Skip to main content
Top
Published in: BMC Pulmonary Medicine 1/2021

Open Access 01-12-2021 | Mood Disorders | Research article

Sex differences in risk factors for depressive symptoms in patients with COPD: The 2014 and 2016 Korea National Health and Nutrition Examination Survey

Authors: Ji Soo Choi, Se Hyun Kwak, Nak-Hoon Son, Jae Won Oh, San Lee, Eun Hye Lee

Published in: BMC Pulmonary Medicine | Issue 1/2021

Login to get access

Abstract

Background

Although depression is a common comorbidity of chronic obstructive pulmonary disease (COPD), the role of sex remains unexplored. We evaluated sex differences of risk factors of depressive symptoms in adults with COPD.

Methods

This was a population-based cross-sectional study using data from the 2014 and 2016 Korea National Health and Nutrition Examination Survey. Spirometry was used to identify patients with COPD, defined as a FEV1/FVC ratio < 0.7. Presence of depressive symptoms was defined as a total score ≥ 5 on the Patient Health Questionnaire-9.

Results

17.8% of participants expressed depressive symptoms. Relative regression analysis revealed that female sex (RR 2.38; 95% CI 1.55–3.66; p < 0.001), living alone (RR 1.46; 95% CI 1.08–1.97; p = 0.013), current smoker (RR 1.70; 95% CI 1.15–2.52; p = 0.008), underweight (RR 1.58 95% CI 1.00–2.49; p = 0.049), and GOLD Stage III/IV (RR 1.92; 95% CI 1.19–3.09; p = 0.007) were the risk factors for depressive symptoms. Low income, living alone, multiple chronic disorders, and low BMI were risk factors of depressive symptoms in male, whereas low educational attainment, urban living, and current smoking were risk factors in female.

