Depression in elderly outpatients with disabling chronic obstructive pulmonary disease

Age and Ageing, March, 1998 by Abebw M. Yohannes, Jamal Roomi, Robert C. Baldwin, Martin J. Connolly

                                     Mean value (SD), by group

                                      COPD              NC

Age (years)                           78 (5)            78 (5)
[FEV.sub.1] (1)                        0.95 (0.36)       1.96 (0.52)
[FEV.sub.1] (% of predicted level)    51 (20)          107 (24)
6-min walk (m)                       212 (96)          373 (84)
NEADL                                 12.9 (4.9)        19.1 (2.2)
Total CRQ                             78 (23.2)        116 (117.3)

                                      DC               P value(a)

Age (years)                           78(5)            NS
[FEV.sub.1] (1)                        1.43(0.46)      <0.0001
[FEV.sub.1] (% of predicted level)    82(25)           <0.0001
6-min walk (m)                         -(b)            <0.0001
NEADL                                  9.6 (4.2)       <0.0001
Total CRQ                            102 (25)          <0.0001

[FEV.sub.1] (%), forced expiratory volume in 1-s percentage; NEADL, Nottingham extended activities of daily living score; CRQ, Chronic Respiratory Questionnaire score.

(a) COPD vs NCs and vs DCs.

(b) Test not performed.

Table 2 shows `caseness' of BASDEC scores. Forty-four of the 96 COPD subjects (46%) had `depressive' symptom scores [is greater than or equal to] 7. Conversely, six of the 55 normal controls (11%) and 14 of the 53 disabled controls (26%) had `depressive' symptom scores. Only five of the COPD subjects and none of the disabled controls or normal controls were receiving antidepressant medication.

Table 2. Screening of `caseness' using Brief Assessment Schedule Depression Cards (BASDEC): a BASDEC score of [is greater than or equal to] 7 is abnormal and indicates a `case'

         No. (and %) of subjects

         By BASDEC score

Group    <7        [is greater than or equal to] 7    Total
COPD     52 (55)   44 (45)(a,b)                       96
NC       49 (89)   6 (11)                             55
DC       39 (76)   14 (26)                            53

COPD, chronic obstructive pulmonary disease; NC, normal control; DC, disabled control.

(a) [X.sup.2] and P vs NCs: [X.sup.2] = 17.7; P < 0.0001.

(b) [X.sup.2] and P vs DCs: [X.sup.2] = 4.6; P = 0.031

Table 3 shows multiple regression analysis to identify variables that best predict BASDEC score in COPD subjects. The dependent variable was BASDEC and the independent variables were dyspnoea score, total CRQ, [FEV.sub.1] (% of predicted level), age, household composition (living alone versus living with others), previous occupation (social class scale), body mass index, gender, 6-min walk score and NEADL. Dyspnoea score, body mass index, previous occupation, age, sex, physiological measurements and 6-min walk distance did not help to predict BASDEC. Further analysis showed 34% of the variance was accounted for by variance in NEADL and 16% by variance in total CRQ

Table 3. Results of multiple regression analysis factors predicting Brief Assessment Schedule Depression Cards score

Variable                        B        SE       t-score   P value

Total CRQ                      -0.10     0.02     -4.29     <0.0001
NEADL                          -0.36     0.11     -3.16      0.00
[FEV.sub.1] (%)                 0.01     0.07      0.62      0.53
Age                            -0.05     0.07     -0.81      0.41
Household composition(a)        1.19     0.74      1.62      0.1
Dyspnoea CRQ                    0.06     0.07      0.85      0.39
Body mass index                 0.004    0.06      0.06      0.95
Sex                             1.02     0.71      1.43      0.15
6-min walking test              0.005    0.004     1.17      0.24
Previous occupation(b)         -0.38     0.49     -0.78      0.43