dyspnea at rest, improvements were observed in all outcome measures after PR. Multiple regression analyses showed that before and after PR, anxiety and depression were significantly associated with greater dyspnea after the 6MWT and during activities and with reduced QoL, even after controlling for the effects of age, sex, lung function, and smoking status. Moreover, before and after PR, anxiety was related to greater dyspnea at rest, whereas depression was significantly associated with reduced functional performance in the 6MWT.
  
  
  CONCLUSIONS
  This study demonstrates that anxiety and depression are significantly associated with increased dyspnea and reduced functional performance and QoL in patients with COPD. These negative associations remain stable over the course of PR, even when improvements in these outcomes are achieved during PR. The results underline the clinical importance of detecting and treating anxiety and depression in patients with COPD.
authors: Department of Psychology, University of Hamburg, Hamburg; Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg. Electronic address: andreas.vonleupoldt@uni-hamburg.de.
authors: Andreas
authors: A
authors: von Leupoldt
authors: Atem-Reha GmbH, Hamburg.
authors: Karin
authors: K
authors: Taube
authors: Atem-Reha GmbH, Hamburg.
authors: Kirsten
authors: K
authors: Lehmann
authors: Department of Psychology, University of Hamburg, Hamburg.
authors: Anja
authors: A
authors: Fritzsche
authors: Pulmonary Research Institute at Hospital Grosshansdorf, Grosshansdorf, Germany.
authors: Helgo
authors: H
authors: Magnussen
mesh_terms: D001007:Anxiety / Q000453:epidemiology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D004417:Dyspnea / Q000453:epidemiology; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation*; D011788:Quality of Life