Frequency and correlates of anxiety, depression, and cognitive dysfunctions in patients with chronic obstructive pulmonary disease: a case–control study

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Appearance of anxiety, depression, and cognitive dysfunction represents important parameters that could complicate the outcome of chronic obstructive pulmonary disease (COPD).


The objective of this study was to assess the frequency of anxiety, depression, and cognitive dysfunctions among COPD patients and to find possible risk factors.


A total of 80 COPD patients were assessed using severe combined immunodeficiency for establishing psychiatric diagnosis, Beck depression inventory for assessment of severity of depressive symptoms, Hamilton anxiety scale for severity of anxiety symptoms, trail making tests (TMTs) A and B for cognitive functions, and spirometry and arterial blood gases for ascertainment of COPD, and they were matched to 80 healthy controls.


In all, 17.5% of patients had mild COPD, 35.5% had moderate COPD, 35.5% had severe COPD, and 12.5% had very severe COPD. Their mean pO2 level was 65.62 (±15.90), and the mean level of forced expiratory volume in 1 s (FEV1) was 51.36 (±15.55). The patient group showed higher statistically significant difference in the presence of psychiatric illness (55%, P=0.001), anxiety level (22.5%, P=0.06), depression level (42.5%, P=0.0001), substance abuse (15%, P=0.035), TMT A (P=0.0001), and TMT B (P=0.0001). Anxiety and depressive scores were significantly associated with the severity of COPD (P<0.001). Anxiety score correlated with age (r=−0.267) and pO2 (r=0.326). Depression score correlated with FEV1 (r=−0.262). Cognitive functions correlated with the level of pO2 (r=0.324). Age, pO2, FEV1, and substance abuse were independent predictors of cognitive dysfunction, whereas the former three predicted psychiatric symptoms.


COPD increases the risk for depression, anxiety, and cognitive impairments, and thus raising awareness of clinicians to screen for psychiatric risk factors is essential in improving COPD outcome.

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