title: Long-term Course of Depression Trajectories in Patients With COPD: A 3-Year Follow-up Analysis of the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints Cohort.
abstract: BACKGROUND
  There is insufficient evidence about the long-term course of depressive symptom trajectories and their impact among patients with COPD.
  
  
  METHODS
  We analysed 3-year data obtained from patients with COPD participating in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints study. Patients were split into four groups on the basis of Center for Epidemiologic Studies Depression Scale score (< 16 vs ≥ 16) and antidepressant use (yes vs no) at baseline and at 3 years: never depressed, new onset, remittent, and persistent depression. Baseline characteristics were used to assess factors associated with the group by using logistic regression.
  
  
  RESULTS
  A total of 1,589 patients with COPD completed the 3-year follow-up. Of these, 55% (n = 869) were classified as never depressed, 24% (n = 377) were classified as persistently depressed, 14% (n = 226) developed new onset of depression, and 7% (n = 117) had depression that remitted. Female sex and history of stroke were associated with substantial increases in the odds of persistent depression (OR, 2.95; 95% CI, 2.05-4.24 and OR, 3.09; 95% CI, 1.43-6.67, respectively). Odds of new onset depression increased with worse health status (OR, 1.10; 95% CI, 1.04-1.17 per 4-point increase in St. George's Respiratory Questionnaire score) and moderate to severe dyspnea (OR, 1.57; 95% CI, 1.07-2.31 for modified Medical Research Council score ≥ 2 vs 0 or 1). During follow-up, patients with persistent or new-onset depression experienced more exacerbations and more pronounced loss in performance as assessed by reduction in the 6-min walk distance (6MWD) test score.
  
  
  CONCLUSIONS
  About one in four patients with COPD had persistent depressive symptoms over 3 years. Clinicians should be aware of the characteristics of persistent and new onset depressive symptoms, which are associated with risk of exacerbations and loss of performance on the 6MWD test. Interventions that ameliorate the course of depression are needed.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT00292552; URL: www.clinicaltrials.gov.
authors.affiliation: Department of Health Professions, Manchester Metropolitan University, Manchester, England. Electronic address: A.yohannes@mmu.ac.uk.
authors.forename: Abebaw M
authors.initials: AM
authors.lastname: Yohannes
authors.affiliation: Respiratory Epidemiology, GlaxoSmithKline research and Development, Uxbridge, England.
authors.forename: Hana
authors.initials: H
authors.lastname: Müllerová
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Hanania
authors.affiliation: Department of Psychology, University of Quebec at Montreal, Montreal, QC, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Lavoie
authors.affiliation: Respiratory Therapy Area Unit, GlaxoSmithKline, King of Prussia, PA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Tal-Singer
authors.affiliation: Centre for Respiratory Medicine and Allergy, Manchester Academic Health Science Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, England.
authors.forename: Jorgen
authors.initials: J
authors.lastname: Vestbo
authors.affiliation: University of Nebraska Medical Center, Omaha, NE.
authors.forename: Steven I
authors.initials: SI
authors.lastname: Rennard
authors.affiliation: Respiratory Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Emil F M
authors.initials: EF
authors.lastname: Wouters
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D019742:Chemokines, CC / Q000378:metabolism; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D003866:Depressive Disorder / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D018450:Disease Progression; D004417:Dyspnea / Q000503:physiopathology; D005080:Exercise Test; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology / Q000523:psychology*; D037663:Pulmonary Surfactant-Associated Protein D / Q000378:metabolism; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000523:psychology; D014598:Uteroglobin / Q000378:metabolism
chemical_list: D015415:Biomarkers; C111792:CCL18 protein, human; D019742:Chemokines, CC; D037663:Pulmonary Surfactant-Associated Protein D; C556389:SCGB1A1 protein, human; D005340:Fibrinogen; D002097:C-Reactive Protein; D014598:Uteroglobin
keywords: COPD; depression; dyspnea; long-term follow-up; new onset; persistent; remittent