The Impact of Depression and Anxiety on Chronic Obstructive Pulmonary Disease Acute Exacerbations: A prospective cohort study

To explore the impact of anxiety and depression in chronic obstructive pulmonary disease(COPD) patients on the risk of acute exacerbation. 600 COPD patients were recruited and followed in Beijing, China. The demographic data, medical history, smoking history, therapy, assessments for anxiety and depression were completed by our physicians by face-to-face interview. Then the acute exacerbation events during the past one year was derived from their case record. 504 people (295 men and 209 women) were thus included in the final analyses.The patients with anxiety scored more than 50 showed higher risk of acute exacerbation(54.1%) than those who scoring less than 50(39.8%). Similarly, the patients with depression scored more than 53 showed higher risk of acute exacerbation(52.1%) than those who scoring less than 53(40.4%). Eventually, Anxiety and/or depression will increase the risk of acute exacerbation in chronic obstructive pulmonary disease patients(AECOPD) (adjusted OR = 1.60, 95%CI: 1.10-2.31), after adjusting the influence of family history, duration of disease, BMI index and other factors. Besides, the prevalence of acute exacerbation in patients with anxiety and/or depression was higher than those without acute exacerbation (P<0.05). The frequency of AECOPD was limited to self-reported data, recall bias should be reconsidered, and it also may underestimate the association between anxiety and/or depression and AECOPD. Anxiety and depression were assessed by questionnaires rather than by a clinical diagnosis. Anxiety and/or depression in stable COPD patients were significantly associated with a higher risk of acute exacerbation. Mental health care should be paid more attention, to decrease the risk of acute exacerbation in COPD patients.