Conclusions

Female sex is a main risk factor of depressive symptoms in adults with COPD. As risk factors of depressive symptoms in COPD patients vary according to their sex, different approaches are needed to manage depression in males and females with COPD.
Literature
1.
go back to reference Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001;163(5):1256–76.CrossRef Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001;163(5):1256–76.CrossRef
2.
go back to reference Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J. 2008;32(4):962–9.CrossRef Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J. 2008;32(4):962–9.CrossRef
3.
go back to reference Sin DD, Man JP, Man SF. The risk of osteoporosis in Caucasian men and women with obstructive airways disease. Am J Med. 2003;114(1):10–4.CrossRef Sin DD, Man JP, Man SF. The risk of osteoporosis in Caucasian men and women with obstructive airways disease. Am J Med. 2003;114(1):10–4.CrossRef
4.
go back to reference Young RP, Hopkins RJ, Christmas T, Black PN, Metcalf P, Gamble GD. COPD prevalence is increased in lung cancer, independent of age, sex and smoking history. Eur Respir J. 2009;34(2):380–6.CrossRef Young RP, Hopkins RJ, Christmas T, Black PN, Metcalf P, Gamble GD. COPD prevalence is increased in lung cancer, independent of age, sex and smoking history. Eur Respir J. 2009;34(2):380–6.CrossRef
5.
go back to reference Maurer J, Rebbapragada V, Borson S, Goldstein R, Kunik ME, Yohannes AM, Hanania NA. Anxiety and depression in COPD: current understanding, unanswered questions, and research needs. Chest. 2008;134(4 Suppl):43s–56s.CrossRef Maurer J, Rebbapragada V, Borson S, Goldstein R, Kunik ME, Yohannes AM, Hanania NA. Anxiety and depression in COPD: current understanding, unanswered questions, and research needs. Chest. 2008;134(4 Suppl):43s–56s.CrossRef
6.
go back to reference Matte DL, Pizzichini MM, Hoepers AT, Diaz AP, Karloh M, Dias M, Pizzichini E. Prevalence of depression in COPD: A systematic review and meta-analysis of controlled studies. Respir Med. 2016;117:154–61.CrossRef Matte DL, Pizzichini MM, Hoepers AT, Diaz AP, Karloh M, Dias M, Pizzichini E. Prevalence of depression in COPD: A systematic review and meta-analysis of controlled studies. Respir Med. 2016;117:154–61.CrossRef
7.
go back to reference Laurin C, Moullec G, Bacon SL, Lavoie KL. Impact of anxiety and depression on chronic obstructive pulmonary disease exacerbation risk. Am J Respir Crit Care Med. 2012;185(9):918–23.CrossRef Laurin C, Moullec G, Bacon SL, Lavoie KL. Impact of anxiety and depression on chronic obstructive pulmonary disease exacerbation risk. Am J Respir Crit Care Med. 2012;185(9):918–23.CrossRef
8.
go back to reference Almagro P, Calbo E, Ochoa de Echaguen A, Barreiro B, Quintana S, Heredia JL, Garau J. Mortality after hospitalization for COPD. Chest. 2002;121(5):1441–8.CrossRef Almagro P, Calbo E, Ochoa de Echaguen A, Barreiro B, Quintana S, Heredia JL, Garau J. Mortality after hospitalization for COPD. Chest. 2002;121(5):1441–8.CrossRef
9.
go back to reference Cully JA, Graham DP, Stanley MA, Ferguson CJ, Sharafkhaneh A, Souchek J, Kunik ME. Quality of life in patients with chronic obstructive pulmonary disease and comorbid anxiety or depression. Psychosomatics. 2006;47(4):312–9.CrossRef Cully JA, Graham DP, Stanley MA, Ferguson CJ, Sharafkhaneh A, Souchek J, Kunik ME. Quality of life in patients with chronic obstructive pulmonary disease and comorbid anxiety or depression. Psychosomatics. 2006;47(4):312–9.CrossRef
10.
go back to reference van Manen JG, Bindels PJ, Dekker FW, Ijzermans CJ, van der Zee JS, Schade E. Risk of depression in patients with chronic obstructive pulmonary disease and its determinants. Thorax. 2002;57(5):412–6.CrossRef van Manen JG, Bindels PJ, Dekker FW, Ijzermans CJ, van der Zee JS, Schade E. Risk of depression in patients with chronic obstructive pulmonary disease and its determinants. Thorax. 2002;57(5):412–6.CrossRef
11.
go back to reference Ghaemi Kerahrodi J, Brahler E, Wiltink J, Michal M, Schulz A, Wild PS, Munzel T, Toenges G, Lackner KJ, Pfeiffer N, et al. Association between medicated obstructive pulmonary disease, depression and subjective health: results from the population-based Gutenberg Health Study. Sci Rep. 2019;9(1):20252.CrossRef Ghaemi Kerahrodi J, Brahler E, Wiltink J, Michal M, Schulz A, Wild PS, Munzel T, Toenges G, Lackner KJ, Pfeiffer N, et al. Association between medicated obstructive pulmonary disease, depression and subjective health: results from the population-based Gutenberg Health Study. Sci Rep. 2019;9(1):20252.CrossRef
12.
go back to reference Kweon S, Kim Y, Jang M, Kim Y, Kim K, Choi S, Chun C, Khang Y-H, Oh K. Data Resource Profile: The Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol. 2014;43(1):69–77.CrossRef Kweon S, Kim Y, Jang M, Kim Y, Kim K, Choi S, Chun C, Khang Y-H, Oh K. Data Resource Profile: The Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol. 2014;43(1):69–77.CrossRef
13.
go back to reference Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319–38.CrossRef Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319–38.CrossRef
14.
