The Difficulty Of Improving Quality Of Life In COPD Patients With Depression And Associated Factors

Figures & data

Table 1 Comparison Of Clinical Data Between Depression And No Depression Of COPD Patients

Characteristics	Overall	Depressed	Non-Depressed	p Value*
Number of patients	270	53	217
Male, n (%)	241 (89.3)	41 (77.4)	200 (92.2)	0.002
Age, years (mean ± SD)	70.1±7.6	69.3±8.6	70.3±7.4	0.373
Body mass index, kg/m^2 (mean ± SD)	22.7±3.4	21.6±3.7	23.0±3.3	0.008
BDI-II score	3 [0–12]	34 [22–47]	2 [0–5]	<0.001
Education level				0.002
≤ Middle school graduate	152 (56.3)	41 (77.4)	111 (51.2)
High school graduate	77 (28.5)	9 (17.0)	68 (31.3)
≥ College graduate	41 (15.2)	3 (5.6)	38 (17.5)
Smoking history
Current smoker, n (%)	74 (27.4)	17 (32.1)	57 (26.2)	0.072
Pack-years	42 [28–57]	40 [25–60]	42 [30–57]	0.824
GOLD stage				0.446
I	15 (5.6)	3 (5.7)	12 (5.5)
II	141 (52.2)	26 (49.1)	115 (53.0)
III	88 (32.6)	18 (34.0)	70 (32.3)
IV	17 (6.3)	6 (11.3)	11 (5.1)
FEV1, mean ± SD (% of predicted)	54.8±16.6	53.5±17.8	55.1±16.4	0.516
CAT score	14 [9–21]	18 [9–23]	14 [9–20]	0.080
Total SGRQ-C score	24 [16–43]	44 [25–62]	22 [16–36]	<0.001
6 min walk distance, meter	384 [265–457]	300 [118–387]	400 [303–469]	<0.001
Exacerbator (%) (≥1 AE) in prior 1 year	60/266 (22.6)	22/51 (43.1)	38/215 (17.7)	<0.001
Hospitalized due to AE, prior 1 year	21/270 (7.8)	12/53 (22.6)	9/217 (4.1)	<0.001
Exacerbator (%) (≥1 AE) in 1st year	47/181 (26.0)	10/27 (37.0)	37/154 (24.0)	0.155

Note: *Statistical differences are evaluated between the depression and non-depression groups.

Abbreviations: AE, acute exacerbation; BDI-II, Beck Depression Inventory-II; CAT, COPD assessment test; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 s; GOLD, Global Initiative for Chronic Obstructive Lung Disease; SD, standard deviation; SGRQ-C, the COPD-specific version of the St George’s Respiratory Questionnaire.

Figure 1 Correlation analyses between the BDI-II score and (A) total SGRQ-C score, (B) the 6MWD, (C) the CAT, and (D) BMI.

Abbreviations: BDI, Beck Depression Inventory; SGRQ-C, the COPD-specific version of the St George’s Respiratory Questionnaire; 6MWD, 6 min walk distance; CAT, COPD Assessment Test; BMI, body mass index.

Table 2 St. George’s Respiratory Questionnaire Score

SGRQ Area	Initial			6 Months			1 Year
	Depressed (n=53)	Non-Depressed (n=217)	p-Value*	Depressed (n=20)	Non-Depressed (n=126)	p-Value*	Depressed (n=17)	Non-Depressed (n=102)	p-Value*
Symptoms	50.49	36.84	<0.001	55.39	31.64	<0.001	57.98	32.51	<0.001
Activity	55.89	37.15	<0.001	67.98	38.34	<0.001	66.56	34.46	<0.001
Impacts	35.23	17.82	<0.001	47.69	15.47	<0.001	44.20	14.22	<0.001
Total score	42.95	27.47	<0.001	52.83	25.90	<0.001	51.29	24.36	<0.001

Note: *Statistical differences are evaluated between the depression and non-depression groups.

Abbreviation: SGRQ, St George’s Respiratory Questionnaire.

Figure 2 Changes in (A) SGRQ-C score, (B) CAT score, (C) 6MWD, and (D) number of acute exacerbations/year by follow-up timepoint.

Abbreviations: SGRQ-C, the COPD-specific version of the St George’s Respiratory Questionnaire; 6MWD, 6 min walk distance; CAT, COPD Assessment Test.

Table 3 COPD Assessment Test (CAT) Score And Depression

CAT Items	Initial			6 Months			1 Year
	Depressed (n=48)	Non-Depressed (n=202)	p-Value*	Depressed (n=18)	Non-Depressed (n=87)	p-Value*	Depressed (n=12)	Non-Depressed (n=67)	p-Value*
Cough	1.81	1.78	0.863	2.50	1.56	0.012	2.08	1.43	0.204
Phlegm	1.96	2.11	0.445	2.89	1.98	0.015	2.25	1.70	0.292
Chest tightness	1.75	1.48	0.207	2.56	1.39	0.002	2.25	1.07	0.005
Breathlessness going up hills/stairs	3.27	3.26	0.969	4.11	2.86	<0.001	4.17	2.88	0.002
Activity limitation at home	1.77	1.26	0.023	4.11	2.86	<0.001	2.50	0.82	0.001
Confidence leaving home	1.69	1.26	0.046	2.67	1.11	0.001	2.58	0.84	0.006
Sleep	2.04	1.35	0.001	2.06	1.26	0.149	2.83	1.07	0.002
Energy	2.73	2.33	0.042	3.61	1.95	<0.001	3.42	1.93	0.005
Total score	17.02	14.84	0.077	23.06	13.11	<0.001	22.08	11.75	<0.001

Note: *Statistical differences are evaluated between the depression and non-depression groups.

