Omachi Theodore A, Katz Patricia P, Yelin Edward H, Gregorich Steven E, Iribarren Carlos, Blanc Paul D, Eisner Mark D
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-0111, USA.
Am J Med. 2009 Aug;122(8):778.e9-15. doi: 10.1016/j.amjmed.2009.01.036.
Prior research on the risk of depression in chronic obstructive pulmonary disease (COPD) has yielded conflicting results. Furthermore, we have an incomplete understanding of how much depression versus respiratory factors contributes to poor health-related quality of life.
Among 1202 adults with COPD and 302 demographically matched referents without COPD, depressive symptoms were assessed using the 15-item Geriatric Depression Score. We measured COPD severity using a multifaceted approach, including spirometry, dyspnea, and exercise capacity. We used the Airway Questionnaire 20 and the Physical Component Summary Score to assess respiratory-specific and overall physical quality of life, respectively.
In multivariate analysis adjusting for potential confounders including sociodemographics and all examined comorbidities, COPD subjects were at higher risk for depressive symptoms (Geriatric Depression Score >or=6) than referents (odds ratio [OR] 3.6; 95% confidence interval [CI], 2.1-6.1; P <.001). Stratifying COPD subjects by degree of obstruction on spirometry, all subgroups were at increased risk of depressive symptoms relative to referents (P <.001 for all). In multivariate analysis controlling for COPD severity as well as sociodemographics and comorbidities, depressive symptoms were strongly associated with worse respiratory-specific quality of life (OR 3.6; 95% CI, 2.7-4.8; P <.001) and worse overall physical quality of life (OR 2.4; 95% CI, 1.8-3.2; P <.001).
Patients with COPD are at significantly higher risk of having depressive symptoms than referents. Such symptoms are strongly associated with worse respiratory-specific and overall physical health-related quality of life, even after taking COPD severity into account.
先前关于慢性阻塞性肺疾病（COPD）患者发生抑郁症风险的研究结果相互矛盾。此外，我们对于抑郁症与呼吸因素在导致健康相关生活质量不佳方面各自的作用程度了解尚不完全。
在1202例患有COPD的成年人以及302例人口统计学特征匹配的无COPD对照者中，使用15项老年抑郁量表评估抑郁症状。我们采用多方面方法测量COPD严重程度，包括肺功能测定、呼吸困难和运动能力。我们分别使用气道问卷20和身体成分汇总评分来评估呼吸特异性和总体身体生活质量。
在对包括社会人口统计学和所有检查的合并症等潜在混杂因素进行校正的多变量分析中，COPD患者出现抑郁症状（老年抑郁量表评分≥6）的风险高于对照者（比值比[OR] 3.6；95%置信区间[CI]，2.1 - 6.1；P <.001）。根据肺功能测定的阻塞程度对COPD患者进行分层，所有亚组出现抑郁症状的风险相对于对照者均增加（所有P <.001）。在控制COPD严重程度以及社会人口统计学和合并症的多变量分析中，抑郁症状与较差的呼吸特异性生活质量（OR 3.6；95% CI，2.7 - 4.8；P <.001）和较差的总体身体生活质量（OR 2.4；95% CI，1.8 - 3.2；P <.001）密切相关。
COPD患者出现抑郁症状的风险显著高于对照者。即使考虑了COPD严重程度，这些症状仍与较差的呼吸特异性和总体身体健康相关生活质量密切相关。
