Published: 2017-08-26

Assessment of depression among chronic obstructive pulmonary disease (COPD) patients at rural tertiary care centre of Northern India

Aditya Kumar Gautam, Adesh Kumar, Ashish Kumar Gupta, Bal Krishna Kushwaha, Prashant Yadav, Achyut Kumar Pandey


Background: Chronic obstructive pulmonary disease COPD is a more complex systemic disease that has significant extra pulmonary effects along with pulmonary involvement. Complexity and mortality of COPD is increased by its co-morbidities and exacerbations. Depression is One of the commonest co-morbidity that occurs in patient with COPD and is associated with poor quality of life therefore we planned to assess depression among COPD patients.

Methods: This was a cross-sectional study done in the respiratory medicine department of tertiary care centre, during the period from January 2015 to June 2016. A total of 200 patients of COPD of either sex having age more than 40 years included in the study. Patients who were critically ill and uncooperative excluded from the study. Patients who did not give consent and having previous history of any psychiatric illness also excluded from the study. The diagnosis of COPD was made on the basis of the clinical history, examination, X-ray chest and spirometry. Further, depression was evaluated with the validated Hindi version of nine items PHQ-9 (a subset of patient health questionnaire).

Results: The data of all 200 COPD patients were analysed and it was observed that- prevalence of depression in COPD was found to be 49%. Prevalence was higher in male patients 147 (73.5%) as compared to female 53 (26.5%) patients in the present study. Minimal depression was found in 14.28 % COPD patients and mild depression in 25.51 % moderate depression in 39.79 % cases and severe depression in 20.40% cases.

Conclusions: Symptoms of depression are common in patients with COPD and its presence may have significant impact on the quality of life of such patients and may be associated with a higher mortality rate.


COPD, Co-Morbidity, Depression

Full Text:



Nussbaumer-Ochner Y, Rabe KF. Systemic manifestations of COPD. Chest. 2011;139:165-73.

Chatila WM, Thomashow BM, Minai OA, Criner GJ, Make BJ. Comorbidities in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2008;5:549-55.

Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J. 2009;33:1165-85.

GOLD- the global initiative for chronic obstructive lung disease (updated 2013 Feb 1; accessed 2013 Jun 20). Available at http://www.

Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J. 2008;32:962-9.

Soler Cataluna J, Martinez Garcia MA, Roman Sanchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005;60:925-31.

Sevenoaks MJ, Stockley RA. Chronic obstructive pulmonary disease, inflammation and co-morbidity- a common inflammatory phenotype? Respir Res. 2006;7:70.

Maurer J, Rebbapragada V, Borson S, Goldstein R, Kunik ME, Yohannes AM, Hanania NA. ACCP workshop panel on anxiety and depression in COPD: anxiety and depression in COPD: current understanding, unanswered questions, and research needs. Chest. 2008;134(4):43S-56S.

Van Ede L, Yzermans CJ, Brouwer HJ. Prevalence of depression in patients with chronic obstructive pulmonary disease: a systematic review. Thorax. 1999;54(8):688-92.

Kunik ME, Roundy K, Veazey C, Souchek J, Richardson P, Wray NP, et al. Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest.2005;127(4):1205-11.

Kim HF, Kunik ME, Molinari VA, Hillman SL, Lalani S, Orengo CA, et al. Functional impairment in COPD patients: the impact of anxiety and depression. Psychosomatics. 2000;41(6):465-71.

Gudmundsson G, Gislason T, Janson C, Lindberg E, SuppliUlrik C, Brondum E, et al. Depression, anxiety and health status after hospitalisation for COPD: a multicentre study in the Nordic countries. Respir Med. 2006;100(1):87-93.

Norwood RJ. A review of etiologies of depression in COPD. Int J Chron Obstruct Pulmon Dis. 2007;2(4):485-91.

Hill K, Geist R, Goldstein RS, Lacasse Y. Anxiety and depression in end-stage COPD. Eur Respir J. 2008;31(3):667-7.

Schroder CM, O’Hara R. Depression and obstructive sleep apnea (OSA). Ann Gen Psychiatry. 2005;27(4):13.

Kochhar PH, Rajadhyaksha SS, Suvarna VR. Translation and validation of brief patient health questionnaire against DSM IV as a tool to diagnose major depressive disorder in Indian patients. J Postgrad Med. 2007;53:102-7.

Spitzer RL, Kroenke K, Williams JBW. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care evaluation of mental disorders. Patient Health Questionnaire. JAMA. 1999;282:1737-44.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606-13.

Robotham JL, Lixfeld W, Holland L, Mac Gregor D, Bryan AC, Rabson J. Effect of respiration on cardiac performance. J Appl Physiol. 1978;44:703-9.

Negi H, Sarkar M, Raval AD, Pandey K, Das P. Presence of depression and its risk factors in patients with chronic obstructive pulmonary disease. Indian J Med Res. 2014;139:402-8.

Waseem SMA, Hossain M, Azmi S A, Rizvi SAA, Ahmad Z, Zaidi SH. Assessment of anxiety and depression in COPD patients-A pilot study. Current Neurobiol. 2012;3(2):112-6.

Cleland JA, Lee AJ, Hall S. Associations of depression and 28. anxiety with gender, age, health-related quality of life and symptoms in primary care COPD patients. Fam Pract. 2007;24:217-23.

Hanania NA, Mullerova H, Locantore NW, Vestbo J, Watkins ML, Wouters EF, et al. Determinants of depression in the ECLIPSE chronic obstructive pulmonary disease cohort. Am J Respie Crit Care Med. 2011;183:604-11.