Depression and anxiety predict health-related quality of life in chronic obstructive pulmonary disease: systematic review and meta-analysis

Abstract

Amy Blakemore,1,2 Chris Dickens,3 Else Guthrie,2 Peter Bower,1 Evangelos Kontopantelis,1 Cara Afzal,2 Peter A Coventry4 1National Institute for Health Research School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, 2Department of Psychiatry, Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK; 3Institute of Health Service Research, University of Exeter Medical School and Peninsula Collaboration for Leadership in Health Research and Care, University of Exeter, Exeter, UK; 4Collaboration for Leadership in Applied Health Research and Care for Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK Background: The causal association between depression, anxiety, and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD) is unclear. We therefore conducted a systematic review of prospective cohort studies that measured depression, anxiety, and HRQoL in COPD. Methods: Electronic databases (Medline, Embase, Cumulative Index to Nursing and Allied Health Literature [CINAHL], British Nursing Index and Archive, PsycINFO and Cochrane database) were searched from inception to June 18, 2013. Studies were eligible for inclusion if they: used a nonexperimental prospective cohort design; included patients with a diagnosis of COPD confirmed by spirometry; and used validated measures of depression, anxiety, and HRQoL. Data were extracted and pooled using random effects models. Results: Six studies were included in the systematic review; of these, three were included in the meta-analysis for depression and two were included for the meta-analysis for anxiety. Depression was significantly correlated with HRQoL at 1-year follow-up (pooled r=0.48, 95% confidence interval 0.37–0.57, P<0.001). Anxiety was also significantly correlated with HRQoL at 1-year follow-up (pooled r=0.36, 95% confidence interval 0.23–0.48, P<0.001). Conclusion: Anxiety and depression predict HRQoL in COPD. However, this longitudinal analysis does not show cause and effect relationships between depression and anxiety and future HRQoL. Future studies should identify psychological predictors of poor HRQoL in well designed prospective cohorts with a view to isolating the mediating role played by anxiety disorder and depression. Keywords: long-term conditions, COPD, quality of life, panic