Photo Credit: Jovanmandic

Researchers found the Hospital Anxiety and Depression Scale to be a useful tool for anxiety assessment in routine COPD management.

Anxiety is a well-documented comorbidity in patients with chronic obstructive pulmonary disease (COPD) that can compromise a patient’s QOL and prognosis. Despite the dangers of anxiety and other mental health comorbidities in patients with COPD, studies show gaps in consistent diagnosis and referral to mental health resources.

More Consistent Diagnosis

Authors of a study in the Journal of Personalized Medicine explained that the Hospital Anxiety and Depression Scale (HADS) may prove useful in diagnosing anxiety in the primary care setting. To gauge its value and applicability, Miguel A. Hernández-Mezquita, MD, PhD, and colleagues developed an observational, multicentric, prospective, transversal study with a non-probabilistic sample.

The study drew its participant pool from two primary care facilities. Patients had COPD confirmed through spirometry with a bronchodilator test. They also underwent a complete respiratory history and an updated smoking history. Study participants who had a confirmed anxiety diagnosis scored a value of 7 or greater on the HADS test.

Smoking History

With these criteria, the researchers included 229 men and 64 women with a mean age of 68.2 ±10.3 years (range, 40-91). At the start of the study, 93 participants were active smokers. All participants, however, were smokers at some point, with an average smoking history of 39.7 ±11.5 years, and the average rate of use during their period of active smoking was 25.5 ±13.6 cigarettes per day. Those participants who were not smokers at the start of the study had quit 11.7 ±0.7 years prior to enrollment.

Participants received a COPD diagnosis 6.6 ±6.4 years before the study. Regarding their risk level, 64.5% of the patients were classified as high risk and 35.5% as low risk, according to the Spanish COPD Guidelines.

Anxiety Diagnosis

The researchers divided patients into three groups based on their HADS test scores: 7 or less, 8 and 10, and 11 or more. If the patient had a HADS score greater than 7, the investigators recorded suspicion of anxiety. Overall, 208 patients did not have anxiety, while 85 had suspected anxiety. Of those with suspected anxiety, 17 had possible anxiety, and 68 had probable suspicion of anxiety (Table).

Before the study, 27 participants had a clinical diagnosis of anxiety by a mental health professional. The researchers noted the mean HADS score for patients entering the study with an anxiety diagnosis was an average 4.9 points higher than that of undiagnosed patients (Table). Researchers noted that this confirmed the usefulness of the HADS test.

The only personal factors that influenced the diagnosis of anxiety were female sex, lower weight, and BMI. Other personal variables, such as age and residence in an urban or rural area, were not significant on the test scores.

“The use of simple tools like the HADS test in primary care and pulmonology services could facilitate a diagnosis and the referral of patients to mental health units,” Dr. Hernández-Mezquita and colleagues wrote. “A multidisciplinary approach involving family medicine, pulmonology, and psychiatry would be a strategic alliance that could help improve the health status of patients with COPD and the overall course of the disease.”