(020) Moderate Depression in Patients with COPD: A Call for Treatment Parity

Abstract: BACKGROUND

While those with COPD are twice as likely to develop depression, it is under-diagnosed and under-treated due to symptom overlap (i.e. low energy) and broad treatment guidelines (Yohannes, 2014; Kroenke, 2002). Specifically, moderate depression management (PHQ=10-14) may range from follow-up to psychotherapy or pharmacotherapy (Kroenke, 2002). This leaves patients with COPD vulnerable as clinicians may misconstrue depression symptoms to be a consequence of COPD and opt to treat more conservatively. Hence, it is crucial to understand how the presentation of depression is affected by COPD. Though von Siemens et al. (2019, Germany) found single symptom homogeneity among those with varying degrees of COPD, the generalizability of their findings to the more heterogeneous American population remains unclear. Therefore, we aim to study if moderate depression is captured similarly by the PHQ-9 in patients with and without co-morbid COPD, in an effort to highlight the importance of depression treatment in both groups.

METHODS

A retrospective review of nationally representative NHANES data from 2017 to March 2020 was conducted (CDC, 2021). To illustrate the limited role COPD symptomatology plays in how moderate depression presents (PHQ=10-14), individual question responses were compared between participants with and without COPD, using Pearson Chi-Square test for independence (Kroenke, 2002).

RESULTS

Among the 8306 participants evaluated, 503 screened positive for moderate depression and, of those, 91 were told they had co-morbid COPD. In participants who screened positive for moderate depression, the number of responses to how frequently one was bothered by anhedonia, feeling down/depressed/hopeless, trouble sleeping (too much), poor appetite/overeating, feeling bad about oneself, moving/speaking too slowly/quickly, and thoughts of self harm, over the last two weeks, did not statistically differ between those with and those without COPD (p > 0.05). Meanwhile, the frequency with which those with and those without COPD reported being bothered by feeling tired/fatigued and/or trouble concentrating did significantly differ (p > 0.05).

DISCUSION

These results suggest the PHQ-9 similarly captures moderate depression in American population, regardless of co-morbid COPD. Therefore, clinicians should not attribute patient symptoms to a consequence of COPD and opt for conservative management.

CONCLUSIONS/IMPLICATIONS

Understanding that depression symptomatology depression is largely unchanged by COPD should result in its increased diagnosis and treatment.



References:

Centers for Disease Control and Prevention. National Center for Health Statistics. National Health and Nutrition Examination Survey Data, 2017-2020. https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?cycle=2017-2020.

Kroenke K, Spitzer R. The PHQ-9: A New Depression Diagnostic and Severity Measure. Psychiatric Annals. 09/01 2002;32:509-521.

von Siemens SM, et al. Effect of COPD severity and comorbidities on the result of the PHQ-9 tool for the diagnosis of depression: results from the COSYCONET cohort study. Respir Res. Feb 11 2019;20(1):30.

Yohannes AM, Alexopoulos GS. Depression and anxiety in patients with COPD. Eur Respir Rev. Sep 2014;23(133):345-9.