The Effect of Complex Interventions on Depression and Anxiety in Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

Abstract

BackgroundDepression and anxiety are very common in people with chronic obstructive pulmonary disease (COPD) and are associated with excess morbidity and mortality. Patients prefer non-drug treatments and clinical guidelines promote non-pharmacological interventions as first line therapy for depression and anxiety in people with long term conditions. However the comparative effectiveness of psychological and lifestyle interventions among COPD patients is not known. We assessed whether complex psychological and/or lifestyle interventions are effective in reducing symptoms of anxiety and depression in patients with COPD. We then determined what types of psychological and lifestyle interventions are most effective.Methods and FindingsSystematic review of randomised controlled trials of psychological and/or lifestyle interventions for adults with COPD that measured symptoms of depression and/or anxiety. CENTRAL, Medline, Embase, PsychINFO, CINAHL, ISI Web of Science and Scopus were searched up to April 2012. Meta-analyses using random effects models were undertaken to estimate the average effect of interventions on depression and anxiety. Thirty independent comparisons from 29 randomised controlled trials (n = 2063) were included in the meta-analysis. Overall, psychological and/or lifestyle interventions were associated with small reductions in symptoms of depression (standardised mean difference −0.28, 95% confidence interval −0.41 to −0.14) and anxiety (standardised mean difference −0.23, 95% confidence interval −0.38 to −0.09). Multi-component exercise training was the only intervention subgroup associated with significant treatment effects for depression (standardised mean difference −0.47, 95% confidence interval −0.66 to −0.28), and for anxiety (standardised mean difference −0.45, 95% confidence interval −0.71 to −0.18).ConclusionsComplex psychological and/or lifestyle interventions that include an exercise component significantly improve symptoms of depression and anxiety in people with COPD. Furthermore, multi-component exercise training effectively reduces symptoms of anxiety and depression in all people with COPD regardless of severity of depression or anxiety, highlighting the importance of promoting physical activity in this population.

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

“…Other studies including one with a waiting list as the control group failed to find significant effects. In line with these findings, a recent meta-analysis revealed only small, nonsignificant effects of CBT on self-reported symptoms of depression in COPD patients [63]. In comparison to COPD education, CBT has been shown to have a comparable antidepressant effect [64].…”

Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…Furthermore, in one randomized clinical trial in patients with COPD and depression, a personalized outpatient intervention program composed of education and counseling improved not only depressive symptoms and adherence to antidepressants, but also dyspnea-related disability (43). Pulmonary rehabilitation can modify both depression symptoms and readmission rates (44,45), but whether there is a causative link between reduction in depression scores and readmission rates has not been tested. In a retrospective analysis of Medicare data, Ahmedani and colleagues showed that patients with congestive heart failure, pneumonia, and acute myocardial infarction experienced increased risk of 30-day hospital readmission in the presence of comorbid depression (46).…”

Exercise training combined with psychological interventions for people with chronic obstructive pulmonary disease

“…cognitive behaviour therapy) have also been used in this same population to manage anxiety, depression, QOL, [5][6][7][8][9][10][11] dyspnoea 12 and exercise tolerance. 13 Over the last decade, four systematic reviews (with and without meta-analysis) have examined the evidence base for psychologically based interventions to alleviate anxiety and depression in people with COPD [14][15][16][17] with one systematic review for adults with asthma. 18 These reviews variously concluded that there was insufficient, 17,18 limited 14,16 and sufficient evidence 15 to support the use of psychological interventions.…”

“…13 Over the last decade, four systematic reviews (with and without meta-analysis) have examined the evidence base for psychologically based interventions to alleviate anxiety and depression in people with COPD [14][15][16][17] with one systematic review for adults with asthma. 18 These reviews variously concluded that there was insufficient, 17,18 limited 14,16 and sufficient evidence 15 to support the use of psychological interventions. Each of these reviews included studies where psychological interventions may have been provided in combination with exercise training, and (with the exception of Coventry et al 15 ) did not undertake subgroup analyses to compare different forms of interventions.…”