Prevalence of depression and anxiety in patients with chronic obstructive pulmonary disease and their association with psychosocial outcomes: A cross-sectional study from Pakistan

Abstract

Objectives: Chronic obstructive pulmonary disease contributes to substantial health and economic burden worldwide. Co-morbid depression and anxiety are highly prevalent in patients with chronic obstructive pulmonary disease. Depressive symptoms in chronic obstructive pulmonary disease are associated with poorer survival, longer hospitalisation and impaired quality of life. Literature on chronic obstructive pulmonary disease is largely derived from high-income countries; yet 90% of deaths related to chronic obstructive pulmonary disease occur in low- and middle-income countries. We aimed to establish the prevalence of anxiety and depression in patients with chronic obstructive pulmonary disease, as well as the association with psychosocial outcomes. Methods: This was a cross-sectional study of chronic obstructive pulmonary disease patients attending outpatient primary care clinics in Karachi, Pakistan. The Patient Health Questionnaire-9 was used to assess depression and the Generalised Anxiety Disorder-7 scale was used for the assessment of anxiety. Health-related quality of life was assessed with EuroQol–Five Dimensions, social support with Oslo-3 and social stress with Life Events Checklist. We recruited 293 subjects. Results: The prevalence of depression and anxiety in the sample was 51% ( n = 149) and 20% ( n = 59), respectively. Depressed chronic obstructive pulmonary disease patients reported significantly lower health-related quality of life scores as compared to non-depressed patients. Participants with depression had significantly higher levels of anxiety, less social support, higher social stress and more subjective impairment in quality of life. Conclusion: Given the association with reduced social support and increased perceived stress, the role of psychosocial interventions must be explored in improving outcomes of chronic obstructive pulmonary disease patients in Pakistan.

Flourishing despite Chronic Obstructive Pulmonary Disease (COPD): Findings from a Nationally Representative Survey of Canadians Aged 50 and Older

“…Depression and anxiety are difficult to diagnose and treat in COPD patients because their symptoms frequently coincide with COPD symptoms [ 69 ]. COPD patients with co-occurring depression have been found to have higher levels of anxiety, less social support, higher social stress and more subjective impairment in quality of life than COPD patients without depression [ 70 ]. These findings emphasize the need to address individual’s history of mental illness to support the health of COPD patients.…”

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“…Evidence has shown that anxiety and depression are common in COPD. COPD patients have a greater prevalence of depression and anxiety than unaffected persons [ 33 ] and are reported to have a higher relative risk of depression [ 34 ]. A large cross-sectional study (n = 4803) reported a higher rate of depression in patients with COPD (62.1%) than those with other chronic diseases [ 35 ].…”

Burden of respiratory problems in low-income and middle-income countries

“…These findings have been confirmed for LMICs as well. A cross-sectional study of 293 COPD patients attending outpatient clinic in Pakistan found that 51 and 20% of people reported depression and anxiety, respectively [18]. Those reporting breathlessness had significantly higher levels of depression and lower quality of life.…”