A1161 - Symptoms of Depression and Anxiety in Patients with COPD: A Network Analysis
Author Block: A. M. Yohannes¹, M. Belvederi Murri², K. F. Hoth³, E. A. Regan⁴, A. S. Iyer⁵, S. P. Bhatt⁶, V. Kim⁷, G. L. Kinney⁸, R. A. Wise⁹, M. Eakin⁹, N. A. Hanania¹⁰; ¹Physical Therapy, Azusa Pacific Univ, Azusa, CA, United States, ²Department of Biomedical and Specialty of Surgical Sciences, University of Ferrara, Ferera, Italy, ³Psychiatry, University of Iowa, Iowa City, IA, United States, ⁴National Jewish Health, Denver, CO, United States, ⁵Pulmonary, Allergy, Critical Care Medicine, UAB, Birmingham, AL, United States, ⁶Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States, ⁷Thoracic Medicine and Surgery, Temple Lung Center, Philadelphia, PA, United States, ⁸Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, United States, ⁹Johns Hopkins Univ, Baltimore, MD, United States, ¹⁰Department of Medicine, Bayor College of Medicine, Houston, TX, United States.
Background. Depression and anxiety in COPD are related with frequent hospitalization and increased disability. Knowledge about these comorbid symptoms, however, was derived from questionnaire sum-scores, which may lead to a loss of clinical detail. In contrast, the network approach to psychopathology was designed to examine the relationship between individual symptoms, and to identify their most meaningful causal interactions. The aim of this study was to examine the relationship and directions between individual depressive and anxiety symptoms and clinical features of COPD using a network approach. Method. We analyzed data collected during the Phase 2 visit of the COPDGene study, (n=1,587, mean age 67.97±8.30, 49.5% females). Symptoms of depression and anxiety were measured using items from the Hospital Anxiety and Depression Scale (HADS), COPD symptom impact by COPD Assessment Test (CAT), functional capacity by Six Minute Walk Test, and lung function by spirometry. BMI and items of clinical characteristics were extracted from the self-reported medical history. We performed Network Analyses with Bayesian estimation of the Gaussian Graphical Model to identify the most relevant connections (edges) between mood symptoms and clinical variables (nodes), and represent them as a Network. The final model also included additional clinical parameters. We calculated centrality metrics for each node (strength, predictability, bridge centrality) as well as comparing networks between sex and race (Caucasian vs. Black). Results. A sparse network was identified, where multiple positive connections were identified between symptoms of COPD, anxiety and depression. Among others, reduced energy and cough were connected with sadness; chest tightness with fear/panic and restlessness; breathlessness with psychomotor slowing. Activity limitations, cough, worries, low energy, slowing, chest tightness and sadness were the most central symptoms. Activity limitations, slowing and sleep problems were frequently “bridges” from COPD-related symptoms to psychological symptoms. Age was connected positively with slowing, and negatively with fear/panic and anhedonia. The connection between worries and activity limitation was stronger among males than females, and among Caucasians than Blacks. In the final model (Figure) clinical parameters were mostly connected with breathlessness, restlessness, anhedonia and psychomotor slowing. Conclusion. Activity limitation, psychomotor slowing and sleep problems were identified as the most relevant “bridge symptoms” between COPD and depression and anxiety. Network analyses identified meaningful clinical symptom connections that highlight the complex interaction between physical and psychological features in COPD patients. Future longitudinal studies might examine activity limitation and sleep problems either as elective targets for preventive or therapeutic interventions for depression and anxiety.