Chest
Volume 132, Issue 1, July 2007, Pages 148-155
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ORIGINAL RESEARCH
COPD
Sex Differences in the Prevalence of Psychiatric Disorders and Psychological Distress in Patients With COPD

https://doi.org/10.1378/chest.07-0134Get rights and content

Background:

Psychiatric disorders are highly prevalent in patients with COPD. In general, psychiatric disorders are more common in women than in men. The extent to which women with COPD suffer from greater psychiatric and psychological morbidity is not known. The present cross-sectional study evaluated the prevalence of mood and anxiety disorders, levels of psychological distress, and quality of life in 62 women and 54 men with documented, stable COPD.

Methods:

All patients (n = 116) underwent a sociodemographic and medical history interview, followed by a structured psychiatric interview and standard spirometry. Patients also completed a battery of questionnaires measuring psychological distress and quality of life.

Results:

The overall prevalence of psychiatric disorders was 49%. Significantly more women than men met the diagnostic criteria for anxiety disorders (56% vs 35%), and a trend for greater levels of major depression in women was found (18% vs 7%). Women had significantly higher anxiety sensitivity and depressive symptoms compared to men but did not report more limitations in psychological functioning. Women also reported being less confident in their ability to control respiratory symptoms, and more daily physical limitations compared to men, despite having comparable COPD severity, dyspnea scores, and exacerbation rates.

Conclusions:

Results indicate that psychiatric disorders are at least three times higher in COPD patients compared to the general population, and nearly two times higher in women than in men. Women also have greater psychological distress, worse perceived control of symptoms, and greater functional impairment. Greater efforts should be made to identify and treat psychiatric disorders in COPD patients, particularly in women.

Section snippets

Subjects

A total of 116 COPD patients (62 women [53%]; mean age ± SD, 66 ± 8 years) attending the respiratory outpatient clinics of Hôpital du Sacré-Coeur de Montréal (an urban university-affiliated hospital, n = 66) and Hôpital de St-Eustache (a suburban community hospital, n = 50) were recruited between April 2003 and December 2005. Potentially eligible patients received a letter giving brief details of the study and indicating that the study coordinator would contact them to discuss participation and

Sample Characteristics

As detailed in Table 1, compared to men, women were significantly younger, more likely to live alone, drank less alcohol units per week, and had smoked for fewer pack-years. There were no other significant sociodemographic differences between groups. With the exception of BMI and FEV1/FVC ratio being significantly higher in women than in men, no other COPD-related or medical-related differences were found between the sexes (Table 2).

Prevalence of Psychiatric Disorders

As displayed in Table 3, the prevalence of psychiatric

Discussion

The results of the present cross-sectional study indicate a high rate (49%) of psychiatric disorders among COPD patients compared to published levels in the general population (31%).49 These findings are consistent with the majority of previous studies232425262728 indicating a high prevalence of overall anxiety and depressive disorders among COPD patients (16 to 51%). In contrast to some previous studies232627 that have tended to report higher rates of mood than anxiety disorders among COPD

Conclusions

The results of the present study highlight the high prevalence of psychiatric disorders and psychological morbidity among COPD outpatients, particularly in women. Greater efforts should be made to improve recognition of psychological morbidity in the routine assessment and dissemination of appropriate referral and treatment (ie, pharmacologic and psychotherapeutic interventions). Further studies are needed to assess the long-term impact of psychiatric disorders on COPD morbidity and mortality,

ACKNOWLEDGMENT

The authors thank Mr. Philippe Stébenne for his invaluable assistance with data collection and Dr. Marcel Julien for his contributions to earlier versions of the protocol. The authors are also grateful for the assistance of the nurses and inhalotherapist from Hôpital du Sacré-Coeur de Montréal (Lucie Jolicoeur, Lorraine Lachance, Bernadette Tardivel, Suzanne Valois) and Hôpital de St-Eustache (Marie-Noelle Bélanger).

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    This study was supported by La Fondation de l'Hôpital du Sacré-Coeur de Montréal (Gemma Moisan Family Foundation).

    None of the authors have declared any potential conflicts of interest.

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