Abbreviation: CAT, COPD assessment test.

Table 4 Multivariable Logistic Regression Analysis For Factors Predictive Of Probable Depression (BDI-II ≥17)

Characteristics	Univariate			Multivariable	95% CI	P
	OR	95% CI	P	Adjusted OR
Age^a	0.849	0.945–1.022	0.907	0.961	0.914–1.011	0.121
Female sex	3.443	1.529–7.754	0.003	2.539	0.831–7.759	0.102
FEV1 (% predicted)^a	0.994	0.976–1.012	0.514	–	–	–
SGRQ score^a	1.041	1.024–1.057	<0.001	1.038	1.018–1.059	<0.001
BMI^a	0.883	0.803–0.970	0.009	0.855	0.758–0.964	0.010
6MWD^a	0.993	0.991–0.996	<0.001	0.994	0.991–0.997	<0.001
Education level (≤middle school/high school and college graduate)	3.263	1.626–6.545	0.001	1.723	0.697–4.255	0.238
Smoking experience (current smoker/non or ex-smoker)	1.566	0.797–3.078	0.193	–	–	–

Note: ^aIndicate risk associated with 1-unit increase.

Abbreviations: 6MWD, 6-min walk distance; BDI-II, Beck Depression Inventory-II; BMI, body mass index; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 s; SGRQ, St George’s Respiratory Questionnaire.

Table 5 Comparison Of The Four Subgroups Stratified By BDI-II ≥17 And SGRQ ≥25 (n=268)

Characteristics	Depressed		Non-Depressed		pValue*
	SGRQ-C ≥25	SGRQ-C <25	SGRQ-C ≥25	SGRQ-C <25
Number of patients	40	13	91	124
Male, n (%)	32 (80.0)	9 (69.2)	84 (92.3)	114 (91.9)	0.013
Age, years (mean ± SD)	69.3±8.7	69.1±8.8	71.4±7.5	69.5±7.1	0.258
Body mass index, kg/m^2 (mean ± SD)	21.7±3.3	21.3±4.8	22.4±3.3	23.3±3.1	0.013^c
BDI-II score	34 [24–46]	26 [19–62]	4 [0–7]	1 [0–3]	<0.001^b,c,d,e
Education level					<0.001^c
≤Middle school	32 (80.0)	9 (69.2)	56 (61.5)	55 (44.4)
High school and college	8 (20.0)	4 (30.8)	35 (38.5)	69 (55.6)
Current smoker, no (%)	13 (37.1)	4 (40.0)	19 (22.1)	38 (32.8)	0.230
GOLD stage					0.007
I–II	21 (52.5)	8 (61.6)	45 (50.0)	82 (70.7)
III–IV	19 (47.5)	5 (38.5)	45 (50.0)	34 (29.3)
FEV1, mean ± SD (% of predicted)	51.9±17.6	58.2±18.1	50.3±17.1	59.3±14.6	0.001^a,f
mMRC dyspnea score					<0.001^a,c,d
0–1	16 (40.0)	11 (84.6)	32 (35.2)	96 (77.4)
≥2	24 (60.0)	2 (15.4)	59 (64.8)	28 (22.6)
CAT score	21 [14–26]	9 [5–11]	19 [13–24]	11 [8–15]	<0.001^a,c,d,f
Total SGRQ-C score	52 [36–65]	13 [10–22]	40 [32–54]	16 [12–20]	<0.001^a,c,d,e,f
6 min walk distance (meters)	300 [104–345]	280 [163–421]	352 [241–413]	436 [370–498]	<0.001^a,b,c,e
At least 1 exacerbation in 1st year	10/23 (43.5)	0/4 (0.0)	21/64 (32.8)	16/90 (17.8)	0.021
Exacerbator (%) (≥1 AE) in prior 1 year	18/40 (45.0)	6/13 (46.2)	28/91 (30.8)	11/124 (8.9)	<0.001^a,b,c
Hospitalized due to AE, prior 1 year	11/40 (27.5)	1/13 (7.7)	8/91 (8.8)	1/124 (0.8)	<0.001^a,c,e

Notes: *Statistical differences are evaluated between the four groups. Statistical difference between ^aLow SGRQ and high SGRQ non-depressed group, ^bLow SGRQ non-depressed group and low SGRQ depressed group, ^cLow SGRQ non-depressed group and high SGRQ-depressed group, ^dHigh SGRQ non-depressed group and low SGRQ depressed group, ^eHigh SGRQ non-depressed group and high SGRQ-depressed group, and ^fHigh and low SGRQ depressed group.

Abbreviations: AE, acute exacerbation; BDI-II, Beck Depression Inventory-II; CAT, COPD assessment test; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 s; GOLD, Global Initiative for Chronic Obstructive Lung Disease; mMRC, modified Medical research council; SD, standard deviation; SGRQ-C, the COPD-specific version of the St George’s Respiratory Questionnaire.