go back to reference Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187(4):347–65.CrossRef Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187(4):347–65.CrossRef
15.
go back to reference WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157.CrossRef WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157.CrossRef
16.
go back to reference Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.CrossRef Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.CrossRef
17.
go back to reference American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-IV: American Psychiatric Association; 1994. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-IV: American Psychiatric Association; 1994.
18.
go back to reference Kung S, Alarcon RD, Williams MD, Poppe KA, Jo Moore M, Frye MA. Comparing the Beck Depression Inventory-II (BDI-II) and Patient Health Questionnaire (PHQ-9) depression measures in an integrated mood disorders practice. J Affect Disord. 2013;145(3):341–3.CrossRef Kung S, Alarcon RD, Williams MD, Poppe KA, Jo Moore M, Frye MA. Comparing the Beck Depression Inventory-II (BDI-II) and Patient Health Questionnaire (PHQ-9) depression measures in an integrated mood disorders practice. J Affect Disord. 2013;145(3):341–3.CrossRef
19.
go back to reference Kim Y, Austin SB, Subramanian SV, Kawachi I. Body weight perception, disordered weight control behaviors, and depressive symptoms among Korean adults: The Korea National Health and Nutrition Examination Survey 2014. PLoS ONE. 2018;13(6):e0198841.CrossRef Kim Y, Austin SB, Subramanian SV, Kawachi I. Body weight perception, disordered weight control behaviors, and depressive symptoms among Korean adults: The Korea National Health and Nutrition Examination Survey 2014. PLoS ONE. 2018;13(6):e0198841.CrossRef
20.
go back to reference Lee S, Oh SS, Park EC, Jang SI. Sex differences in the association between thyroid-stimulating hormone levels and depressive symptoms among the general population with normal free T4 levels. J Affect Disord. 2019;249:151–8.CrossRef Lee S, Oh SS, Park EC, Jang SI. Sex differences in the association between thyroid-stimulating hormone levels and depressive symptoms among the general population with normal free T4 levels. J Affect Disord. 2019;249:151–8.CrossRef
21.
go back to reference Schuetz P, Birkhahn R, Sherwin R, Jones AE, Singer A, Kline JA, Runyon MS, Self WH, Courtney DM, Nowak RM, et al. Serial procalcitonin predicts mortality in severe sepsis patients: results from the Multicenter Procalcitonin MOnitoring SEpsis (MOSES) Study. Crit Care Med. 2017;45(5):781–9.CrossRef Schuetz P, Birkhahn R, Sherwin R, Jones AE, Singer A, Kline JA, Runyon MS, Self WH, Courtney DM, Nowak RM, et al. Serial procalcitonin predicts mortality in severe sepsis patients: results from the Multicenter Procalcitonin MOnitoring SEpsis (MOSES) Study. Crit Care Med. 2017;45(5):781–9.CrossRef
22.
go back to reference Han C, Jo SA, Kwak JH, Pae CU, Steffens D, Jo I, Park MH. Validation of the Patient Health Questionnaire-9 Korean version in the elderly population: the Ansan Geriatric study. Compr Psychiatry. 2008;49(2):218–23.CrossRef Han C, Jo SA, Kwak JH, Pae CU, Steffens D, Jo I, Park MH. Validation of the Patient Health Questionnaire-9 Korean version in the elderly population: the Ansan Geriatric study. Compr Psychiatry. 2008;49(2):218–23.CrossRef
23.
go back to reference DeJean D, Giacomini M, Vanstone M, Brundisini F. Patient experiences of depression and anxiety with chronic disease: a systematic review and qualitative meta-synthesis. Ont Health Technol Assess Ser. 2013;13(16):1–33.PubMedPubMedCentral DeJean D, Giacomini M, Vanstone M, Brundisini F. Patient experiences of depression and anxiety with chronic disease: a systematic review and qualitative meta-synthesis. Ont Health Technol Assess Ser. 2013;13(16):1–33.PubMedPubMedCentral
24.
go back to reference Xu W, Collet JP, Shapiro S, Lin Y, Yang T, Platt RW, Wang C, Bourbeau J. Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. Am J Respir Crit Care Med. 2008;178(9):913–20.CrossRef Xu W, Collet JP, Shapiro S, Lin Y, Yang T, Platt RW, Wang C, Bourbeau J. Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. Am J Respir Crit Care Med. 2008;178(9):913–20.CrossRef
25.
go back to reference de Voogd JN, Wempe JB, Koeter GH, Postema K, van Sonderen E, Ranchor AV, Coyne JC, Sanderman R. Depressive symptoms as predictors of mortality in patients with COPD. Chest. 2009;135(3):619–25.CrossRef de Voogd JN, Wempe JB, Koeter GH, Postema K, van Sonderen E, Ranchor AV, Coyne JC, Sanderman R. Depressive symptoms as predictors of mortality in patients with COPD. Chest. 2009;135(3):619–25.CrossRef
26.
go back to reference Jordan N, Lee TA, Valenstein M, Pirraglia PA, Weiss KB. Effect of depression care on outcomes in COPD patients with depression. Chest. 2009;135(3):626–32.CrossRef Jordan N, Lee TA, Valenstein M, Pirraglia PA, Weiss KB. Effect of depression care on outcomes in COPD patients with depression. Chest. 2009;135(3):626–32.CrossRef
27.
go back to reference Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007;22(11):1596–602.CrossRef Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007;22(11):1596–602.CrossRef
28.
