School of Nursing and Midwifery, Campbelltown Campus, NSW, Australia.
School of Science and Health, University of Western Sydney, Campbelltown Campus, NSW, Australia.
Chest. 2013 Sep;144(3):766-777. doi: 10.1378/chest.12-1911.
The longitudinal associations between depression or anxiety and COPD, and their comorbid effect on prognosis, have not been adequately addressed by previous reviews. We aimed to systematically assess these associations to inform guidelines and practice.
We searched electronic databases for articles published before May 2012. Longitudinal studies in adult populations that reported an association between clinically relevant depression or anxiety and COPD, or that reported their comorbid effect on exacerbation and/or mortality, were eligible. Risk ratios (RRs) were pooled across studies using random-effects models and were verified using fixed-effects models. Heterogeneity was explored with subgroup and metaregression analyses.
Twenty-two citations yielded 16 studies on depression or anxiety as predictors of COPD outcomes (incident COPD/chronic lung disease or exacerbation) and/or mortality, in 28,759 participants followed for 1 to 8 years, and six studies on COPD as a predictor of depression in 7,439,159 participants followed for 1 to 35 years. Depression or anxiety consistently increased the risk of COPD outcomes (RR, 1.43; 95% CI, 1.22-1.68), particularly in higher-quality studies and in people aged ≤ 66 years. Comorbid depression increased the risk of mortality (RR, 1.83; 95% CI, 1.00-3.36), particularly in men. Anxiety (or psychologic distress) increased the risk of COPD outcomes/mortality in most studies (RR, 1.27; 95% CI, 1.02-1.58). Finally, COPD consistently increased the risk of depression (RR, 1.69; 95% CI, 1.45-1.96).
Depression and anxiety adversely affect prognosis in COPD, conferring an increased risk of exacerbation and possibly death. Conversely, COPD increases the risk of developing depression. These bidirectional associations suggest potential usefulness of screening for these disease combinations to direct timely therapeutic intervention.
先前的综述并没有充分解决抑郁或焦虑与 COPD 之间的纵向关联及其对预后的共病影响。我们旨在系统评估这些关联，为指南和实践提供信息。
我们检索了截至 2012 年 5 月发表的电子数据库中的文章。纳入了成人人群中报告抑郁或焦虑与 COPD 之间具有临床相关性的纵向研究，或报告其对加重和/或死亡率的共病影响的研究。使用随机效应模型汇总研究间的风险比（RR），并使用固定效应模型进行验证。通过亚组和荟萃回归分析探索异质性。
22 篇引文产生了 16 项研究，这些研究探讨了抑郁或焦虑作为 COPD 结局（新发 COPD/慢性肺部疾病或加重）和/或死亡率的预测因素，共纳入 28759 名参与者，随访时间为 1 至 8 年，6 项研究探讨了 COPD 作为 7439159 名参与者中抑郁的预测因素，随访时间为 1 至 35 年。抑郁或焦虑始终增加 COPD 结局的风险（RR，1.43；95%CI，1.22-1.68），尤其是在质量较高的研究中和年龄≤66 岁的人群中。共病性抑郁增加了死亡率的风险（RR，1.83；95%CI，1.00-3.36），尤其是在男性中。在大多数研究中，焦虑（或心理困扰）增加了 COPD 结局/死亡率的风险（RR，1.27；95%CI，1.02-1.58）。最后，COPD 始终增加了抑郁的风险（RR，1.69；95%CI，1.45-1.96）。
抑郁和焦虑对 COPD 的预后产生不利影响，增加了加重和可能死亡的风险。相反，COPD 增加了发生抑郁的风险。这些双向关联表明，筛查这些疾病组合以指导及时的治疗干预可能具有潜在的作用。
