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To measure the prevalence rate of significant depressive symptoms and depression and examine their consequences on quality of life in patients with severe oxygen-dependent chronic obstructive pulmonary disease (COPD).Between November 1997 and March 1998, the authors conducted a cross-sectional study among the COPD patients registered at the Quebec City area respiratory home care service. Depression and quality of life were assessed using the Geriatric Depression Scale and the Medical Outcome Survey - Short Form 36 (SF-36).109 patients (63 men; mean age: 71) with severe COPD (median FEV1: 34%) were surveyed. Of them, 105 were on long-term oxygen therapy (LTOT), which had been introduced (median) 19 months earlier. Sixty-two patients (57%; 95% CI: 47-66) demonstrated significant depressive symptoms; in addition, 20 patients (18%; CI: 12-27) were severely depressed. Only 6% of those patients who met the criteria for depression were taking an antidepressant drug. We found significant and moderate correlations between the scores obtained from the Geriatric Depression Scale and 7 of the 8 domains of the SF-36.Significant depressive symptoms and depression are highly prevalent in patients with severe COPD on LTOT. There is strong evidence that depression is under-recognized and under-treated in this group of patients.