go back to reference Levis B, Benedetti A, Levis AW, Ioannidis JPA, Shrier I, Cuijpers P, Gilbody S, Kloda LA, McMillan D, Patten SB, et al. Selective cutoff reporting in studies of diagnostic test accuracy: a comparison of conventional and individual-patient-data meta-analyses of the Patient Health Questionnaire-9 Depression Screening Tool. Am J Epidemiol. 2017;185(10):954–64.CrossRef Levis B, Benedetti A, Levis AW, Ioannidis JPA, Shrier I, Cuijpers P, Gilbody S, Kloda LA, McMillan D, Patten SB, et al. Selective cutoff reporting in studies of diagnostic test accuracy: a comparison of conventional and individual-patient-data meta-analyses of the Patient Health Questionnaire-9 Depression Screening Tool. Am J Epidemiol. 2017;185(10):954–64.CrossRef
29.
go back to reference Levis B, Benedetti A, Thombs BD. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476.CrossRef Levis B, Benedetti A, Thombs BD. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476.CrossRef
30.
go back to reference He C, Levis B, Riehm KE, Saadat N, Levis AW, Azar M, Rice DB, Krishnan A, Wu Y, Sun Y, et al. The accuracy of the Patient Health Questionnaire-9 algorithm for screening to detect major depression: an individual participant data meta-analysis. Psychother Psychosom. 2020;89(1):25–37.CrossRef He C, Levis B, Riehm KE, Saadat N, Levis AW, Azar M, Rice DB, Krishnan A, Wu Y, Sun Y, et al. The accuracy of the Patient Health Questionnaire-9 algorithm for screening to detect major depression: an individual participant data meta-analysis. Psychother Psychosom. 2020;89(1):25–37.CrossRef
31.
go back to reference Stafford L, Berk M, Jackson HJ. Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease. Gen Hosp Psychiatry. 2007;29(5):417–24.CrossRef Stafford L, Berk M, Jackson HJ. Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease. Gen Hosp Psychiatry. 2007;29(5):417–24.CrossRef
32.
go back to reference Lim JU, Park CK, Kim TH, Jang AS, Park YB, Rhee CK, Jung KS, Yoo KH, Lee WY, Yoon HK. The difficulty of improving quality of life in COPD patients with depression and associated factors. Int J Chron Obstruct Pulmon Dis. 2019;14:2331–41.CrossRef Lim JU, Park CK, Kim TH, Jang AS, Park YB, Rhee CK, Jung KS, Yoo KH, Lee WY, Yoon HK. The difficulty of improving quality of life in COPD patients with depression and associated factors. Int J Chron Obstruct Pulmon Dis. 2019;14:2331–41.CrossRef
33.
go back to reference Gut-Gobert C, Cavailles A, Dixmier A, Guillot S, Jouneau S, Leroyer C, Marchand-Adam S, Marquette D, Meurice JC, Desvigne N, et al. Women and COPD: do we need more evidence? Eur Respir Rev. 2019;28(151):180055.CrossRef Gut-Gobert C, Cavailles A, Dixmier A, Guillot S, Jouneau S, Leroyer C, Marchand-Adam S, Marquette D, Meurice JC, Desvigne N, et al. Women and COPD: do we need more evidence? Eur Respir Rev. 2019;28(151):180055.CrossRef
34.
go back to reference Aryal S, Diaz-Guzman E, Mannino DM. Influence of sex on chronic obstructive pulmonary disease risk and treatment outcomes. Int J Chron Obstruct Pulmon Dis. 2014;9:1145–54.PubMedPubMedCentral Aryal S, Diaz-Guzman E, Mannino DM. Influence of sex on chronic obstructive pulmonary disease risk and treatment outcomes. Int J Chron Obstruct Pulmon Dis. 2014;9:1145–54.PubMedPubMedCentral
35.
go back to reference Di Marco F, Verga M, Reggente M, Maria Casanova F, Santus P, Blasi F, Allegra L, Centanni S. Anxiety and depression in COPD patients: the roles of sex and disease severity. Respir Med. 2006;100(10):1767–74.CrossRef Di Marco F, Verga M, Reggente M, Maria Casanova F, Santus P, Blasi F, Allegra L, Centanni S. Anxiety and depression in COPD patients: the roles of sex and disease severity. Respir Med. 2006;100(10):1767–74.CrossRef
36.
go back to reference Laurin C, Lavoie KL, Bacon SL, Dupuis G, Lacoste G, Cartier A, Labrecque M. Sex differences in the prevalence of psychiatric disorders and psychological distress in patients with COPD. Chest. 2007;132(1):148–55.CrossRef Laurin C, Lavoie KL, Bacon SL, Dupuis G, Lacoste G, Cartier A, Labrecque M. Sex differences in the prevalence of psychiatric disorders and psychological distress in patients with COPD. Chest. 2007;132(1):148–55.CrossRef
37.
go back to reference Sawalha S, Hedman L, Rönmark E, Lundbäck B, Lindberg A. Pre- and post-bronchodilator airway obstruction are associated with similar clinical characteristics but different prognosis—report from a population-based study. Int J Chron Obstruct Pulmon Dis. 2017;12:1269–77.CrossRef Sawalha S, Hedman L, Rönmark E, Lundbäck B, Lindberg A. Pre- and post-bronchodilator airway obstruction are associated with similar clinical characteristics but different prognosis—report from a population-based study. Int J Chron Obstruct Pulmon Dis. 2017;12:1269–77.CrossRef
Metadata
Title
Sex differences in risk factors for depressive symptoms in patients with COPD: The 2014 and 2016 Korea National Health and Nutrition Examination Survey
Authors
Ji Soo Choi
Se Hyun Kwak
Nak-Hoon Son
Jae Won Oh
San Lee
Eun Hye Lee
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2021
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-021-01547-x

Other articles of this Issue 1/2021

BMC Pulmonary Medicine 1/2021 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.