Background

Anxiety and depression are prevalent among individuals with chronic obstructive pulmonary disease (COPD), but the impact of these comorbidities on long-term mortality is unknown.

Aims

This study aims to compare mortality in individuals with COPD who had or did not have symptoms of anxiety or depression as well as the impact of a change in these symptoms on mortality.

Methods

Individuals with COPD according to the Global Lung Initiative (GLI) LLN criteria (n = 2076) were recruited from the second (1995–97) and third (2006–08) surveys of the HUNT Study and followed until January 2019 for mortality. We assessed baseline status of anxiety or depression using the Hospital Anxiety and Depression Scale (HADS), and probable cases were defined by a score ≥8. We used Cox regression to calculate hazard ratios (HR) with 95% confidence intervals (CI). Change in HADS score over time was assessed using joint models.

Results

Among the individuals with COPD, 16.2% had symptoms of anxiety and 15.9% had symptoms of depression. Compared to those with HADS-A and -D score <8, symptoms of anxiety or depression increased mortality by 21% (95% CI 05–47%) and 21% (2–44%), respectively. Over the approximately 11-year period between surveys, change of HADS-A from ≥8 to <8 was associated with a decrease in mortality (HR 0.97 [95% CI 0.94–1.00]), but not in HADS-D (0.97 [95% CI 0.93–1.18]).

Conclusions

Individuals with COPD and symptoms of anxiety or depression have increased mortality, and improved HADS-A score with time is associated with lower mortality.

中文翻译：

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在COPD队列中，焦虑和抑郁与死亡率相关。HUNT研究，挪威。

背景

焦虑和抑郁在患有慢性阻塞性肺疾病（COPD）的患者中普遍存在，但这些合并症对长期死亡率的影响尚不清楚。

目的

这项研究旨在比较患有或没有焦虑或抑郁症状的COPD患者的死亡率，以及这些症状变化对死亡率的影响。

方法

根据HUNT研究的第二次（1995–97年）和第三次（2006–08年）调查，招募了根据全球肺病倡议（GLI）LLN标准（n = 2076）患有COPD的患者，并随访至2019年1月进行死亡率调查。我们使用医院焦虑和抑郁量表（HADS）评估了焦虑或抑郁的基线状态，可能的病例定义为得分≥8。我们使用Cox回归来计算具有95％置信区间（CI）的危险比（HR）。使用联合模型评估HADS分数随时间的变化。

结果

在COPD患者中，有16.2％的患者有焦虑症状，有15.9％的患者有抑郁症状。与HADS-A和-D得分<8的人相比，焦虑或抑郁症状的死亡率分别增加了21％（95％CI 05-47％）和21％（2-44％）。在两次调查之间大约11年的时间里，HADS-A从≥8变为<8与死亡率降低相关（HR 0.97 [95％CI 0.94–1.00]），但与HADS-D无关（0.97 [ 95％CI 0.93-1.18]）。

结论

患有COPD并伴有焦虑或抑郁症状的个体死亡率增加，而随时间推移而改善的HADS-A得分与较低的死亡率相关。