Depression More Than Doubles Risk of Emergency Care Use in COPD

Psychological comorbidities are common in people with chronic obstructive pulmonary disease (COPD), particularly depression and anxiety. The presence of depression, especially, has important implications for outcomes, according to a new study that found depression is a predictor of emergency care for the patient population.

The findings, coming from data on more than 900 patients with COPD, indicate that as depression severity increased, so did the odds of landing in the hospital. According to the researchers, this was the first study to show that even mild symptoms of depression increased the risk of emergency care.

Depression severity was measured using the Hospital Anxiety and Depression Scale, which is scored on a scale of 0 to 21. For patients with COPD who had depression scores between 4 and 7, there was a 2.8 times increased odds of being admitted to the hospital within the 1 year of follow-up. Those with scores of 8 or higher were nearly 5 times more likely to be admitted to the hospital.

“Patients understandably view their contacts with urgent care services as unavoidable and a result of an exacerbation of their illness,” wrote the researchers, adding, “However, whilst some hospital admissions may be unavoidable and necessary for patients with COPD, our findings provide further evidence that there may be modifiable psychosocial factors, which are also driving contact with acute care.”

Among the 950 patients, 7.6% suffered from depression, and according to the researchers, just a small amount were receiving any kind of recognized intervention for their mental health. Previous research has indicated that there is a significant unmet mental health care need for patients with COPD.

Older age, the number of comorbid physical health conditions, the severity of COPD, and prior use of emergency care were all also associated with both emergency department attendance and emergency hospital admission. Depression severity was still a predictive factor for emergency department use independent of these other factors.

The researchers noted that how depression influences the use of emergency care in these patients is unclear but that there’s a large evidence base of studies on long-term conditions that shows depression has a deleterious effect on many aspects of physical health outcomes, including adherence to treatment and self-care.

“Depression is also associated with feelings of hopelessness, social withdrawal, lower self-efficacy, loss of autonomy and uncertainty,” explained the researchers. “All of these factors could potentially contribute to acute exacerbations in COPD, prompting the need for acute care.”

Reference

Blakemore A, Dickens C, Chew-Graham C, et al. Depression predicts emergency care use in people with chronic obstructive pulmonary disease: a large cohort study in primary care [published online June 28, 2019]. Int J Chron Obstruct Pulmon Dis. doi:10.2147/COPD.S179109.