Chest
Volume 137, Issue 2, February 2010, Pages 341-347
Journal home page for Chest

Original Research
COPD
COPD and the Risk of Depression

https://doi.org/10.1378/chest.09-0614Get rights and content

Background

Chronic comorbidities are often associated with depression. Most previous studies exploring the association between COPD and depression were rather small and based on a cross-sectional study design. We conducted a large population-based study on the risk of developing an incident depression diagnosis in association with a previous COPD diagnosis.

Methods

We used the UK-based General Practice Research Database to assess and compare the prevalence of a history of depression and to quantify the risk of developing incident depression in patients with COPD and patients without COPD between 1995 and 2005. We conducted a nested case-control analysis, matching up to four patients who did not develop depression for each case patient with depression, to further analyze the impact of COPD severity.

Results

In a study population of 35,722 patients with COPD and 35,722 patients without COPD, the prevalence of diagnosed depression prior to the first COPD diagnosis was higher in the population with COPD (23.1%) than among patients without COPD (16.8%). The incidence rate of a new-onset diagnosis of depression after the first COPD diagnosis was 16.2/1,000 person-years (py) in the COPD group, whereas it was only 9.4/1,000 py in the COPD-free comparison group. In the nested case-control analysis, patients with severe COPD had the highest risk of developing depression (odds ratio, 2.01; 95% CI, 1.45–2.78).

Conclusion

This large observational study provides further evidence that patients with COPD are at an increased risk of developing depression.

Section snippets

Data Source

We used the UK-based General Practice Research Database (GPRD) to conduct a follow-up study with a nested case-control analysis. The GPRD has been described in detail elsewhere.14 It is a large primary-care database established in 1987 that encompasses some 5 million patients who are enrolled with selected GPs throughout the United Kingdom. The GPs who contribute data to the GPRD have been trained to record medical information in a standard manner and to supply it anonymously. The recorded

Results

We identified 35,772 patients with COPD and the same number of matched patients in the COPD-free comparison group. The study population encompassed slightly more men (51.3%) than women (48.7%). Almost three-quarters (73.3%) of the study population were 60 years or older at the time of the first recorded COPD diagnosis. A previous history of depression was slightly more common among patients with COPD (23.1%) than in the COPD-free comparison group (16.8%).

After excluding patients with prevalent

Discussion

In this large observational study, the prevalence of depression was slightly higher among patients with COPD (23.1%) than in the COPD-free comparison group (16.8%), which is consistent with the range of previously reported estimates in the literature.4 In the follow-up analysis, we found an increased risk of developing an incident diagnosis of depression among patients with COPD as compared with patients without COPD, particularly in women, which is in line with reports from the literature

Acknowledgments

Author contributions: Ms Schneider: contributed to the study concept and design, analysis and/or interpretation of data, drafting of the manuscript, statistical analysis, and administrative, technical, or material support. She had full access to all data in the study and gave final approval of the manuscript.

Dr Jick: contributed to the study concept and design, acquisition of data, analysis and/or interpretation of data, and critical revision of the manuscript for important intellectual

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    Funding/Support: This study was funded by an unconditional grant from Nycomed GmbH.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

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