title: Managing mood disorders in patients attending pulmonary rehabilitation clinics.
abstract: BACKGROUND
  There is good evidence for the positive benefits of pulmonary rehabilitation (PR) in the prevention of hospital admissions, lower mortality, and improved health-related quality of life. There is also increasing evidence about the impact of PR on mental health and, in particular, mood disorders. We aimed to identify how depression in chronic obstructive pulmonary disease (COPD) patients in Victoria, Australia, is being managed in PR, to identify the prevalence of depressive symptoms among COPD patients who attend PR, and to determine whether patients with depressive symptoms or anxiety symptoms dropped out of PR early.
  
  
  METHODS
  Of 61 PR clinics, 44 were invited and 22 agreed to participate. Telephone interviews were conducted to see how depression and anxiety in COPD patients were being recognized and managed in these clinics. A total of 294 questionnaires were distributed to patients by clinic coordinators to determine the prevalence of anxiety/depression, as measured by the Hospital Anxiety and Depression Scale. Coordinators were contacted to provide information on whether respondents dropped out of rehabilitation early or continued with their treatment at 2-4 months post program.
  
  
  RESULTS
  Seven clinics were not aware of local guidelines on assessment/treatment/management of mood. Four clinics did not use any screening tools or other aids in the recognition and management of depression and/or anxiety. Overall, eight clinics participating in this study requested advice on suitable screening tools. The patient survey indicated that the mean depression score on the Hospital Anxiety and Depression Scale was 5.0 (standard deviation 3.0, range 1-13). The mean anxiety score was 5.5 (standard deviation 3.4, range 0-18). There was no evidence of a link between failure to complete rehabilitation and depression or anxiety scores, as only three of 105 patients failed to complete their rehabilitation.
  
  
  CONCLUSIONS
  Awareness of management guidelines for depression and anxiety in COPD patients was variable across the clinics recruited into our study. We found no link between compliance with rehabilitation and depression, but our sample had limitations.
  
  
  CONCLUSIONS
  Future research needs to investigate how best to encourage more use of available guidelines regarding integrating psychological and psychosocial support to supplement the exercise and education that are currently offered routinely by all PR clinics studied in Victoria, Australia.
authors: National Ageing Research Institute, Royal Melbourne Hospital Royal Park Campus, Parkville, Victoria, Australia. c.doyle@nari.unimelb.edu.au
authors: Colleen
authors: C
authors: Doyle
authors: David
authors: D
authors: Dunt
authors: David
authors: D
authors: Ames
authors: Suganya
authors: S
authors: Selvarajah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D001007:Anxiety / Q000175:diagnosis / Q000628:therapy*; D001315:Australia; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011569:Psychiatric Status Rating Scales; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology* / Q000534:rehabilitation*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012657:Self-Help Groups / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: anxiety; chronic obstructive pulmonary disease; depression; pulmonary rehabilitation