Diagnosis of Anxiety in COPD Patients: Usefulness of the HADS Test in Primary Care and Pulmonology Services

Overview

Journal J Pers Med

Date 2024 Jul 27

PMID 39063967

Authors

Enrique Barrueco

Miguel A Hernandez-Mezquita

Vanesa Hidalgo-Sierra

Rosa Cordovilla

Javier Olivera-Pueyo

Javier Galan

Affiliations

Soon will be listed here.

Abstract

Anxiety disorders, characterized by excessive fear and anxiety, are increasingly recognized as significant comorbidities in chronic diseases such as chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the prevalence of anxiety in COPD patients referred from primary care centers to pulmonology services and to identify predictive factors for anxiety. This was a multicentric, observational, and prospective study in which 293 COPD patients were recruited, and they underwent comprehensive respiratory and smoking histories, spirometry, and anxiety assessments using the Hospital Anxiety and Depression Scale (HADS). The results showed a diagnosis of suspected anxiety in 85 patients (29.0%): 17 possible and 68 with a strong suspicion. The study found significant associations between anxiety and factors such as gender (women had a risk that was 3.5 times higher than men), weight, and body mass index (BMI). Disease severity, smoking status, and clinical manifestations did not significantly influence anxiety prevalence. These findings underscore the need for systematic psychological evaluations in COPD management and support the use of simple diagnostic tools like the HADS to facilitate referrals to mental health services. Addressing anxiety in COPD patients could potentially improve their quality of life and disease outcomes. This study highlights the importance of a multidisciplinary approach involving family medicine, pulmonology, and psychiatry to optimize COPD patient care and suggests that future research should focus on the impact of anxiety treatment on COPD progression. These insights call for integrating psychological assessments into routine clinical practice for comprehensive COPD management. The registration number is 10.14201/gredos.148549.

References

Divo M, Cote C, de Torres J, Casanova C, Marin J, Pinto-Plata V . Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2012; 186(2):155-61. DOI: 10.1164/rccm.201201-0034OC. View

Gonzalez-Gutierrez M, Guerrero Velazquez J, Morales Garcia C, Casas Maldonado F, Gomez Jimenez F, Gonzalez Vargas F . Predictive Model for Anxiety and Depression in Spanish Patients with Stable Chronic Obstructive Pulmonary Disease. Arch Bronconeumol. 2015; 52(3):151-7. DOI: 10.1016/j.arbres.2015.09.003. View

Jimenez-Ruiz C, Pascual Lledo J, Cicero Guerrero A, Cristobal Fernandez M, Mayayo Ulibarri M, Villar Laguna C . [Analysis of quality of life in patients with Chronic Obstructive Pulmonary Disorder (COPD) who give up smoking]. Semergen. 2017; 44(5):310-315. DOI: 10.1016/j.semerg.2017.08.003. View

Laurin C, Lavoie K, Bacon S, Dupuis G, Lacoste G, Cartier A . Sex differences in the prevalence of psychiatric disorders and psychological distress in patients with COPD. Chest. 2007; 132(1):148-55. DOI: 10.1378/chest.07-0134. View

Soriano J, Alfageme I, Miravitlles M, de Lucas P, Soler-Cataluna J, Garcia-Rio F . Prevalence and Determinants of COPD in Spain: EPISCAN II. Arch Bronconeumol (Engl Ed). 2020; 57(1):61-69. DOI: 10.1016/j.arbres.2020.07.024. View

Usmani Z, Carson K, Heslop K, Esterman A, Soyza A, Smith B . Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017; 3:CD010673. PMC: 6464539. DOI: 10.1002/14651858.CD010673.pub2. View

Underner M, Cuvelier A, Peiffer G, Perriot J, Jaafari N . [The influence of anxiety and depression on COPD exacerbations]. Rev Mal Respir. 2018; 35(6):604-625. DOI: 10.1016/j.rmr.2018.04.004. View

Wu D, Chang L, Yang P, Kuo T, Tsai D, Chen H . Anxiety Is a Mediator between Heart Rate Variability and Quality of Life in Chronic Obstructive Pulmonary Disease. J Pers Med. 2022; 12(6). PMC: 9225566. DOI: 10.3390/jpm12060960. View

Albarracin G, Rovira J, Carreras L, Rejas J . [Economic and epidemiologic aspects of generalized anxiety disorder: a review of the literature]. Actas Esp Psiquiatr. 2008; 36(3):165-76. View

10.

