Depression, Anxiety Underrecognized and Undertreated in COPD, Increasing Disease Burden
A new analysis reveals significant gaps in diagnosis of and treatment for psychiatric disorders in adults with COPD and calls for larger, longitudinal studies.
A new study conducted by researchers from leading US academic medical centers underscores a significant association between depression, anxiety, and worsened outcomes among individuals with chronic obstructive pulmonary disease (COPD). The findings reveal that adults with COPD who also meet diagnostic criteria for depression or anxiety experience a higher burden of respiratory symptoms, poorer quality of life, and diminished functionality compared to their counterparts without these mental health disorders. 1
Despite their substantial impact, depression and anxiety remain undertreated in this population, with fewer than half of affected individuals receiving pharmacologic or counseling interventions, the study found. Improved diagnostic practices are clearly indicated, according to the authors, writing in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation.
"People with COPD are sometimes screened for mental health disorders using questionnaires; however, these tools lack the ability to confirm diagnoses of depression and anxiety and may hinder those in need from receiving appropriate mental health care," lead author Jing Gennie Wang, MD, a pulmonologist at The Ohio State University Wexner Medical Center, said in a statement. "The study highlights the necessity of integrating comprehensive mental health assessments into COPD management to address the care gap."
Wang and colleagues conducted a secondary analysis of the Anxiety and COPD Evaluation, a national observational survey assessing anxiety screening questionnaires in individuals with COPD. The original study, conducted across 16 American Lung Association Airways Clinical Research Center sites, found that screening questionnaires had only "fair to moderate" psychometric screening properties in the COPD population. The current study used the Mini-International Neuropsychiatric Interview (MINI), a structured diagnostic tool based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria and considered the "gold standard" for identifying anxiety and depression "in situations where an interview with a psychiatrist is not feasible," they wrote.
The team then compared characteristics of disease burden as measured by questionnaires in COPD patients with and without anxiety and depression.
Findings
Among the 220 participants analyzed:
- 8% met MINI criteria for depression, and 8% for an anxiety disorder.
- Anxiety disorder was further classified as agoraphobia (10 participants), panic disorder (6), PTSD (6), generalized anxiety disorder (4) and social anxiety disorder (3).
- Only 39% of those diagnosed with major depressive disorder were prescribed antidepressants, and just 1 in 5 (22%) were receiving mental health counseling.
- Anxiety was also undertreated, with fewer than half (41%) of affected individuals receiving anxiolytics or counseling (47%).
Wang et al reported significant differences in baseline characteristics between those with and without a diagnosed depressive disorder, including age, (median, 60 years vs 66 years; P =.016) and household income (less than $22,000; 61% vs 30%; P =.014). Age also differed between those with and without an anxiety disorder (median, 59 years vs 65 years; P =.018), as did age of COPD onset (median, 48 years vs 55 years; P =.03).
Disease Impact
Findings based on measures of disease impact on symptoms and functionality showed that depression was associated with greater dyspnea, as measured by the modified Medical Research Council Dyspnea Scale (4 vs 3; P =.045), worse sleep quality (Pittsburgh Sleep Quality Index (11 vs 7, P =.001), higher COPD burden (COPD Assessment Test [CAT] 27 vs 17; P <.001), and significantly reduced health-related quality of life (5-Level EQ-5D 0.31 vs 0.59, P <.001).
Wang and colleagues believe the study offers critical insights into the psychiatric comorbidities of COPD patients and their profound impact on daily function and quality of life. The findings also highlight the limitations of current screening methods, which often rely on symptom-based questionnaires rather than structured diagnostic interviews.
"This is the first multicenter study to comprehensively describe the sociodemographic and clinical characteristics of individuals with COPD who meet MINI diagnostic criteria for major depressive and/or anxiety disorders," authors noted.
The findings are essential, they emphasized, because uncontrolled psychiatric comordities are associated with "maladaptive behaviors" that compromise optimal care of the disease and can lead to a cycle of disabling symptoms.2
"There is a need to understand patient and systems-level barriers to the accurate diagnosis of mood and anxiety disorders in this population, and for effective strategies to manage these conditions as an integral part of comprehensive COPD care," they concluded.
