J Korean Med Sci.  2013 Jul;28(7):1048-1054. 10.3346/jkms.2013.28.7.1048.

Chronic Obstructive Pulmonary Disease Assessment Test Can Predict Depression: A Prospective Multi-Center Study

• Lee YS
• Park S
• Oh YM
• Lee SD
• Park SW
• Kim YS
• In KH
• Jung BH
• Lee KH
• Ra SW
• Hwang YI
• Park YB
• Jung KS
• Korean COPD Study Group

• KMID: 1777501
• DOI: http://doi.org/10.3346/jkms.2013.28.7.1048

Abstract

This study was conducted to investigate the association between the chronic obstructive pulmonary disease (COPD) assessment test (CAT) and depression in COPD patients. The Korean versions of the CAT and patient health questionnaire-9 (PHQ-9) were used to assess COPD symptoms and depressive disorder, respectively. In total, 803 patients with COPD were enrolled from 32 hospitals and the prevalence of depression was 23.8%. The CAT score correlated well with the PHQ-9 score (r=0.631; P<0.001) and was significantly associated with the presence of depression (beta+/-standard error, 0.452+/-0.020; P<0.001). There was a tendency toward increasing severity of depression in patients with higher CAT scores. By assessment groups based on the 2011 Global Initiative for Chronic Obstructive Lung Disease guidelines, the prevalence of depression was affected more by current symptoms than by airway limitation. The area under the receiver operating characteristic curve for the CAT was 0.849 for predicting depression, and CAT scores > or =21 had the highest accuracy rate (80.6%). Among the eight CAT items, energy score showed the best correlation and highest power of discrimination. CAT scores are significantly associated with the presence of depression and have good performance for predicting depression in COPD patients.

Keyword

Pulmonary Disease, Chronic Obstructive; COPD Assessment Test; Depression

MeSH Terms

Aged
Depression/*epidemiology
Depressive Disorder/*epidemiology
Female
Humans
Male
Prevalence
Pulmonary Disease, Chronic Obstructive/*diagnosis/*epidemiology/psychology
Quality of Life
Questionnaires
Severity of Illness Index

Figure

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  Fig. 1 Frequency of depression by age group.

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  Fig. 2 Frequency of depression among the four assessment groups recommended by the 2011 GOLD guidelines. The frequency of depression did not differ significantly (P = 0.955) between high-risk patients (Groups C and D; FEV1 < 50% of predicted) and low-risk patients (Groups A and B; FEV1 ≥ 50% of predicted). Frequency of depression was significantly different (P < 0.001) between patients with more symptoms (Groups B and D; CAT score ≥10) and those with less symptoms (Groups A and C; CAT score < 10). CAT, COPD assessment test; FEV1, forced expiratory volume in 1 second.

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  Fig. 3 Frequency and severity of depression according to the GOLD classification of airway limitation (A) and the COPD assessment test (CAT) groups (B). Depression frequency did not differ significantly by airway limitation (A; P = 0.087 and P = 0.283 by chi-square test and linear-by-linear association, respectively). Depression frequency was significantly different between CAT groups (B; P < 0.001 and P < 0.001 by chi-square test and linear-by-linear association). FEV1, forced expiratory volume in 1 second.

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  Fig. 4 Scatter diagrams showing the correlations between two parameters. (A) Correlation between Patient Health Questionnaire-9 (PHQ-9) and COPD assessment test (CAT). (B) Correlation between PHQ-9 and forced expiratory volume in 1 second (FEV1).

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  Fig. 5 Receiver operating characteristic (ROC) curve for the COPD assessment test (CAT) score for predicting depression (the Patient Health Questionnaire-9 score ≥ 10). The area under the curve (AUC) was 0.849 (95% confidence interval, 0.819 to 0.880; P < 0.001).

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