Depression and anxiety predict health-related quality of life in chronic obstructive pulmonary disease: systematic review and meta-analysis

Abstract

Background

The causal association between depression, anxiety, and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD) is unclear. We therefore conducted a systematic review of prospective cohort studies that measured depression, anxiety, and HRQoL in COPD.

Methods

Electronic databases (Medline, Embase, Cumulative Index to Nursing and Allied Health Literature [CINAHL], British Nursing Index and Archive, PsycINFO and Cochrane database) were searched from inception to June 18, 2013. Studies were eligible for inclusion if they: used a nonexperimental prospective cohort design; included patients with a diagnosis of COPD confirmed by spirometry; and used validated measures of depression, anxiety, and HRQoL. Data were extracted and pooled using random effects models.

Results

Six studies were included in the systematic review; of these, three were included in the meta-analysis for depression and two were included for the meta-analysis for anxiety. Depression was significantly correlated with HRQoL at 1-year follow-up (pooled r=0.48, 95% confidence interval 0.37–0.57, P<0.001). Anxiety was also significantly correlated with HRQoL at 1-year follow-up (pooled r=0.36, 95% confidence interval 0.23–0.48, P<0.001).

Conclusion

Anxiety and depression predict HRQoL in COPD. However, this longitudinal analysis does not show cause and effect relationships between depression and anxiety and future HRQoL. Future studies should identify psychological predictors of poor HRQoL in well designed prospective cohorts with a view to isolating the mediating role played by anxiety disorder and depression.

Keywords:

• long-term conditions
• COPD
• quality of life
• panic

Acknowledgments

This study was funded by the National Institute for Health Research under its Programme Grants for Applied Research programme (grant RP-PG-0707-10162), by the University of Manchester (PB, EK, PAC), and the National Institute for Health Research and Care (CLAHRC) for the South West Peninsula (CD). This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0707-10162). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. We wish to acknowledge the contribution of authors who provided additional information on their studies, namely, C Engstrom and T Oga.

Author contributions

AB: planned and designed this systematic review and meta-analysis, the inclusion and exclusion criteria, and search strategies; conducted the search, identified eligible papers, extracted the data, and performed the meta-analysis; interpreted findings and wrote the drafts of the paper for submission; coordinated with coauthors to collate comments; and wrote the final draft of the paper. CD: supervised the planning and design of this review and meta-analysis; assisted in the development of inclusion and exclusion criteria, development of search strategies, meta-analysis, interpretation of findings, and drafting of the paper; and approved the final version of the paper. EG: supervised the planning and design of this review and meta-analysis; assisted in the development of inclusion and exclusion criteria, development of search strategies, meta-analysis, interpretation of findings, and drafting of the paper; and approved the final version of the paper. PB: supervised the planning and design of this review and meta-analysis; assisted in the development of inclusion and exclusion criteria, development of search strategies, meta-analysis, interpretation of findings, and drafting of the paper; and approved the final version of the paper. EK: supervised the planning and design of this review and meta-analysis; assisted in the development of inclusion and exclusion criteria, development of search strategies, meta-analysis, interpretation of findings, and drafting of the paper; and approved the final version of the paper. CA: Made a substantial contribution to the acquisition and interpretation of data by assisting in data extraction, reviewing the quality of included papers, drafting of the paper, making critical revisions to the final draft and approved the final version of the paper. PAC: supervised the planning and design of this review and meta-analysis, assisted in the development of inclusion and exclusion criteria, development of search strategies, meta-analysis, interpretation of findings, drafting of the paper; and approved the final version of the paper.

Disclosure

None of the authors had competing interests to declare.