The association of anxiety and depression with mortality in a COPD cohort. The HUNT study, Norway. (September 2020)

• Record Type: Journal Article
• Authors: Vikjord, Sigrid Anna Aalberg; Brumpton, Ben Michael; Mai, Xiao-Mei; Vanfleteren, Lowie; Langhammer, Arnulf
• Is Part Of: Respiratory medicine. Volume 171(2020)
• Publication Date: 2020-09
• Subjects: COPD -- Epidemiology -- Mortality -- Anxiety -- Depression; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2020.106089
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: 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. Highlights: Anxiety and depression are highly prevalent in individuals with COPD. Anxiety and depression could influence morbidity and mortality in these individuals. In a cohort with up to 23 years follow-up time, both anxiety and depression was found to influence mortality in COPD. Reduction in symptoms of anxiety with time was found to decrease mortality.