title: A review of the effectiveness of psychological interventions used for anxiety and depression in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Anxiety and depression are recognised co-morbidities associated with COPD and have been related to poor health outcomes. Therapies to relieve anxiety and depression are currently not detailed in clinical guidelines.
  
  
  METHODS
  A systematic review of psychological interventions for anxiety and depression in adults with COPD was conducted. Meta-analysis utilising the random effects model was undertaken for 4 studies that employed the same psychological intervention type, Cognitive Behavioural Therapy (CBT).
  
  
  RESULTS
  Seven studies met the inclusion criteria. Four studies used CBT. Included studies utilised psychotherapy, uncertainty management and minimal psychological therapy. 70% of participants were male. Many studies had poor methodological quality. The meta-analysis showed a small decrease in symptoms for both anxiety (SMD -0.49, 95% CI -1.04, 0.06, P=0.08, n=193) and depression (SMD -0.37, 95% CI -0.86, 0.11, P=0.13, n=193). No change occurred when sensitivity analyses were conducted.
  
  
  CONCLUSIONS
  Anxiety and depression in COPD patients are known to impact on health outcomes. Effective psychological interventions such as CBT may assist people with COPD in reducing psychological burden. There remains a need for well-designed studies to provide substantive evidence for the use of psychological interventions in this patient population.
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney , Penrith, New South Wales , Australia ; Centre for Pharmacology and Therapeutics, Imperial College, Chelsea and Westminster Campus , London , UK.
authors.forename: Sheree M S
authors.initials: SM
authors.lastname: Smith
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney , Penrith, New South Wales , Australia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sonego
authors.affiliation: School of Nursing, University of Michigan , Ann Arbor, Michigan , USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Ketcheson
authors.affiliation: School of Nursing, University of Michigan , Ann Arbor, Michigan , USA.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Larson