The COPD Assessment Test (CAT) and Depression: A Longitudinal Analysis During the COVID-19 Pandemic

Abstract

Purpose

Chronic obstructive pulmonary disease (COPD) is multifaceted, with some patients experiencing anxiety and depression. Depression in COPD has been associated with worse total scores for the COPD assessment test (CAT). Also, CAT score worsening has been observed during the COVID-19 pandemic. The relationship between the Center for Epidemiologic Studies Depression Scale (CES-D) score and CAT sub-component scores has not been evaluated. We investigated the relationship between CES-D score and CAT component scores during the COVD-19 pandemic.

Patients and Methods

Sixty-five patients were recruited. Pre-pandemic (baseline) was defined as 23rd March 2019–23rd March 2020, CAT scores and information related to exacerbations were collected via telephone at 8-week intervals between 23rd March 2020–23rd March 2021.

Results

There were no differences in CAT scores pre- compared to during the pandemic (ANOVA p = 0.97). Total CAT scores were higher in patients with symptoms of depression compared to those without both pre- (p < 0.001) and during-pandemic (eg, at 12 months 21.2 versus 12.9, mean difference = 8.3 (95% CI = 2.3–14.2), p = 0.02). Individual CAT component scores showed significantly higher chest tightness, breathlessness, activity limitation, confidence, sleep and energy scores in patients with symptoms of depression at most time points (p < 0.05). Significantly fewer exacerbations were observed during- compared to pre-pandemic (p = 0.04). We observed that COPD patients with symptoms of depression had higher CAT scores both pre- and during the COVID-19 pandemic.

Conclusion

Presence of depressive symptoms was selectively associated with individual component scores. Symptoms of depression may potentially influence total CAT scores.

Keywords:

• COPD
• depression
• COPD assessment test
• CAT
• center for epidemiological studies depression score
• CES-D

Abbreviations

ANOVA, analysis of variance analysis; BD, bronchodilator; BDI, Beck’s depression inventory; BMI, body mass index; CAT, COPD assessment test; CES-D, Center for epidemiologic studies depression scale; CI, confidence interval; COPD, Chronic obstructive pulmonary disease; COVID-19, Coronavirus-19; FEV₁, Forced expiratory volume in one second; FVC, Forced vital capacity; GOLD, Global initiative for chronic obstructive pulmonary disease; HADS, Hospital anxiety and depression scale; NHS, National health service.

Data Sharing Statement

Data for this study are not publicly available.

Ethics Approval and Informed Consent

Patients provided written informed consent using protocols approved by local Ethics Committees (Tameside and Glossop, reference: 05/Q1402/41 and North West – Preston, reference: 16/NW/0836).

Acknowledgments

Dave Singh and Augusta Beech are supported by the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre (BRC).

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

DS has received sponsorship to attend and speak at international meetings, honoraria for lecturing or attending advisory boards from the following companies: Aerogen, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, CSL Behring, Epiendo, Genentech, GlaxoSmithKline, Glenmark, Gossamerbio, Kinaset, Menarini, Novartis, Orion, Pulmatrix, Sanofi, Synairgen, Teva, Theravance and Verona. AB has no conflicts of interest to declare.