Di Raimondo D, Pirera E, Pintus C, De Rosa R, Profita M, Musiari G . The Role of the Cumulative Illness Rating Scale (CIRS) in Estimating the Impact of Comorbidities on Chronic Obstructive Pulmonary Disease (COPD) Outcomes: A Pilot Study of the MACH (Multidimensional Approach for COPD and High Complexity) Study. J Pers Med. 2023; 13(12). PMC: 10745043. DOI: 10.3390/jpm13121674. View

11.

Barrueco-Otero E, Refoyo Matellan B, Martin Puente J, Vinado Manes C, Leon Subias E, Olivera Pueyo J . [Prevalence of Depressive Symptoms, Predictive Factors, and Diagnosis of Suspicion of Depression in Patients with COPD]. Aten Primaria. 2022; 54(3):102236. PMC: 8841611. DOI: 10.1016/j.aprim.2021.102236. View

12.

Fernandez-Villar A, Fernandez-Garcia S, Represas-Represas C . Is the Social Component of chronic obstructive pulmonary disease a Treatable Trait?. Arch Bronconeumol (Engl Ed). 2019; 56(4):199-200. DOI: 10.1016/j.arbres.2019.06.019. View

13.

Kuhl K, Schurmann W, Rief W . Mental disorders and quality of life in COPD patients and their spouses. Int J Chron Obstruct Pulmon Dis. 2009; 3(4):727-36. PMC: 2650604. DOI: 10.2147/copd.s3375. View

14.

Brenes G . Anxiety and chronic obstructive pulmonary disease: prevalence, impact, and treatment. Psychosom Med. 2003; 65(6):963-70. DOI: 10.1097/01.psy.0000097339.75789.81. View

15.

Zigmond A, SNAITH R . The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67(6):361-70. DOI: 10.1111/j.1600-0447.1983.tb09716.x. View

16.

Miravitlles M, Calle M, Molina J, Almagro P, Gomez J, Trigueros J . Spanish COPD Guidelines (GesEPOC) 2021: Updated Pharmacological treatment of stable COPD. Arch Bronconeumol. 2021; 58(1):69-81. DOI: 10.1016/j.arbres.2021.03.005. View

17.

Pooler A, Beech R . Examining the relationship between anxiety and depression and exacerbations of COPD which result in hospital admission: a systematic review. Int J Chron Obstruct Pulmon Dis. 2014; 9:315-30. PMC: 3974694. DOI: 10.2147/COPD.S53255. View

18.

Perpina-Galvan J, Richart-Martinez M, Cabanero-Martinez M . Reliability and validity of a short version of the STAI anxiety measurement scale in respiratory patients. Arch Bronconeumol. 2011; 47(4):184-9. DOI: 10.1016/j.arbres.2010.11.006. View

19.

Xiao T, Qiu H, Chen Y, Zhou X, Wu K, Ruan X . Prevalence of anxiety and depression symptoms and their associated factors in mild COPD patients from community settings, Shanghai, China: a cross-sectional study. BMC Psychiatry. 2018; 18(1):89. PMC: 5883260. DOI: 10.1186/s12888-018-1671-5. View

20.

Fernandez-Garcia S, Represas-Represas C, Ruano-Ravina A, Mosteiro-Anon M, Mouronte-Roibas C, Fernandez-Villar A . Social Profile of Patients Admitted for COPD Exacerbations. A Gender Analysis. Arch Bronconeumol (Engl Ed). 2019; 56(2):84-89. DOI: 10.1016/j.arbres.2019.03.009. View