Academic journal article East Asian Archives of Psychiatry

Association of Psychiatric Co-Morbidities and Quality of Life with Severity of Chronic Obstructive Pulmonary Disease

Academic journal article East Asian Archives of Psychiatry

Association of Psychiatric Co-Morbidities and Quality of Life with Severity of Chronic Obstructive Pulmonary Disease

Article excerpt

Abstract

Objective: This was a single-centre, cross-sectional, observational study performed at a tertiary care hospital in India to study the association of psychiatric co-morbidities and quality of life with severity of chronic obstructive pulmonary disease (COPD).

Methods: A total of 59 clinically stable patients with COPD were assessed for disease severity, as per the updated Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline (2013). Psychiatric co-morbidities like anxiety disorders and depression were diagnosed by clinician-administered interview (as per the DSM-V criteria). Insomnia, anxiety disorders and depression, as well as quality of life were also assessed by self-rating scales including Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale, and St. George's Respiratory Questionnaire, respectively.

Results: Depression was the commonest psychiatric co-morbidity affecting 32.2% of individuals. Patients with depression and anxiety disorders had higher score in COPD assessment test (p = 0.02 and p = 0.004, respectively), ISI (p < 0.001 and p = 0.01, respectively), and poorer quality of life (p < 0.001 and p = 0.02, respectively) compared with those without these conditions. Patients with severe symptoms of COPD were more likely to suffer from anxiety (p = 0.001), depression (p = 0.01), insomnia (p = 0.01), and have poor quality of life (p < 0.001). Patients in the GOLD-D (i.e. those at high risk and with more symptoms) group had poorer quality of life (p = 0.004) when compared with GOLD-A (low risk and less symptoms) and GOLD-C (high risk and less symptoms) groups.

Conclusions: Patients with psychiatric co-morbidities have severe symptoms of COPD and poor quality of life.

Key words: Anxiety; Depression; Mental disorders; Pulmonary disease, chronic obstructive; Quality of life

Introduction

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable respiratory disease characterised by irreversibility of airflow limitations and dyspnoea, affecting the individual's physical health and quality of life, which are the leading causes of disability and death.1,2 Psychiatric illnesses are increasingly common in patients with chronic illnesses; despite this, psychiatric co-morbidities among patients with COPD are less studied in comparison with general medical conditions.1 Psychiatric co-morbidities contribute significantly to functional impairment in patients with COPD, and treatment of these serves to improve both the psychiatric and pulmonary status.1,3 Anxiety disorders and depression are the commonest psychiatry diagnoses among the COPD patients.4 Prevalence of anxiety disorders varies from 2% to > 50% in various studies, while that of depression varies from 6% to 42%.5-7 Higher frequency of anxiety disorders and depression is correlated with severity of COPD.6,7 Earlier, the severity of COPD was classified based on FEV1 value (i.e. % of predicted value of forced expiratory volume in one second) into various stages of Global Initiative for Chronic Obstructive Lung Disease (GOLD).2,6,8 Updated GOLD guideline (2013)2 recommended additional inclusion of current level of symptoms, exacerbation risk, and presence of co-morbidity in the classification of severity, as there were weak correlations with FEV1, symptoms, and impairment in health-related quality of life.

As there is no published evidence assessing psychiatric co-morbidities and quality of life with severity of COPD classified by the updated GOLD guideline, we evaluated association of psychiatric co-morbidities (including insomnia, anxiety disorders, depression, obsessive-compulsive disorder) and quality of life with severity of COPD classified according to the updated GOLD guideline.

Methods

This was a cross-sectional study conducted between September and November 2013 and recruited 59 consecutive patients attending the outpatient clinic of the department of pulmonary medicine at a tertiary care hospital in India. …

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