Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany.
Department of Internal Medicine V, University of Munich (LMU), Ziemssenstr. 1, 80336, Munich, Germany.
Respir Res. 2019 Feb 11;20(1):30. doi: 10.1186/s12931-019-0997-y.
The diagnosis of depression, a frequent comorbidity of chronic obstructive pulmonary disease (COPD), is often supported by questionnaires, such as the Patient Health Questionnaire 9 (PHQ-9). It is unknown to which extent its single questions are affected by the clinical characteristics of COPD patients.We addressed this question in 2255 GOLD grade 1-4 patients from the COSYCONET (COPD and Systemic Consequences - Comorbidities Network) COPD cohort. The dependence on COPD severity was assessed using symptoms, exacerbation risk (GOLD A-D; modified Medical Research Council dyspnoea scale (mMRC)), and frequent comorbidities as predictors of PHQ-9 results, while including age, gender, body mass index (BMI) and smoking habits as covariates.Symptoms and exacerbation risk were associated with depression in an additive manner, with mean elevations in the PHQ-9 sum score by 2.75 and 1.44 points, respectively. Asthma, sleep apnoea, gastrointestinal disorders, osteoporosis and arthritis were linked to increases by 0.8 to 1.3 points. Overall, the COPD characteristics contributed to the mean PHQ-9 score by increases from 4.5 or 5.2 to 6.3 points, respectively, when either taking GOLD A as reference or the absence of comorbidities. This finding was independent of the diagnosis of mental disorder or the intake of antidepressants. The presence of COPD led to an increase in the proportion of scores indicating depression from 12 to 22%. Single item analysis revealed homogenous effects regarding GOLD groups, but heterogeneous effects regarding GOLD grades.These findings indicate specific effects of COPD severity on the PHQ-9 depression score, especially symptoms and exacerbation risk, explaining the high prevalence of depression in COPD. Alternative explanations like an overlap of COPD severity and PHQ-9 items are discussed. Of note, we also found COPD treatment effects on depression scores.
抑郁症是慢性阻塞性肺疾病（COPD）的常见合并症，其诊断通常依赖于问卷，如患者健康问卷 9（PHQ-9）。目前尚不清楚其单项问题在多大程度上受到 COPD 患者临床特征的影响。我们在 COSYCONET（COPD 和全身后果-合并症网络）COPD 队列的 2255 名 GOLD 1-4 级患者中探讨了这一问题。使用症状、加重风险（GOLD A-D；改良医学研究理事会呼吸困难量表（mMRC））和常见合并症作为 PHQ-9 结果的预测因子，评估对 COPD 严重程度的依赖，同时将年龄、性别、体重指数（BMI）和吸烟习惯作为协变量。症状和加重风险以累加的方式与抑郁相关，PHQ-9 总分分别平均升高 2.75 和 1.44 分。哮喘、睡眠呼吸暂停、胃肠道疾病、骨质疏松症和关节炎与升高 0.8 至 1.3 分相关。总的来说，当以 GOLD A 为参考或无合并症时，COPD 特征分别使 PHQ-9 平均评分增加 4.5 或 5.2 至 6.3 分，从而导致 PHQ-9 评分增加。这一发现与精神障碍的诊断或抗抑郁药的摄入无关。COPD 的存在导致表明抑郁的评分比例从 12%增加到 22%。单项分析表明，GOLD 组之间存在同质影响，但 GOLD 等级之间存在异质影响。这些发现表明 COPD 严重程度对 PHQ-9 抑郁评分有特定影响，尤其是症状和加重风险，这解释了 COPD 中抑郁的高患病率。还讨论了 COPD 严重程度和 PHQ-9 项目重叠等替代解释。值得注意的是，我们还发现 COPD 治疗对抑郁评分有影响。
