Anxiety, Depression, and Cognitive Impairment in Patients with Chronic Respiratory Disease

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Key points

  • Depression, anxiety and cognitive impairment are common among persons with COPD, and psychological symptoms are associated with worse outcomes.

  • Psychological symptoms may affect adherence to pulmonary rehabilitation programs, and screening for these symptoms should be considered.

  • Pulmonary rehabilitation may improve depression and anxiety symptoms although the effect on cognitive function is not as clear.

Prevalence of depression

Depression and anxiety are the most common psychosocial concerns seen in chronic pulmonary patients enrolled in pulmonary rehabilitation.7 Estimates of the prevalence of depression range from 10% to close to 80% (depending on the instrument and method used to screen), although the prevalence is most commonly reported as between 25% and 50%.8, 9, 10 The higher percentages likely reflect the presence of symptom burden rather than clinically defined disease. Also, the prevalence of depression may

Does depression affect participation and the likelihood of benefitting from pulmonary rehabilitation?

Depression may affect patients’ ability to engage in self-care behaviors,32 and in diabetes and heart disease depression, it is associated with worse adherence to medications used to treat the disease.33, 34 In COPD, it is not known whether depression affects adherence to medications, but there is increasing evidence that depression affects whether patients initiate or complete a pulmonary rehabilitation program. For example, an analysis of participants in a large randomized controlled trial of

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    VA Statement: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government. This material is the result of work supported by resources from the VA Puget Sound Health Care System, Seattle, Washington.

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