Depression and suicidality in COPD: understandable reaction or independent disorders?

Hegerl, Ulrich; Mergl, Roland

doi:10.1183/09031936.00193213

Cited by 30 publications

(16 citation statements)

References 69 publications

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“…The strong association between COPD and suicide risk, as demonstrated in the present study and earlier studies, underlines the importance of mental healthcare for patients with COPD, 31 especially those recently discharged from hospital treatment or with multiple hospitalisations, female patients and patients of advanced ages. Assessment of suicide risk and prevention effort should take into account patients’ sex, age and psychiatric history.…”

Section: Discussionsupporting

confidence: 85%

“… 30 Somatic patients having been treated for psychiatric problems may receive additional attention on possible suicidal behaviour than individuals who have never had any hospital contact because of psychiatric problems. 7 31 Consequently, a diagnosis of COPD has a relatively smaller effect on risk of suicide for individuals with psychiatric comorbidity than for those without the comorbidity. Moreover, patients with psychiatric illness already have an increased suicide risk a priori, it is therefore understandable that the additional effect from COPD on suicide risk in these patients is not as strong as the effect of COPD in patients who have never received any specialist care or been hospitalised for psychiatric treatment.…”

Section: Discussionmentioning

confidence: 99%

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Hospitalisation for chronic obstructive pulmonary disease and risk of suicide: a population-based case–control study

et al. 2014

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Objectives To examine risk of suicide among individuals with hospitalised chronic obstructive pulmonary disease (COPD) and to profile differences according to sex, age, psychiatric history, and recency and frequency of COPD hospitalisations. Design Nested case–control study. Setting Data were retrieved from Danish national registries. Participants All suicide cases aged 40–95 years deceased between 1981 and 2006 in Denmark (n=19 869) and up to 20 live population controls per case matched on sex and date of birth (n=321 867 controls). Main outcome measures The relative risk of suicide associated with COPD was computed using conditional logistic regression and adjusted for effects of psychiatric history and important sociodemographic factors. Results In our study population, 3% of suicide cases had been hospitalised for COPD compared with 1% of matched population controls. Thus, a hospitalised COPD was associated with a significantly increased risk for suicide (OR 2.6; 95% CI 2.3 to 2.8). The increased risk remained significant after adjustment for psychiatric history and sociodemographic variables (OR 2.0; 95% CI 1.8 to 2.2), and increased progressively with frequency and recency of COPD hospitalisation. At the same time, suicide risk associated with COPD differed significantly by sex, age and psychiatric status. The relative risk was more pronounced in women, in individuals older than 60 years and in persons with no history of psychiatric illness. Conclusions COPD confers an important risk factor for suicide completion. Risk assessment and prevention efforts should take patients’ sex, age and psychiatric history into consideration.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Hospitalisation for chronic obstructive pulmonary disease and risk of suicide: a population-based case–control study

et al. 2014

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“…Two recent reviews suggested that no firm conclusions can be drawn about the effectiveness of antidepressants (selective serotonin reuptake inhibitors and tricyclic antidepressants) in reducing depression in COPD because there are only a small number of published trials in this area, many of which have important methodological limitations, such as small sample sizes, and high dropout rates. 83 , 84 …”

Section: Resultsmentioning

confidence: 99%

Overview of the prevalence, impact, and management of depression and anxiety in chronic obstructive pulmonary disease

Panagioti¹,

Scott²,

Blakemore³

et al. 2014

COPD

120

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More than one third of individuals with chronic obstructive pulmonary disease (COPD) experience comorbid symptoms of depression and anxiety. This review aims to provide an overview of the burden of depression and anxiety in those with COPD and to outline the contemporary advances and challenges in the management of depression and anxiety in COPD. Symptoms of depression and anxiety in COPD lead to worse health outcomes, including impaired health-related quality of life and increased mortality risk. Depression and anxiety also increase health care utilization rates and costs. Although the quality of the data varies considerably, the cumulative evidence shows that complex interventions consisting of pulmonary rehabilitation interventions with or without psychological components improve symptoms of depression and anxiety in COPD. Cognitive behavioral therapy is also an effective intervention for managing depression in COPD, but treatment effects are small. Cognitive behavioral therapy could potentially lead to greater benefits in depression and anxiety in people with COPD if embedded in multidisciplinary collaborative care frameworks, but this hypothesis has not yet been empirically assessed. Mindfulness-based treatments are an alternative option for the management of depression and anxiety in people with long-term conditions, but their efficacy is unproven in COPD. Beyond pulmonary rehabilitation, the evidence about optimal approaches for managing depression and anxiety in COPD remains unclear and largely speculative. Future research to evaluate the effectiveness of novel and integrated care approaches for the management of depression and anxiety in COPD is warranted.

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“…Providers may contribute to this by assuming, incorrectly, that depression is an understandable reaction to COPD. 32 While dealing with COPD does pose powerful adaptive challenges for patients, depression and SI are not inevitable and require an effective clinical response that starts with increased provider awareness of depression, suicide ideation, and suicide risk in COPD, and understanding that these problems are not the direct result of having COPD but of a separate but interacting comorbid condition.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and correlates of suicide ideation in patients with COPD: a mixed methods study

Fleehart

Fan

Nguyen

et al. 2014

COPD

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PurposeThe purpose of this study was to examine the prevalence and correlates of suicidal ideation (SI) in patients with stable moderate to very severe chronic obstructive pulmonary disease (COPD).Patients and methodsWe conducted an exploratory mixed methods analysis of data from participants in a longitudinal observational study of depression in COPD. We measured depression with the Patient Health Questionnaire-9 (PHQ-9), which includes an item on SI. We compared participants with and without SI in relation to sociodemographics, symptoms, anxiety, and healthcare resource use with independent t-tests and chi-square tests. Content analysis was performed on qualitative data gathered during a structured SI safety assessment.ResultsOf 202 participants, 121 (60%) had depressive symptoms (PHQ ≥6); 51 (25%) had a PHQ-9 ≥10, indicating a high likelihood of current major depression; and 22 (11%) reported SI. Compared to the 99 depressed participants without SI, those with SI were more likely to be female (59% vs 27%, P=0.004); had worse dyspnea (P=0.009), depression (P<0.001), and anxiety (P=0.003); and were also more likely to have received treatment for depression and/or anxiety (82% vs 40%, P<0.001) and more hospitalizations for COPD exacerbations (P=0.03) but had similar levels of airflow obstruction and functioning than participants without SI. Themes from the qualitative analysis among those with SI included current or prior adverse life situations, untreated or partially treated complex depression, loss of a key relationship, experience of illness and disability, and poor communication with providers.ConclusionOur findings suggest that current SI is common in COPD, may occur disproportionately in women, can persist despite mental health treatment, and has complex relationships with both health and life events. Adequate management of SI in COPD may therefore require tailored, comprehensive treatment approaches that integrate medical and mental health objectives.

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Depression and suicidality in COPD: understandable reaction or independent disorders?

Cited by 30 publications

References 69 publications

Hospitalisation for chronic obstructive pulmonary disease and risk of suicide: a population-based case–control study

Hospitalisation for chronic obstructive pulmonary disease and risk of suicide: a population-based case–control study

Overview of the prevalence, impact, and management of depression and anxiety in chronic obstructive pulmonary disease

Prevalence and correlates of suicide ideation in patients with COPD: a mixed methods study

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