Association of anxiety and depression with pulmonary-specific symptoms in chronic obstructive pulmonary disease.
Association of anxiety and depression with pulmonary-specific symptoms in chronic obstructive pulmonary disease.
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DOI：
10.2190/pm.45.2.g
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发表时间：
2013
影响因子：
2
通讯作者：
Blumenthal JA
中科院分区：
文献类型：
--
作者：
Doyle T;Palmer S;Johnson J;Babyak MA;Smith P;Mabe S;Welty-Wolf K;Martinu T;Blumenthal JA
研究焦虑和抑郁与慢性阻塞性肺疾病（COPD）肺部特异性症状的相关性，并确定疾病严重程度和功能能力在多大程度上改变了这种相关性。入组INSPIRE-II研究的患者（N = 162），这是一项正在进行的COPD患者及其护理人员的随机临床试验，这些患者接受了基于电话的应对技能培训或教育和症状监测。患者完成了一系列心理社会测试，包括：简明疲劳量表、圣乔治呼吸问卷、UCSD呼吸短促问卷、状态-特质焦虑量表和贝克抑郁量表。疾病严重程度和功能能力的测量（即，FEV 1和6分钟步行试验。协变量校正后，焦虑和抑郁水平越高，疲劳水平越高（ps <0.001，ΔR2分别为0.16和0.29），呼吸急促（ps <0.001，ΔR2 = 0.12和0.10），COPD症状频率（ps <0.001，ΔR2 = 0.11和0.13）。此外，功能能力是焦虑和肺部特异性COPD症状的调节因子。焦虑与呼吸短促（p = 0.009）和COPD症状频率（p = 0.02）之间的相关性在功能能力较低的患者中更大。焦虑和抑郁与更高水平的疲劳、呼吸急促和COPD症状频率相关。对于临床医生来说，重要的是要意识到COPD患者中焦虑和抑郁的存在，这似乎与肺部特异性COPD症状相关，特别是在功能能力较低的患者中。需要前瞻性设计研究来阐明COPD患者焦虑和抑郁与肺部特异性症状之间的因果关系。
To examine the association of anxiety and depression with pulmonary-specific symptoms of Chronic Obstructive Pulmonary Disease (COPD), and to determine the extent to which disease severity and functional capacity modify this association. Patients (N = 162) enrolled in the INSPIRE-II study, an ongoing randomized, clinical trial of COPD patients and their caregivers who received either telephone-based coping skills training or education and symptom monitoring. Patients completed a psychosocial test battery including: Brief Fatigue Inventory, St. George’s Respiratory Questionnaire, UCSD Shortness of Breath Questionnaire, State-Trait Anxiety Inventory, and Beck Depression Inventory. Measures of disease severity and functional capacity (i.e., FEV1 and six-minute walk test) were also obtained. After covariate adjustment, higher anxiety and depression levels were associated with greater fatigue levels (ps < .001, ΔR2 = 0.16 and 0.29, respectively), shortness of breath (ps < .001, ΔR2 = 0.12 and 0.10), and frequency of COPD symptoms (ps < .001, ΔR2 = 0.11 and 0.13). In addition, functional capacity was a moderator of anxiety and pulmonary-specific COPD symptoms. The association between anxiety and shortness of breath (p = 0.009) and frequency of COPD symptoms (p = 0.02) was greater among patients with lower functional capacity. Anxiety and depression were associated with higher levels of fatigue, shortness of breath, and frequency of COPD symptoms. It is important for clinicians to be aware of the presence of anxiety and depression in COPD patients, which appears to correlate with pulmonary-specific COPD symptoms, especially in patients with lower functional capacity. Prospective design studies are needed to elucidate the causal relationships between anxiety and depression and pulmonary-specific symptoms in COPD patients.