Study: Patients With COPD and Anxiety or Depression Affected by Higher Clinical, Economic Burdens

Older patients with chronic obstructive pulmonary disease (COPD) and anxiety or depression had significantly higher clinical and economic burdens than those with only COPD, according to a study published in Frontiers in Psychology.

The researchers explained that patients with chronic conditions often experience poor mental health. Therefore, older adult patients with COPD are more likely to develop mental illnesses, specifically anxiety and depression. They noted that patients with COPD display several risk factors for anxiety or depression, including low socioeconomic status, continuous smoking, and low disease acceptance. The presence of anxiety or depression can complicate the course of COPD by causing poor treatment adherence, increased emergency care use, and increased exacerbation risk; it can also affect patients’ quality of life and result in additional health care costs.

Consequently, the researchers noted the importance of evaluating the burden of mental comorbidities as they play an “indispensable role” in guiding policy makers in allocating resources to help patients achieve optimal treatment goals. Therefore, they conducted a study on older adult patients with COPD in China to estimate differences in the economic and clinical burdens of patients with or without anxiety and/or depression symptoms.

Patients with COPD and anxiety and/or depression have increased clinical and economic burden. | Image Credit: kinwun - stock.adobe.com

To conduct their study, the researchers selected patients from the respiratory department of the Affiliated Hospital of Guangdong Medical University. They conducted face-to-face interviews at admission to measure patients’ anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), a 14-item scale with 7 items each for anxiety and depression rated on a Likert scale from 0 to 3; the higher the score, the greater the likelihood that the patient had anxiety or depression disorders. The researchers also held telephone follow-up interviews 6, 12, 18, 24, and 36 months after initial discharge to determine clinical and economic burden.

Between 2017 and 2021, the researchers screened 661 patients who were 60 years or older, diagnosed with COPD via a lung function test following GOLD guidelines, and able to understand the research purpose and sign the consent form. After applying exclusion criteria, the researchers included 579 patients in the final baseline study sample. The mean (SD) age of enrolled subjects was 68.75 (0.44) years, and the study population consisted of mostly men (82.55%). The researchers divided the participants into 2 groups based on those with only COPD and those also diagnosed with anxiety and/or depression; of the study population, 213 (36.9%) had anxiety and/or depression.

Overall, after adjusting for demographic and clinical characteristics, the researchers found that the annual number of COPD-related outpatient visits was 59.74% (incidence rate ratio [IRR], 0.47; 95% CI, 0.27-0.66) higher in the COPD–anxiety and/or depression group compared with the COPD-only group. Also, after adjusting for demographic and clinical characteristics, they found the annual number of COPD-related hospitalizations and the annual length of COPD-related hospitalizations to be 32.20% (IRR, 0.29; 95% CI, 0.16-0.42) and 37.97% (IRR, 0.32; 95% CI, 0.16-0.48) higher, respectively, in the COPD–anxiety and/or depression group.

Additionally, when the researchers adjusted for all factors that may influence health care expenditures, they found that those in the COPD–anxiety and/or depression group had higher health care costs; the group’s adjusted mean annual total health care cost was 10,599.89 Chinese Yuan (CNY) (95% CI, 9068.53-12,131.24), or approximately $1493.66, while the COPD-only group’s mean cost was CNY 7729.09 (95% CI, 6575.43-8882.75), or approximately $1089.13.

Lastly, after adjusting for all factors that may influence health care expenditures, the researchers found that the COPD–anxiety and/or depression group had higher mean annual COPD-related medical costs (CNY 6627.60; 95% CI, 5662.93-7592.28) and pharmacy costs (CNY 3972.28; 95% CI, 3345.81-4598.75) than those of the COPD-only group.

The researchers acknowledged their study’s limitations, one being that the findings may not apply to all older adult patients with COPD. Because their study population only consisted of older adult patients with COPD admitted to the Respiratory Department of the Affiliated Hospital of Guangdong Medical University, the findings may not apply to those in the general population or other clinical environments. Despite their limitations, the researchers made future research suggestions based on their findings.

“Further understanding of the impact of comorbidities such as anxiety and depression on the assessment and management of COPD may be beneficial for controlling the health care costs of chronic diseases and guiding the formulation of health insurance policies," the authors concluded.

Reference

Zhao X, Liu G, Liu D, et al. Clinical and economic burden of anxiety/depression among older adult COPD patients: evidence from the COPD-AD China Registry study. Front Psychiatry. 2024;14:1221767. doi:10.3389/fpsyt.2023.1221767