Anxiety, Depression May Increase Risk of Acute Exacerbation in COPD

Patients with chronic obstructive pulmonary disease (COPD) may experience an acute exacerbation of their illness if they have depression and/or anxiety, suggests a study in the Journal of Affective Disorders.

Guangxi Li, M.D., Ph.D., of Guang'anmen Hospital at the China Academy of Chinese Medical Sciences in Beijing and colleagues interviewed 504 adults with COPD who visited the pulmonary clinic at the hospital from January 2012 through July 2013. The patients completed the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) to screen for depression and anxiety symptoms. Those with an SAS score of 50 or more were considered to have anxiety. Those with an SDS score of 53 or more were considered to have depression. The researchers defined an acute exacerbation of COPD as an acute event that worsened a patient’s respiratory symptoms of COPD beyond normal day-to-day variation and led to a change in at least one of three medications such as antibiotics, corticosteroids, or bronchodilators. The researchers determined acute exacerbations from the patients’ case records from February to August 2014.

Just over 54% of patients with anxiety experienced an acute exacerbation of their COPD compared with about 40% of patients without anxiety. About 52% of patients with depression experienced an acute exacerbation of their COPD compared with slightly more than 40% of those without depression. Overall, the risk of acute exacerbation was 60% higher in patients with anxiety and/or depression.

The findings suggest that health care professionals should pay attention to symptoms of anxiety and depression in patients with COPD, as these symptoms may be associated with worse outcomes, the researchers wrote. “[L]arger multi-center prospective cohort studies [could] explore the association between anxiety and/or depression and [acute exacerbation of] COPD, in order to reduce the additional burden of disease associated with these mental stresses, as well as discover new therapies or interventions to decrease the morbidity and mortality of acute exacerbation.”

For related information, see the Psychiatric Services article “Effects of Mental Health on the Costs of Care for Chronic Illnesses.”

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Depression May Increase Risk of Death Following Heart Procedure, Study Suggests

Older patients with depression may be at greater risk of death following a procedure to replace a damaged aortic valve of the heart, reports a study published today in JAMA Cardiology.

“The clinical implications of our findings support active screening for depression before and after aortic valve procedures to identify patients who may benefit from further psychiatric evaluation for the diagnosis and treatment of a depressive disorder,” wrote Jonathan Afilalo, M.D., M.Sc., of Jewish General Hospital, Montreal, and colleagues.

The study included patients who were at least 70 years of age with symptomatic aortic stenosis and who had undergone transcatheter or surgical aortic valve replacement. As part of a larger prospective cohort study, these patients completed a preprocedural assessment of frailty, disability, comorbidity, cognitive function, and mood. Depressive symptoms were assessed using the five-item Geriatric Depression Scale Short Form (GDS-SF) at baseline and follow-up at six and 12 months. The authors defined a GDS-SF score of at least 2 of 5 as indicative of clinically relevant depression.

Of the 1,035 patients (427 men and 608 women; mean age of 81.4 years) included in the analysis, 326 patients (31.5%) screened positive for depression. Compared with patients without depression, those with depression were more likely to have diabetes, chronic kidney disease, hypertension, chronic obstructive pulmonary disease, and/or cerebrovascular disease. Patients with depression were also more likely to be physically frail and to be cognitively impaired compared with those without depression.

After adjusting for clinical and geriatric confounders, the researchers found that baseline depression increased risk of death at one month (odds ratio [OR], 2.20) and at 12 months (OR, 1.532). Persistent depression—defined as baseline depression that remained six months after the procedure—was associated with a threefold increase in mortality at 12 months (OR, 2.98).

“Given the prognostic implications and diagnostic challenges, coordinated care involving cardiovascular and psychogeriatric specialists is indicated to provide optimal management to patients undergoing TAVR [transcatheter aortic valve replacement] and SAVR [surgical aortic valve replacement] who exhibit depressive symptoms,” the authors wrote.

For related information, see the Psychiatric News article “Can Collaborative Care Really Help Patients With Depression and Diabetes or Heart Disease?” by David Katzelnick, M.D., Rebecca Rossom, M.D., M.S., and Leif Solberg, M.D.

(Image: iStock/kupicoo)