SAN DIEGO — Most patients with chronic obstructive pulmonary disease have at least moderate levels of anxiety or depression, results from a Veterans Affairs hospital study showed.
In fact, most such patients have anxiety as well as depressive symptoms, often at moderate to severe levels, Mark E. Kunik, M.D., reported at the annual meeting of the American Association for Geriatric Psychiatry.
In a study that was part of a larger randomized, controlled trial of cognitive behavioral therapy for cognitively intact COPD patients who are anxious or depressed, Dr. Kunik and his associates at the Michael E. DeBakey VA Medical Center, Houston, screened 557 men with COPD or related diagnoses by telephone with five questions from the Primary Care Evaluation of Mental Disorders (PRIME-MD):
1. During the past month, have you been bothered often by “nerves” or feeling anxious or on edge?
2. During the past month, have you been bothered often by worrying about a lot of different things?
3. During the past month, have you had an anxiety attack (suddenly feeling fear or panic)?
4. During the past month, have you been bothered often by feeling down, depressed, or hopeless?
5. During the past month, have you been bothered often by having little interest or pleasure in doing things?
Patients who screened positive by phone were assessed at the medical center with the Beck Depression Inventory, the Beck Anxiety Inventory, spirometry, the Mini Mental State Examination, and the structured clinical interview for DSM-III-R (SCID). Of the 557 men, 204 met eligibility for the trial.
Of the 204 eligible men, 24 (12%) met SCID criteria for depressive disorder only, 48 (23%) met SCID criteria for anxiety disorder only, and 53 (26%) met criteria for co-occurring depressive and anxiety disorder, whereas 79 (39%) did not meet SCID criteria for anxiety or depression, reported Dr. Kunik, a geropsychiatry health services researcher at the medical center.
When the 204 patients were asked if they were currently receiving treatment for their depression or anxiety, 31% said they were. But a chart review revealed that only 20% were receiving anxiolytics or antidepressants.
Of the 91 patients who had severe levels of depression or anxiety, less than half (46%) were receiving treatment for depression and/or anxiety, and about 31% were taking an antidepressant or an anxiolytic. “I find that the most troublesome finding of the study,” he said.
A limitation of the study, he noted, was that the sample consisted only of males in the VA.