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Surprisingly High Prevalence of Anxiety and Depression in Chronic Breathing Disorders^*

^* From the Houston Center for Quality of Care and Utilization Studies (Drs. Kunik, Veazey, Souchek, Richardson, and Wray), Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston; and Department of Psychiatry (Drs. Roundy and Stanley), Baylor College of Medicine, Houston, TX.

Correspondence to: Mark E. Kunik, MD, MPH, Houston Center for Quality of Care and Utilization Studies, MEDVAMC (152), 2002 Holcombe, Houston, TX 77030; e-mail: mkunik{at}bcm.tmc.edu

Study objectives: The objectives of this study were to assess the prevalence, screening, and recognition of depression and anxiety in persons with chronic breathing disorders, including COPD.

Design: Cross-sectional study.

Setting: The Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC).

Participants: A large sample of 1,334 persons with chronic breathing disorder diagnoses who received care at the MEDVAMC.

Measurements: The prevalence of anxiety and depression was measured in a large sample of persons with a chronic breathing disorder diagnosis who received care at the MEDVAMC, using the Primary Care Evaluation of Mental Disorders (PRIME-MD) screening questions. The positive predictive value of the PRIME-MD questions was then determined. The prevalence of anxiety and depressive diagnoses in patients determined to have COPD was then measured, using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID).

Results: Of patients screened with the PRIME-MD, 80% screened positive for depression, anxiety, or both. The predictive value of a positive phone screen for either depression or anxiety was estimated to be 80%. In the subsample of patients who had COPD and received a diagnosis using the SCID, 65% received an anxiety and/or depressive disorder diagnosis. Of those patients, only 31% were receiving treatment for depression and/or anxiety.

Conclusions: It is troubling that a mere 31% of COPD patients with depression or anxiety are being treated, particularly given their high prevalence in this population. Practical screening instruments may help increase the recognition of anxiety and depression in medical patients, as suggested by the excellent positive predictive value of the PRIME-MD in our study.

Key Words: anxiety • anxiety disorders • depression • depressive disorder • lung diseases, obstructive • prevalence • pulmonary disease, chronic obstructive

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