Depression in elderly outpatients with disabling chronic obstructive pulmonary disease

Depression is common in both young adults and elderly people with chronic obstructive pulmonary disease (COPD).

We compared the prevalence of depressive symptomatology in elderly outpatients with stable disabling COPD with that in healthy controls and age-matched patients with other disabilities, and also assessed the relation between degree of disability, quality of life and depressive symptoms. The subjects were 96 older people with COPD [56 men; aged 70-93 (mean 78) years], 55 normal controls [23 men; aged 70-90 (mean 78) years] and 53 disabled controls [27 men; aged 70-92 (mean 78) years]. Exclusion criteria were acute respiratory exacerbation or use of oral steroids in the last 6 weeks, known previous psychiatric disorder and acute or chronic confusion.

Mean (and SD) values for 1-s forced expiratory volume (FEV1) were 51 (20) % in COPD subjects, 107 (24) % in normal controls and 82 (13)% in disabled controls. Forty-four subjects with COPD (46%), six normal controls (11%) and 14 disabled controls (26%) scored in the 'caseness' range for depressive ideation on the Brief Assessment Schedule Depression Cards (BASDEC) screening questionnaire. A multiple regression analysis was performed for the COPD group to identify factors predictive of BASDEC score. Predictive variables were total quality of life score [P<0.0001], Chronic Respiratory Questionnaire and level of activities of daily living (Nottingham extended activities of daily living scale) [P = 0.001]. Spirometry results and exercise tolerance (6-min walk distance) did not help predict BASDEC score (R2 = 0.50).

Depressive symptoms are common in elderly patients with COPD; prevalence and/or severity of depressive symptoms may be greater in those who are most disabled.