The association of anxiety and depression with mortality in a COPD cohort. The HUNT study, Norway

Sigrid Anna Aalberg Vikjord; Ben Michael Brumpton; Xiao-Mei Mai; Lowie Vanfleteren; Arnulf Langhammer

doi:10.1016/j.rmed.2020.106089

The association of anxiety and depression with mortality in a COPD cohort. The HUNT study, Norway

Respir Med. 2020 Sep:171:106089. doi: 10.1016/j.rmed.2020.106089. Epub 2020 Aug 5.

Authors

Sigrid Anna Aalberg Vikjord¹, Ben Michael Brumpton², Xiao-Mei Mai³, Lowie Vanfleteren⁴, Arnulf Langhammer⁵

Affiliations

¹ Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway; HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Levanger, Norway. Electronic address: sigrid.a.vikjord@ntnu.no.
² Clinic of Thoracic and Occupational Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
³ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
⁴ COPD Centre, Sahlgrenska University, Hospital and Institute of Medicine, Gothenburg University, Gothenburg, Sweden.
⁵ HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Levanger, Norway.

PMID: 32799059
DOI: 10.1016/j.rmed.2020.106089

Abstract

Background: Anxiety and depression are prevalent among individuals with chronic obstructive pulmonary disease (COPD), but the impact of these comorbidities on long-term mortality is unknown.

Aims: This study aims to compare mortality in individuals with COPD who had or did not have symptoms of anxiety or depression as well as the impact of a change in these symptoms on mortality.

Methods: Individuals with COPD according to the Global Lung Initiative (GLI) LLN criteria (n = 2076) were recruited from the second (1995-97) and third (2006-08) surveys of the HUNT Study and followed until January 2019 for mortality. We assessed baseline status of anxiety or depression using the Hospital Anxiety and Depression Scale (HADS), and probable cases were defined by a score ≥8. We used Cox regression to calculate hazard ratios (HR) with 95% confidence intervals (CI). Change in HADS score over time was assessed using joint models.

Results: Among the individuals with COPD, 16.2% had symptoms of anxiety and 15.9% had symptoms of depression. Compared to those with HADS-A and -D score <8, symptoms of anxiety or depression increased mortality by 21% (95% CI 05-47%) and 21% (2-44%), respectively. Over the approximately 11-year period between surveys, change of HADS-A from ≥8 to <8 was associated with a decrease in mortality (HR 0.97 [95% CI 0.94-1.00]), but not in HADS-D (0.97 [95% CI 0.93-1.18]).

Conclusions: Individuals with COPD and symptoms of anxiety or depression have increased mortality, and improved HADS-A score with time is associated with lower mortality.

Keywords: Anxiety; COPD; Depression; Epidemiology; Mortality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Anxiety Disorders / epidemiology*
Cohort Studies
Comorbidity
Depression / epidemiology*
Female
Humans
Male
Middle Aged
Norway / epidemiology
Pulmonary Disease, Chronic Obstructive / epidemiology*
Pulmonary Disease, Chronic Obstructive / mortality*
Time Factors