Nowak Christoph, Sievi Noriane A, Clarenbach Christian F, Schwarz Esther Irene, Schlatzer Christian, Brack Thomas, Brutsche Martin, Frey Martin, Irani Sarosh, Leuppi Jörg D, Rüdiger Jochen, Thurnheer Robert, Kohler Malcolm
Division of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland ; Medical Sciences Department, Uppsala University, 75237 Uppsala, Sweden.
Division of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland.
Pulm Med. 2014;2014:973858. doi: 10.1155/2014/973858. Epub 2014 Dec 4.
Psychological morbidity is common in chronic respiratory diseases. The diagnostic accuracy of the Hospital Anxiety and Depression Scale (HADS) and risk factors for comorbid depression in chronic obstructive pulmonary disease (COPD) are addressed. Consecutive COPD patients (GOLD stage I-IV, 40-75 years old) were enrolled in a multicentre, cross-sectional cohort study. Diagnosis of depression was ascertained through clinical records. Lung function, HADS score, 6-minute walking test (6-MWT), MRC dyspnoea score, and COPD Assessment Test (CAT) were evaluated. Two hundred fifty-nine COPD patients (mean age 62.5 years; 32% female; mean FEV1 48% predicted) were included. Patients diagnosed with depression (29/259; 11.2%) had significantly higher HADS-D and HADS-Total scores than nondepressed patients (median (quartiles) HADS-D 6 [4; 9] versus 4 [2; 7], median HADS-Total 14 [10; 20] versus 8 [5; 14]). Receiver-operating characteristic plots showed moderate accuracy for HADS-D, AUC 0.662 (95%CI 0.601-0.719), and HADS-Total, AUC 0.681 (95%CI 0.620-0.737), with optimal cut-off scores of >5 and >9, respectively. Sensitivity and specificity were 62.1% and 62.6% for HADS-D compared to 75.9% and 55.2% for HADS-Total. Age, comorbidities, sex, and lower airflow limitation predicted depression. The HADS exhibits low diagnostic accuracy for depression in COPD patients. Younger men with comorbidities are at increased risk for depression.
心理疾病在慢性呼吸道疾病中很常见。本文探讨了医院焦虑抑郁量表（HADS）在慢性阻塞性肺疾病（COPD）中的诊断准确性以及共病抑郁的危险因素。连续纳入多中心横断面队列研究的COPD患者（GOLD分级I-IV级，年龄40-75岁）。通过临床记录确定抑郁症诊断。评估肺功能、HADS评分、6分钟步行试验（6-MWT）、医学研究委员会（MRC）呼吸困难评分和慢性阻塞性肺疾病评估测试（CAT）。共纳入259例COPD患者（平均年龄62.5岁；32%为女性；平均第一秒用力呼气容积（FEV1）为预测值的48%）。诊断为抑郁症的患者（29/259；11.2%）的HADS-D和HADS总分显著高于未患抑郁症的患者（中位数（四分位数间距）HADS-D：6[4；9]对4[2；7]，中位数HADS总分：14[10；20]对8[5；14]）。受试者工作特征曲线显示HADS-D的诊断准确性中等，曲线下面积（AUC）为0.662（95%置信区间0.601-0.719），HADS总分为0.681（95%置信区间0.620-0.737），最佳截断分数分别为>5和>9。HADS-D的敏感性和特异性分别为62.1%和62.6%，而HADS总分为75.9%和55.2%。年龄、合并症、性别和较低的气流受限是抑郁症的预测因素。HADS在COPD患者抑郁症诊断中的准确性较低。患有合并症的年轻男性患抑郁症的风险增加。
