抑郁和焦虑可预测慢性阻塞性肺疾病患者的健康相关生活质量：系统评价和荟萃分析。
Depression and anxiety predict health-related quality of life in chronic obstructive pulmonary disease: systematic review and meta-analysis.
机构信息
National Institute for Health Research School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, UK ; Department of Psychiatry, Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK.
Institute of Health Service Research, University of Exeter Medical School and Peninsula Collaboration for Leadership in Health Research and Care, University of Exeter, Exeter, UK.
出版信息
Int J Chron Obstruct Pulmon Dis. 2014 May 20;9:501-12. doi: 10.2147/COPD.S58136. eCollection 2014.
BACKGROUND
The causal association between depression, anxiety, and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD) is unclear. We therefore conducted a systematic review of prospective cohort studies that measured depression, anxiety, and HRQoL in COPD.
METHODS
Electronic databases (Medline, Embase, Cumulative Index to Nursing and Allied Health Literature [CINAHL], British Nursing Index and Archive, PsycINFO and Cochrane database) were searched from inception to June 18, 2013. Studies were eligible for inclusion if they: used a nonexperimental prospective cohort design; included patients with a diagnosis of COPD confirmed by spirometry; and used validated measures of depression, anxiety, and HRQoL. Data were extracted and pooled using random effects models.
RESULTS
Six studies were included in the systematic review; of these, three were included in the meta-analysis for depression and two were included for the meta-analysis for anxiety. Depression was significantly correlated with HRQoL at 1-year follow-up (pooled r=0.48, 95% confidence interval 0.37-0.57, P<0.001). Anxiety was also significantly correlated with HRQoL at 1-year follow-up (pooled r=0.36, 95% confidence interval 0.23-0.48, P<0.001).
CONCLUSION
Anxiety and depression predict HRQoL in COPD. However, this longitudinal analysis does not show cause and effect relationships between depression and anxiety and future HRQoL. Future studies should identify psychological predictors of poor HRQoL in well designed prospective cohorts with a view to isolating the mediating role played by anxiety disorder and depression.
背景
在慢性阻塞性肺疾病（COPD）中，抑郁、焦虑与健康相关生活质量（HRQoL）之间的因果关系尚不清楚。因此，我们进行了一项系统评价，纳入了前瞻性队列研究，这些研究均测量了 COPD 患者的抑郁、焦虑和 HRQoL。
方法
我们检索了电子数据库（Medline、Embase、护理与联合健康文献累积索引[CINAHL]、英国护理索引和档案、PsycINFO 和 Cochrane 数据库），检索时间截至 2013 年 6 月 18 日。如果研究符合以下标准，则纳入分析：采用非实验性前瞻性队列设计；纳入通过肺量计检查确诊为 COPD 的患者；使用经过验证的抑郁、焦虑和 HRQoL 测量工具。使用随机效应模型提取和汇总数据。
结果
系统评价共纳入 6 项研究；其中，3 项研究纳入抑郁的荟萃分析，2 项研究纳入焦虑的荟萃分析。抑郁与 1 年随访时的 HRQoL 显著相关（汇总 r=0.48，95%置信区间 0.37-0.57，P<0.001）。焦虑与 1 年随访时的 HRQoL 也显著相关（汇总 r=0.36，95%置信区间 0.23-0.48，P<0.001）。
结论
焦虑和抑郁可预测 COPD 患者的 HRQoL。但是，这种纵向分析并未显示抑郁和焦虑与未来 HRQoL 之间的因果关系。未来的研究应在设计良好的前瞻性队列中确定 HRQoL 不良的心理预测因子，以期确定焦虑障碍和抑郁所起的中介作用。
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