Alexopoulos George S, Sirey Jo Anne, Raue Patrick J, Kanellopoulos Dora, Clark Timothy E, Novitch Richard S
Department of Psychiatry, Weill Medical College of Cornell University, USA.
Am J Geriatr Psychiatry. 2006 May;14(5):466-75. doi: 10.1097/01.JGP.0000199381.98971.d1.
Approximately 30% of patients with chronic obstructive pulmonary disease (COPD) experience depression. Pulmonary rehabilitation for COPD focuses on physical conditioning, but includes behavioral interventions that may address depressive symptoms. This study tested the hypothesis that brief inpatient pulmonary rehabilitation is followed by improvement in both depressive symptoms and function in patients with COPD with major depression.
The subjects, who were recruited from the pulmonary rehabilitation unit of the Burke Rehabilitation Hospital in White Plains, NY, who had COPD and major depression were consecutively admitted patients to a pulmonary rehabilitation unit. Symptoms of depression, disability, medical burden, the experience of support, and satisfaction with treatment were systematically ascertained on admission and before discharge.
Three hundred sixty-one patients were screened and 63 met criteria for COPD and major depression. Depressive symptoms improved by discharge (z = -6.785, p <0.0001); median length of stay was 16 days. Approximately 51% of subjects met criteria for response (50% or greater reduction in depressive symptoms scores from baseline), and 39% met criteria for remission (final Hamilton Depression scale score equal to or less than 10). History of treatment for depression was associated with limited change in depressive symptoms, whereas social support and satisfaction with treatment were predictors of improvement. All disability domains were lower at discharge compared to baseline (z = -3.928, p <0.0001). Subjects with pronounced disability at baseline had the greatest improvement if their depression improved by discharge.
Acute inpatient rehabilitation is followed by improvement of depressive symptoms and disability in older patients with COPD and major depression. Improvement of depression may be the result of behavioral interventions rather than the use of antidepressant drugs.
约30%的慢性阻塞性肺疾病（COPD）患者伴有抑郁症。COPD的肺康复主要关注身体机能训练，但也包括可能改善抑郁症状的行为干预措施。本研究检验了以下假设：对患有重度抑郁症的COPD患者进行短期住院肺康复治疗后，其抑郁症状和功能均会得到改善。
研究对象从纽约州白原市伯克康复医院的肺康复科招募，均为患有COPD且伴有重度抑郁症的连续入院患者。在入院时和出院前，系统地确定患者的抑郁症状、残疾情况、医疗负担、支持体验以及对治疗的满意度。
共筛查了361例患者，其中63例符合COPD和重度抑郁症的标准。出院时抑郁症状有所改善（z = -6.785，p <0.0001）；中位住院时间为16天。约51%的受试者达到反应标准（抑郁症状评分较基线降低50%或更多），39%的受试者达到缓解标准（汉密尔顿抑郁量表最终评分等于或低于10分）。抑郁症治疗史与抑郁症状变化有限相关，而社会支持和对治疗的满意度是改善的预测因素。与基线相比，出院时所有残疾领域的情况均有所改善（z = -3.928，p <0.0001）。基线时残疾明显的受试者，如果出院时抑郁症状有所改善，则改善最为显著。
对于患有COPD且伴有重度抑郁症的老年患者，急性住院康复治疗后抑郁症状和残疾情况均有所改善。抑郁症状的改善可能是行为干预的结果，而非使用抗抑郁药物的结果。
