Elsevier

General Hospital Psychiatry

Volume 33, Issue 3, May–June 2011, Pages 217-223
General Hospital Psychiatry

Prevalence of depressive symptoms in patients with chronic obstructive pulmonary disease: a systematic review, meta-analysis and meta-regression

https://doi.org/10.1016/j.genhosppsych.2011.03.009Get rights and content

Abstract

Objective

This meta-analysis was aimed to evaluate the differences in aggregated prevalence of depressive symptoms among people with chronic obstructive pulmonary disease (COPD) as compared to controls without COPD and to determine underlying moderators to explain potential heterogeneity of prevalence.

Methods

A meta-analysis of published work was performed using the random effect model. A total of eight studies were identified. We calculated the differences in prevalence proportion of depressive symptoms in patients with COPD versus controls. Meta-regression and subgroup analysis were performed to identify factors that may contribute to heterogeneity.

Results

The prevalence proportion of depressive symptoms was found to be significantly higher (pooled odds ratio: 2.81; 95% CI: 1.69–4.66) among 39587 individuals with COPD as compared to 39,431 controls (24.6%, 95% CI: 20.0–28.6% vs. 11.7%, 95% CI: 9–15.1%). Meta-regression was conducted to account for the heterogeneity of the prevalence proportion, but moderators like mean age, gender, mean FEV1 and proportion of current smokers among COPD patients were nonsignificant and could not explain heterogeneity in prevalence of depressive symptoms. Subgroup analyses showed no significant differences based on different methods of assessment of depressive symptoms and countries sampled.

Conclusion

This meta-analytical review identified higher prevalence of depressive symptoms among COPD patients, and meta-regression showed that demographic and clinical factors were not the determinants of heterogeneity in prevalence of depressive symptoms.

Introduction

Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation [1], exertional dyspnea and recurrent respiratory infections. Depressive symptoms are characterized by low mood, low energy, loss of interest, insomnia, poor appetite, somatic symptoms, poor concentration, pessimism and suicidal ideation [2]. By 2020, depression will rank the second and COPD will rank the fifth in global burden of disease [3]. Depression is one of the most common comorbidities associated with COPD [4], and the combination of the two conditions will lead to significant worldwide health problem in the next decade. Before planning treatment provision targeting at these two conditions, it is necessary to estimate the prevalence of depression in patients with COPD accurately. High prevalence of depressive symptoms among COPD patients was reported in qualitative reviews [4], [5], [6]. Ede et al. [7] conducted the most recent (1999) systematic review of the prevalence of depression in patients with COPD. They concluded that the empirical evidence for a significant risk of depression in patients with COPD remained inconclusive. This review was based on the analysis of four controlled studies and lacked detailed statistical analysis without addressing the potential heterogeneity in prevalence of depressive symptoms among COPD patients. Since more studies [13], [14], [16], [18], [19], [20] were conducted, a new meta-analysis is required to establish the aggravated prevalence of depressive symptoms in patients with COPD and determine whether there is a significant risk of depression in patients with COPD compared to controls. The present meta-analysis therefore aims to evaluate the differences in aggregated prevalence of depressive symptoms among people with COPD as compared to controls without COPD and to identify moderators accounting for the potential heterogeneity of prevalence in depressive symptoms.

Section snippets

Search strategy and selection criteria

The following online databases were searched from inception to September 2010: Pubmed (from 1966), Embase (from 1980), PsychINFO (from 1806), BIOSIS (from 1926), Science Direct (from 2006) and Cochrane CENTRAL (from 1993). The search terms used are summarized as follows: depress’⁎ and chronic obstructive pulmonary disease; depress’⁎ and COPD; depress’⁎ and chronic obstructive airway disease; depress’⁎ and COAD; depress’⁎ and chronic obstructive lung; depress’⁎ and chronic airway obstruction;

Results

From an initial 1245 potentially relevant articles, we excluded 1237 articles because they did not meet our inclusion criteria (Fig. 1). Finally, we included eight articles [13], [14], [15], [16], [17], [18], [19], [20] in our analysis and majority of the studies were from Western countries (Table 1). In all, the studies involved 39,587 patients and 39,431 controls. The prevalence of depressive symptoms among COPD patients using the random-effect model was 24.6% (95% CI: 20.0–28.6%, Q

Discussion

This work represents, to our knowledge, the first meta-analytical study aimed to estimate the prevalence of depressive symptoms in adults with COPD compared with those without COPD. The aggregated prevalence of depressive symptoms in patients with COPD was 24.6%, suggesting that approximately one in four people with COPD are likely to experience depressive symptoms. The aggregated prevalence of depressive symptoms was nearly two times as high in people with COPD compared with those without

Acknowledgments

Melvyn W.B. Zhang and Roger C.M. Ho wrote the manuscript. Mike W.L. Cheung and Erin Fu performed the meta-analysis. Anselm Mak reviewed the whole manuscript and identified for errors.

There was no funding source.

This meta-analysis only involved extraction of data from other published studies. No consent from patients was required.

Dr. Abebaw Yohannes from the Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Elizabeth Gaskell Campus, provided and approved our usage

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    Declaration of interest: none.

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