Published: 2018-05-25

Mental health, sleep and quality of life in patients with chronic obstructive pulmonary disease: a correlational study

Pooja M. Akhtar, Sujata Yardi, B. O. Tayade, Mayuri Pathak, Bhargavi Saraf


Background: Co-morbid psychological impairments (depression and anxiety) are common in COPD and are often associated with increased disability, health care usage and morbidity. They also impair quality of life in COPD and are often not fully explored in the clinical management of COPD patients. Psychological distress may, however, contribute to sleep difficulties in all stages of disease severity. Both anxiety and depression have been shown to have a negative effect on the sleep and quality of life (QoL).

Objectives: To study the correlation between depression, anxiety and sleep with quality of life in patients with COPD.

Methodology: In a tertiary care hospital, this Observational study was conducted on 39 patients of age group 40-70 years, with spirometry confirmed COPD GOLD category I-IV and smokers with more than 5 years of disease who fulfilled were included  in the study. Quality of life was assessed using SGRQ-C, SF-12 and CAT. Depression, Anxiety and Sleep were assessed using PHQ-9, GAD-7 and PSQI questionnaires respectively. The correlation between quality of life scores and mental health scores were analysed using Pearson’s correlation coefficient.

Results: Anxiety was significantly correlated with all the sub domains of SGRQ-C, PCS, MCS of SF-12 and the CAT score. (p value<0.001) Similarly, sleep was significantly correlated with all the three QoL Scales. (p value< 0.001) However, depression significantly correlated with all the subdomains of SGRQ-C and CAT except activity sub-domain of SGRQ-C and MCS of SF-12. (p value<0.001)

Conclusion: Anxiety, Depression and Sleep moderately correlated with QoL scores in patients with COPD.


Anxiety, COPD, Depression, Quality of life, SGRQ-C

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Afonso ASM, Verhamme KMC, Sturkenboom MCJM, Brusselles GGO. COPD in the general population: Prevalence, incidence and survival. Respir Med. 2011;105:1872-84.

Aydin IO, Ulusahin A: Depression, Anxiety comorbidity, and disability in tuberculosis and chronic obstructive pulmonary disease patients: applicability of the GHQ-12. Gen Hosp Psychiatry. 2001;23:77-83 2.

Yohannes AM, Baldwin RC, Connolly MJ. Depression and anxiety in elderly outpatients with chronic obstructive pulmonary disease: prevalence, and validation of the BASDEC screening questionnaire. Int J Geriatr Psychiatry. 2000;15:1090-1096.

Dahlen I, Janson C. Anxiety and depression are related to the outcome of emergency treatment in patients with obstructive pulmonary disease. Chest. 2002;122:1633-1637.

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 Apr 1;127(4):1205-11.

Hynninen MJ, Pallesen S, Nordhus IH. Factors affecting health status in COPD patients with co-morbid anxiety or depression. International journal of chronic obstructive pulmonary disease. 2007 Sep;2(3):323-28.

Dignani L, Toccaceli A, Lucertini C, Petrucci C, Lancia L. Sleep and quality of life in people with COPD: a descriptive-correlational study. Clinical nursing research. 2016 Aug;25(4):432-47.

Okutan O, Tas D, Demirer E, Kartaloglu Z. Evaluation of quality of life with the chronic obstructive pulmonary disease assessment test in chronic obstructive pulmonary disease and the effect of dyspnea on disease-specific quality of life in these patient. Yonsei Med J. 2013 Sep;54(5):1214-9.

Balcells E, Gea J, Ferrer J, Serra I, Orozco-Levi M, de Batlle J, et al. Factors affecting the relationship between psychological status and quality of life in COPD patients. Health and quality of life outcomes. 2010 Dec;8(1):108.

Meguro M, Barley EA, Spencer S, Jones PW. Development and validation of an improved, COPD-specific version of the St. George Respiratory Questionnaire. Chest. 2007;132(2):456-63.

Utah Health Status Survey, Utah Department of Health. Interpreting the SF-12: Comparing Versions 1 and 2 of the SF-12. 2001. Available at:

Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Leidy NK. Development and first validation of the COPD Assessment Test. Euro Res J. 2009 Sep 1;34(3):648-54.

PHQ and GAD-7 Instructions. International manual instructions for patient health questionnaire-9 and generalised anxiety disorder-7 measures. Available at: GAD7_InstructionManual.pdf.

Cully JA, Graham DP, Stanley MA, Ferguson CJ, Sharafkhaneh A, Souchek J, et al. Quality of life in patients with chronic obstructive pulmonary disease and comorbid anxiety or depression. Psychosomatics. 2006 Jul 1;47(4):312-9.

Hill K, Geist R, Goldstein RS, Lacasse Y. Anxiety and depression in end-stage COPD. European respiratory J. 2008 Mar 1;31(3):667-77.

Giardino ND, Curtis JL, Andrei AC, Fan VS, Benditt JO, Lyubkin M, et al. Anxiety is associated with diminished exercise performance and quality of life in severe emphysema: a cross-sectional study. Respiratory Res. 2010 Dec;11(1):29.

Mackay AJ, Donaldson GC, Patel AR, Jones PW, Hurst JR, Wedzicha JA. Usefulness of the chronic obstructive pulmonary disease assessment test to evaluate severity of COPD exacerbations. Am J Respir Crit Care Med. 2012;185:1218-24.

Hu J, Paula Meek P. Heath-related quality of life in individuals with chronic obstructive disease. Heart and lung. 2005;34(6):415-22.

Al-shair K, Dockry R, Mallia-Milanes B, Kolsum U, Singh D, Vestbo J. Depression and its relationship with poor exercise capacity, BODE index and muscle wasting in COPD. Respiratory Med. 2009 Oct 1;103(10):1572-9.