Anxiety Disorders in Patients With COPD: A Systematic Review

BACKGROUND: There is a growing interest in the role of comorbid anxiety in patients with COPD. Comorbid anxiety has a major impact on physical functioning, health-related quality of life, and healthcare utilization. However, the prevalence of clinical anxiety, particularly specific anxiety diagnoses, in patients with COPD remains unclear. OBJECTIVE: We performed a systematic review of studies that report the prevalence of clinical anxiety and specific anxiety disorders in patients with COPD. METHODS: We searched for articles in CINAHL, EMBASE, MEDLINE, and PsycINFO, from 1966 to January 31, 2012, with a focus on studies that utilized clinical interviews for a robust psychiatric diagnosis in patients with COPD. RESULTS: Of 410 studies identified, 10 met the inclusion criteria for review. The studies had small to modest sample sizes (n = 20-204) and included mainly male COPD subjects (71% male). The prevalence of clinical anxiety ranged from 10-55% among in-patients and 13-46% among out-patients with COPD. The reported prevalence of specific anxiety disorders ranged considerably, and included generalized anxiety disorder (6-33%), panic disorder (with and without agoraphobia) (0-41%), specific phobia (10-27%), and social phobia (5-11%). Women were significantly more likely to have a clinical anxiety disorder, particularly specific phobia and panic disorder. CONCLUSIONS: There is a high prevalence of clinical anxiety in patients with COPD. Social phobia and specific phobia appear to be particularly prevalent, yet they have received little attention within existing literature. Further research into effective management and screening for clinical anxiety disorders is warranted.