Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Science, University of Würzburg, Würzburg, Germany.
Klinik Bad Reichenhall, Center of Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany.
J Affect Disord. 2018 Nov;240:33-40. doi: 10.1016/j.jad.2018.07.021. Epub 2018 Jul 23.
Depression is a frequent comorbidity in COPD. COPD symptoms such as dyspnea may play an important role in the causal relationship between COPD and depression. We investigated the interrelations among different aspects of dyspnea and other COPD parameters and symptoms of depression in COPD patients.
This is a secondary analysis of N = 590 COPD patients. At the beginning (T0) and the end (T1) of a 3-week inpatient pulmonary rehabilitation, dyspnea aspects intensity (BORG scale), frequency (2 CCQ items), functioning (CCQ-function) and cognitive/emotional response (2 SGRQ items) as well as cough (2 CCQ items), functional capacity (6MWD), lung function (FEV1) and symptoms of depression (PHQ-9) were assessed. Regression analyses with PHQ-9 sum score as dependent variable as well as network analysis using PHQ-9 single items were performed. Structural invariance over time was examined.
Dyspnea frequency, function, and cognitive/emotional response showed conditional independent relationships with PHQ-9 sum score. Network analysis showed that dyspnea frequency and dyspnea functioning were primarily associated with somatic depression symptoms (for example, sleep problems, loss of energy), while cognitive/emotional response was primarily related to cognitive-affective depression symptoms (for example, feeling down/depressed/hopeless). Regression parameters, network structure and network global strength did not differ between T0 and T1.
Models are based on between-person relationships. Results should be confirmed using time-series data.
Dyspnea and depression seem to be interrelated through a variety of different and complex pathways in COPD patients. Results may be used to explain intervention effects and develop new intervention strategies to reduce depression in COPD.
抑郁症是 COPD 的常见合并症。COPD 症状，如呼吸困难，可能在 COPD 和抑郁症之间的因果关系中起重要作用。我们研究了呼吸困难的不同方面与 COPD 患者的其他 COPD 参数和抑郁症状之间的相互关系。
这是对 590 例 COPD 患者的二次分析。在 3 周住院肺康复的开始（T0）和结束（T1）时，评估了呼吸困难方面的强度（BORG 量表）、频率（2 个 CCQ 项目）、功能（CCQ-功能）和认知/情绪反应（2 个 SGRQ 项目）以及咳嗽（2 个 CCQ 项目）、功能能力（6MWD）、肺功能（FEV1）和抑郁症状（PHQ-9）。使用 PHQ-9 总分作为因变量进行回归分析，并使用 PHQ-9 单项进行网络分析。检查了随时间的结构不变性。
呼吸困难频率、功能和认知/情绪反应与 PHQ-9 总分呈条件独立关系。网络分析表明，呼吸困难频率和呼吸困难功能主要与躯体抑郁症状相关（例如，睡眠问题，精力丧失），而认知/情绪反应主要与认知情感抑郁症状相关（例如，感到沮丧/沮丧/绝望）。T0 和 T1 之间的回归参数、网络结构和网络整体强度没有差异。
模型基于个体之间的关系。应使用时间序列数据来验证结果。
在 COPD 患者中，呼吸困难和抑郁似乎通过各种不同且复杂的途径相互关联。结果可用于解释干预效果并开发新的干预策略，以降低 COPD 患者的抑郁水平。
