Prevalence survey and analysis of influencing factors of chronic obstructive pulmonary disease comorbid with emotional disorders in Yangpu District, Shanghai_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

FAN Zheng ^1,2 , WANG Yurao ¹ , DANZENG Quzhen ¹ ,  ZHENG Cuixia ³

1. School of Medicine, Tongji University, Shanghai 200092, P. R. China;
2. Yinhang Community Health Service Center of Yangpu District, Shanghai 200438, P. R. China;
3. Department of Respiratory and Critical Care Medicine, Yangpu Hospital Affiliated to Tongji University, Shanghai 200090, P. R. China;

Corresponding?author：

ZHENG Cuixia, Email: zcx661123@163.com

Keywords：

Chronic obstructive pulmonary disease; anxiety; depression; risk factors

DOI：

10.7507/1671-6205.202505002

Video：

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Objective To investigate the prevalence and risk factors of comorbid anxiety and/or depressive disorders among patients with chronic obstructive pulmonary disease (COPD) in Yangpu District, Shanghai. Methods A cross-sectional study included 343 COPD patients hospitalized at the Department of Respiratory Medicine, Yangpu Hospital, Tongji University, from December 2022 to April 2024. The patients completed the Hospital Anxiety and Depression Scale (HADS) questionnaire, and were divided into a COPD with anxiety and/or depression disorders group and a pure COPD group. Sociodemographic factors, medical history, clinical features, and laboratory data were collected. LASSO regression and multivariate logistic regression analyses were conducted to identify influencing factors. Results Among 343 COPD patients, 77 patients (22.45%) had comorbid anxiety and/or depression disorders, including 39 patients (11.37%) with anxiety, 63 patients (18.37%) with depression, and 25 patients (7.29%) with both conditions. Independent risk factors included heavier economic burden (OR=2.85, 95%CI 1.52-5.34), living alone (OR=0.28, 95%CI 0.13-0.57), reduced cholinesterase levels (OR=0.43, 95%CI 0.23-0.80), increased acute exacerbation frequency in the past year (OR=1.99, 95%CI 1.34-2.95), and higher COPD assessment test (CAT) scores (OR=1.10, 95%CI 1.05-1.15). The logistic model exhibited strong diagnostic performance (AUC=0.82, 95%CI 0.76-0.87). Conclusions The prevalence of emotional disorders among COPD patients in Yangpu District is high, affecting nearly one-quarter of the patients. Economic burden, living arrangements, cholinesterase levels, acute exacerbation frequency, and CAT scores are independent predictors for comorbid anxiety and depressive disorders.

Citation： FAN Zheng, WANG Yurao, DANZENG Quzhen, ZHENG Cuixia. Prevalence survey and analysis of influencing factors of chronic obstructive pulmonary disease comorbid with emotional disorders in Yangpu District, Shanghai. Chinese Journal of Respiratory and Critical Care Medicine, 2026, 25(3): 163-170. doi: 10.7507/1671-6205.202505002 Copy

1.	中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病診治指南(2021年修訂版). 中華結核和呼吸雜志, 2021, 44(3): 170-205.
2.	Adeloye D, Song P, Zhu Y, et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med, 2022, 10(5): 447-458.
3.	GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2100-2132.
4.	Thapa N, Maharjan M, Shrestha TM, et al. Anxiety and depression among patients with chronic obstructive pulmonary disease and general population in rural Nepal. BMC Psychiatry, 2017, 17(1): 397.
5.	董明林, 熊夢清, 胡衛華, 等. 慢性阻塞性肺疾病合并焦慮抑郁癥的臨床特征及相關危險因素分析. 國際呼吸雜志, 2021, 41(4): 253-258.
6.	Huang K, Huang KW, Xu JY, et al. Anxiety and depression in patients with chronic obstructive pulmonary disease in China: results from the China Pulmonary Health study. Int J Chron Obstruct Pulmon Dis, 2021, 16: 3387-3396.
7.	Lou P, Zhu Y, Chen P, et al. Prevalence and correlations with depression, anxiety, and other features in outpatients with chronic obstructive pulmonary disease in China: a cross-sectional case control study. BMC Pulm Med, 2012, 12: 53.
8.	孫振曉, 劉化學, 焦林瑛, 等. 醫院焦慮抑郁量表的信度及效度研究. 中華行為醫學與腦科學雜志, 2017, 26(2): 198-201.
9.	Olsson I, Mykletun A, Dahl AA. The hospital anxiety and depression rating scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry, 2005, 5: 46.
10.	Stolz D, Mkorombindo T, Schumann DM, et al. Towards the elimination of chronic obstructive pulmonary disease: a lancet commission. Lancet, 2022, 400(10356): 921-972.
11.	Zhao X, Liu G, Liu D, et al. Clinical and economic burden of anxiety/depression among older adult COPD patients: evidence from the COPD-AD China registry study. Front Psychiatry, 2024, 14: 1307353.
12.	Wu D, Zhao X, Huang D, et al. Outcomes associated with comorbid anxiety and depression among patients with stable COPD: a patient registry study in China. J Affect Disord, 2022, 313: 77-83.
13.	Liu Y, Tian X, Guo X, et al. Prevalence of anxiety and depression in chronic obstructive pulmonary disease. Chin J Respir Crit Care Med, 2020, 19(5): 425-429.
14.	Zhang J, Song YL, Bai CX. MIOTIC study: a prospective, multicenter, randomized study to evaluate the long-term efficacy of mobile phone-based internet of things in the management of patients with stable COPD. Int J Chron Obstruct Pulmon Dis, 2013, 8: 433-438.
15.	Tse HN, Tseng CZS, Wong KY, et al. Frequent exacerbator: the phenotype at risk of depressive symptoms in geriatric COPD patients. Lung, 2016, 194(4): 665-673.
16.	劉瑩瑩. 醫院慢性阻塞性肺疾病患者焦慮抑郁發生情況及影響因素. 青島: 青島大學, 2016.
17.	Ng TP, Niti M, Tan WC, et al. Depressive symptoms and chronic obstructive pulmonary disease - effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Arch Intern Med, 2007, 167(1): 60-67.
18.	Liu M, Li Y, Yin D, et al. COPD assessment test as a screening tool for anxiety and depression in stable COPD patients: a feasibility study. COPD, 2023, 20(1): 144-152.
19.	Miyazaki M, Nakamura H, Chubachi S, et al. Analysis of comorbid factors that increase the COPD assessment test scores. Respir Res, 2014, 15(1): 13.
20.	Chen Z, Zha L, Feng G, et al. Prognostic value of serum cholinesterase levels for in-hospital mortality among patients with acute exacerbation of chronic obstructive pulmonary disease. COPD, 2023, 20(1): 178-185.
21.	胡詩禮, 李麗華, 張李, 等. 血清IL-17和CHE及和肽素水平與老年 COPD合并肺部感染的相關性. 中華醫院感染學雜志 , 2020, 30(21): 3272-3276.
22.	Chen Z, Zha L, Hu B, et al. Use of the serum level of cholinesterase as a prognostic marker of nonfatal clinical outcomes in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease. Can Respir J, 2024: 5512374.

