title: Predictors of All-Cause Mortality in Patients With Severe COPD and Major Depression Admitted to a Rehabilitation Hospital.
abstract: BACKGROUND
  COPD is a major cause of all-cause mortality. We examined predictors of 1-year mortality in patients with severe COPD and major depression after inpatient treatment in a rehabilitation hospital.
  
  
  METHODS
  We screened 898 consecutively admitted patients. Of these, 138 patients received the diagnoses of COPD according to American Thoracic Society Guidelines and major depression by Diagnostic and Statistical Manual of Mental Disorders, 4th edition and signed consent; 67 were randomized to a treatment adherence enhancement intervention and 71 to usual care. We assessed history of falls, dyspnea-related disability, severity of depression, medical burden, and cognitive functioning. Following discharge from inpatient rehabilitation, participants were prospectively followed, and mortality was ascertained over 52 weeks from hospital notes and reports of primary care physicians and relatives.
  
  
  RESULTS
  One-year, all-cause mortality was 22% (31 of 138). Multivariate Cox regression analysis showed that history of falls in the 6 months preceding hospital admission was the strongest predictor of mortality (OR, 3.05; 95% CI, 1.40-6.66; P < .005). Dyspnea during activities (Pulmonary Functional Status and Dyspnea Questionnaire-Modified domain) was also associated with mortality (OR, 1.05; 95% CI, 1.02-1.08; P < .002). Depression severity, medical burden, and cognitive impairment were not predictors of mortality.
  
  
  CONCLUSIONS
  Recent falls and dyspnea during activities identify subgroups of depressed patients with COPD at increased risk for all-cause mortality. These subgroups are in need of clinical attention and follow-up and can serve as targets for prevention research aiming to inform clinical strategies and public health planning.
authors.affiliation: Department of Health Professions, Manchester Metropolitan University, Manchester, England. Electronic address: A.yohannes@mmu.ac.uk.
authors.forename: Abebaw Mengistu
authors.initials: AM
authors.lastname: Yohannes
authors.affiliation: Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Raue
authors.affiliation: Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY.
authors.forename: Dora
authors.initials: D
authors.lastname: Kanellopoulos
authors.affiliation: Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY.
authors.forename: Amanda
authors.initials: A
authors.lastname: McGovern
authors.affiliation: Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY.
authors.forename: Jo Anne
authors.initials: JA
authors.lastname: Sirey
authors.affiliation: Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY.
authors.forename: Dimitris N
authors.initials: DN
authors.lastname: Kiosses
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY.
authors.forename: Samprit
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY.
authors.forename: Joanna K
authors.initials: JK
authors.lastname: Seirup
authors.affiliation: Burke Rehabilitation Hospital, New York, NY.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Novitch
authors.affiliation: Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY.
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
mesh_terms: D000058:Accidental Falls / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D003865:Major Depressive Disorder / Q000209:etiology / Q000401:mortality* / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology / Q000401:mortality* / Q000534:rehabilitation; D012047:Rehabilitation Centers; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: COPD; depression; dyspnea; falls; mortality