Health Services Research and Development, Seattle, Washington, USA.
J Pain Symptom Manage. 2011 Feb;41(2):402-11. doi: 10.1016/j.jpainsymman.2010.05.012. Epub 2010 Dec 8.
Depressive symptoms are common among patients with chronic obstructive pulmonary disease (COPD) and may modify patients' preferences for life-sustaining therapy. Examining the relationship between patient preferences for life-sustaining treatments and depressive symptoms is important for clinicians engaging in end-of-life care discussions.
To assess whether a history of depression or active depressive symptoms is associated with preferences for life-sustaining therapies among veterans with COPD.
This was a cross-sectional study of 376 veterans who participated in a randomized trial to improve the occurrence and quality of end-of-life communication between providers and patients. Depressive symptoms were assessed by self-reported history and the Mental Health Index-5 survey. Preferences for mechanical ventilation (MV) and cardiopulmonary resuscitation (CPR) were assessed using standardized instruments. Multivariate logistic regression was conducted to adjust for potential confounding factors.
Participants were older men with severe COPD. A substantial proportion of participants noted that they would want MV (64.2%) or CPR (77.8%). Depressive history and active symptoms were not associated with preferences for MV and CPR either before or after adjusting for confounding variables.
Depressive history and active symptoms among veterans with severe COPD were not associated with their decisions for life-sustaining treatments. Clinicians caring for patients with COPD should understand the importance of assessing and treating patients with depressive symptoms, yet recognize that depressive symptoms may not be predictive of a patient declining life-sustaining treatments.
抑郁症状在慢性阻塞性肺疾病（COPD）患者中很常见，可能会改变患者对维持生命治疗的偏好。研究患者对维持生命治疗的偏好与抑郁症状之间的关系，对于参与临终关怀讨论的临床医生非常重要。
评估 COPD 退伍军人是否有抑郁病史或现患抑郁症状与对维持生命治疗的偏好之间的关系。
这是一项横断面研究，共纳入 376 名参与改善提供者与患者之间临终沟通的发生和质量的随机试验的退伍军人。抑郁症状通过自我报告的病史和心理健康指数-5 调查进行评估。使用标准化工具评估对机械通气（MV）和心肺复苏（CPR）的偏好。进行多变量逻辑回归以调整潜在的混杂因素。
参与者均为患有严重 COPD 的老年男性。相当一部分参与者表示他们希望接受 MV（64.2%）或 CPR（77.8%）。有抑郁病史和现患抑郁症状与 MV 和 CPR 的偏好均无相关性，无论是在调整混杂变量之前还是之后。
严重 COPD 退伍军人的抑郁病史和现患抑郁症状与他们对维持生命治疗的决策无关。照顾 COPD 患者的临床医生应了解评估和治疗抑郁症状患者的重要性，但要认识到抑郁症状可能不能预测患者拒绝维持生命的治疗。
