Depressive symptoms among patients with COPD according to smoking status: a Danish nationwide case�control study of 21 184 patients

Abstract

IntroductionDepressive symptoms appear more often among patients with chronic obstructive pulmonary disease (COPD) and are associated with reduced disease control and increased mortality. Both smoking and COPD increase the risk of depressive symptoms. Whether smoking cessation among COPD patients affects the occurrence of depressive symptoms is unknown. We hypothesised that smoking cessation in patients with COPD leads to reduced use of antidepressants and fewer admissions to psychiatric hospitals with depression, anxiety or bipolar disorder.MethodsWe conducted a nationwide retrospective case-control study, in patients from The Danish Register for Chronic Obstructive Pulmonary Disease (DrCOPD) with spirometry verified COPD, age ≥40 years, a history of smoking and absence of cancer. Consistent smokers were matched 1:1 with ex-smokers using a propensity score model. Prescription fillings of antidepressants and risk of admissions to psychiatric hospitals with either depression, anxiety or bipolar disorder both descriptively was assessed by Cox proportional hazard models.ResultsWe included 21 184 patients. A total of n=2011 consistent smokers collected antidepressant prescriptions compared with 1821 ex-smokers. Consistent smoking was associated with increased risk of filling prescription on antidepressants (HR 1.4, 95% CI 1.3–1.5, p<0.0001). and with increased risk of psychiatric hospital admission with either depression, anxiety or bipolar disorder (HR 2.0, 95% CI 1.6–2.5). The associations persisted after adjustment for former use of antidepressants.ConclusionConsistent smoking among COPD patients was associated with increased use of antidepressants and admissions to psychiatric hospitals with either depression, anxiety or bipolar disorder, compared to smoking cessation.

Common Mental Disorders, Functional Limitation and Diet Quality Trends and Related Factors among COPD Patients in Spain, 2006–2017: Evidence from Spanish National Health Surveys

“…It has also been reported that men with COPD take part in significantly more physical activity than women and that physical activity relieves their symptoms, improves their quality of life and decreases the risk of exacerbations [ 13 ]. Additionally, in the current study, being a smoker was related to an increased likelihood of CMDs in women, which supports previous reports [ 60 , 71 ]. Female COPD patients are more likely to suffer from depression and anxiety than their male counterparts, with manifestations that can be severe [ 60 ].…”

Physical and mental health status of former smokers and non‐smokers patients with bipolar disorder

“…BD (and probably psychiatric disorders in general) remains a risk factor for persistent smoking compared with unaffected individuals. 56 Tobacco smoking has been associated with a wide range of psychiatric/psychological and non-psychiatric difficulties in BD 25,38,44 and it decreases the plasma levels and the effectiveness of several psychotropic drugs. 5 Finally, smoking also impacts quality of life of patients with BD.…”