Results Patient characteristics One hundred twenty two patients were included in the study. The baseline characteristics of these patients are shown in table 2. The number of patients in stages I to IV of COPD severity as defined by GOLD and the median BODE index of the patients in each stage are shown in table 3. The majority of patients had severe-to-very severe COPD (stages III to IV). The median BODE index increased from stage I to stage IV. | Table 2 Baseline characteristics of the patients sample (n = 122)* |
| Table 3 Classification of patients according to GOLD with the BODE index in each stage (n = 122); the BODE index is given as median and 1st to 3rd quartiles. |
Symptoms of anxiety and depression The mean anxiety score and the mean depression score were 8.0 ± 4.3 and 7.8 ± 4.5, respectively. 60 patients (49%) and 63 patients (52%) were found to have symptoms suggestive of anxiety and depression, respectively. Anxious symptoms were more common in women (59% in women versus 41% in men, p = 0.036). Presence of depressive symptoms was independent of gender (51% of the men; 52% of the women). FEV1%predicted was lower in patients with anxious symptoms (40.5 ± 17.3) compared to patients without (48.3 ± 20.5), mean difference -7.8, 95%CI -14.5 to -1.1; p = 0.025. FEV1%predicted was lower in patients with depressive symptoms (37.0 ± 15.2) compared to patients without (52.5 ± 20.0), mean difference -15.5, 95%CI -21.8 to -9.2; p < 0.001. 78% of the patients with anxious symptoms also had depressive symptoms and 75% of the patients with depressive symptoms also had anxious symptoms. Anxiety and depression in COPD classified by GOLD or BODE The anxiety score and the depression score correlated closer with the BODE index (Kτ = 0.20, p = 0.001; Kτ = 0.41, p < 0.001; respectively) than with FEV 1%predicted (Kτ = -0.13, p = 0.037; Kτ = -0.28, p < 0.001; respectively). The prevalence of anxiety increased with increasing BODE stage (χ 2 = 9.38, p = 0.002) but not with increasing GOLD stages (χ 2 = 3.29, p = 0.070). The prevalence of depression increased with both increasing GOLD and BODE stages (χ 2 = 20.47, p < 0.001; χ 2 = 32.84, p < 0.001). The prevalences of anxious and depressive symptoms within the GOLD and BODE stages are shown in Figures 1 and 2. | Figure 1 Prevalence of anxious and depressive symptoms in patients with COPD classified according to GOLD stages. |
| Figure 2 Prevalence of anxious and depressive symptoms in patients with COPD classified according to quartiles of the BODE index. |
The mean anxiety score in the GOLD stages I, II, III and IV was 3.7 ± 2.6, 7.9 ± 4.2, 8.0 ± 4.1 and 8.6 ± 4.2, respectively; p = 0.069. The mean depression score in the GOLD stages I, II, III and IV was 1.5 ± 1.4, 6.7 ± 4.6, 7.8 ± 4.7 and 9.3 ± 4.5, respectively; p < 0.0001. The mean anxiety score in the BODE stages I, II, III and IV was 6.3 ± 3.5, 7.7 ± 4.6, 9.5 ± 4.1 and 8.5 ± 4.6, respectively; p = 0.009. The mean depression score in the BODE stages I, II, III and IV was 4.6 ± 3.1, 7.2 ± 4.3, 9.7 ± 3.4 and 10.9 ± 4.2, respectively; p < 0.0001. Association of the components of the BODE index with anxiety and depression Linear regression was used to determine which components of the BODE index were independently associated with the anxiety and depression score. The six minute walking distance and the MMRC dyspnoea scale were independently associated with the depression score, whereas the MMRC dyspnoea scale had a borderline significant association with the anxiety score. (Table 4). After removing the non-significant BMI and FEV 1%predicted from the regression equation and adjusting for the six-minute walking distance the MMRC dyspnoea scale was significantly associated with the anxiety score (MMRC dyspnoea scale: β = 0.75, p = 0.043; six-minute walking distance: β = -0.002, p = 0.497). FEV 1%predicted and BMI were associated with neither anxiety nor depression. | Table 4 Linear regression of the components of the BODE index on the anxiety score and the depression score. |
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