1. 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病診治指南(2021年修訂版). 中華結核和呼吸雜志, 2021, 44(3): 170-205.
2. Adeloye D, Song P, Zhu Y, et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med, 2022, 10(5): 447-458.
3. GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2100-2132.
4. Thapa N, Maharjan M, Shrestha TM, et al. Anxiety and depression among patients with chronic obstructive pulmonary disease and general population in rural Nepal. BMC Psychiatry, 2017, 17(1): 397.
5. 董明林, 熊夢清, 胡衛華, 等. 慢性阻塞性肺疾病合并焦慮抑郁癥的臨床特征及相關危險因素分析. 國際呼吸雜志, 2021, 41(4): 253-258.
6. Huang K, Huang KW, Xu JY, et al. Anxiety and depression in patients with chronic obstructive pulmonary disease in China: results from the China Pulmonary Health study. Int J Chron Obstruct Pulmon Dis, 2021, 16: 3387-3396.
7. Lou P, Zhu Y, Chen P, et al. Prevalence and correlations with depression, anxiety, and other features in outpatients with chronic obstructive pulmonary disease in China: a cross-sectional case control study. BMC Pulm Med, 2012, 12: 53.
8. 孫振曉, 劉化學, 焦林瑛, 等. 醫院焦慮抑郁量表的信度及效度研究. 中華行為醫學與腦科學雜志, 2017, 26(2): 198-201.
9. Olsson I, Mykletun A, Dahl AA. The hospital anxiety and depression rating scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry, 2005, 5: 46.
10. Stolz D, Mkorombindo T, Schumann DM, et al. Towards the elimination of chronic obstructive pulmonary disease: a lancet commission. Lancet, 2022, 400(10356): 921-972.
11. Zhao X, Liu G, Liu D, et al. Clinical and economic burden of anxiety/depression among older adult COPD patients: evidence from the COPD-AD China registry study. Front Psychiatry, 2024, 14: 1307353.
12. Wu D, Zhao X, Huang D, et al. Outcomes associated with comorbid anxiety and depression among patients with stable COPD: a patient registry study in China. J Affect Disord, 2022, 313: 77-83.
13. Liu Y, Tian X, Guo X, et al. Prevalence of anxiety and depression in chronic obstructive pulmonary disease. Chin J Respir Crit Care Med, 2020, 19(5): 425-429.
14. Zhang J, Song YL, Bai CX. MIOTIC study: a prospective, multicenter, randomized study to evaluate the long-term efficacy of mobile phone-based internet of things in the management of patients with stable COPD. Int J Chron Obstruct Pulmon Dis, 2013, 8: 433-438.
15. Tse HN, Tseng CZS, Wong KY, et al. Frequent exacerbator: the phenotype at risk of depressive symptoms in geriatric COPD patients. Lung, 2016, 194(4): 665-673.
16. 劉瑩瑩. 醫院慢性阻塞性肺疾病患者焦慮抑郁發生情況及影響因素. 青島: 青島大學, 2016.
17. Ng TP, Niti M, Tan WC, et al. Depressive symptoms and chronic obstructive pulmonary disease - effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Arch Intern Med, 2007, 167(1): 60-67.
18. Liu M, Li Y, Yin D, et al. COPD assessment test as a screening tool for anxiety and depression in stable COPD patients: a feasibility study. COPD, 2023, 20(1): 144-152.
19. Miyazaki M, Nakamura H, Chubachi S, et al. Analysis of comorbid factors that increase the COPD assessment test scores. Respir Res, 2014, 15(1): 13.
20. Chen Z, Zha L, Feng G, et al. Prognostic value of serum cholinesterase levels for in-hospital mortality among patients with acute exacerbation of chronic obstructive pulmonary disease. COPD, 2023, 20(1): 178-185.
21. 胡詩禮, 李麗華, 張李, 等. 血清IL-17和CHE及和肽素水平與老年 COPD合并肺部感染的相關性. 中華醫院感染學雜志 , 2020, 30(21): 3272-3276.
22. Chen Z, Zha L, Hu B, et al. Use of the serum level of cholinesterase as a prognostic marker of nonfatal clinical outcomes in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease. Can Respir J, 2024: 5512374.

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