What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Chronic obstructive pulmonary disease (COPD) (n=61). Intervention: Observational (Dyspnea severity and smoking exposure). Primary outcome: Correlation between dyspnea severity (mMRC) and anxiety scores (BAI) (Spearman's ρ 0.407, p=0.001).

What question did this study set out to answer?

This study aimed to determine the prevalence of anxiety and depression among COPD patients and assess their relationship with dyspnea severity.

April 27, 2026Open Access

The Investigation of Anxiety and Depression in COPD Patients

Key Result

Higher dyspnea severity was moderately associated with increased anxiety scores (Spearman's ρ 0.407, p=0.001) and smoking exposure correlated with depressive symptoms in patients with COPD.

Key Points

This study aimed to determine the prevalence of anxiety and depression among COPD patients and assess their relationship with dyspnea severity.
Cross-sectional study conducted from July 2018 to July 2019 at a pulmonary outpatient clinic.
Sixty-one COPD patients assessed using BAI, BDI, HADS, and mMRC dyspnea scale.
Statistical analysis included Spearman's correlation and p-values for evaluating associations.
Anxiety scores increased with mMRC grades (p = 0.012); clinically relevant anxiety present in 9.8%.
Depression scores also rose with dyspnea severity (p = 0.018); clinically relevant depression found in 11.5%.
Moderate association between dyspnea severity and anxiety (ρ = 0.407, p = 0.001) and a weaker trend with depression (ρ = 0.251, p = 0.051).

Study Design

Type

Cross-Sectional (n=61)

Multicenter

Structured PICO

Population

61 adults aged ≥ 40 years with a confirmed diagnosis of COPD according to the GOLD criteria (post-bronchodilator FEV1/FVC < 0.70), clinically stable. Mean age 62.3, 80.3% male. Excluded: acute exacerbation, requiring inpatient management, prior psychiatric diagnoses, current use of psychotropic medications, severe cognitive impairment.

Outcome

Prevalence of anxiety and depression and their relationship with dyspnea severity (mMRC) and GOLD stages, measured using Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS).patient reported

In patients with COPD, psychological distress is significantly associated with patient-reported dyspnea severity and smoking exposure rather than objective spirometric impairment.

Main Result

Effect estimate: Spearman's ρ 0.407

p-value: p=0.001

Limitations

Cross-sectional design precluded causal inference
Relatively small sample size limits generalizability and statistical power
Single-center design may not fully represent the broader COPD population
Psychiatric medication use was assessed using self-reports and may be subject to recall bias
Social support and certain comorbid conditions were not systematically evaluated

Abstract

Aim: This study aimed to determine the prevalence of anxiety and depression among patients with chronic obstructive pulmonary disease (COPD) and examine the relationship between psychological symptoms and dyspnea severity across Global Initiative for Obstructive Lung Disease (GOLD) defined COPD stages. Methods: A cross-sectional study was conducted between July 2018 and July 2019 at a pulmonary diseases outpatient clinic. Sixty-one patients with COPD were evaluated using the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), and the Modified Medical Research Council (mMRC) dyspnea scale. Results: Anxiety and depression scores increased significantly with higher mMRC grades (BAI: p = 0.012; BDI: p = 0.018). Using established cut-offs, clinically relevant anxiety was present in 9.8% (BAI ≥16; n = 6) and 8.2% (HADS-A ≥10; n = 5) of the patients. Clinically relevant depression was present in 11.5% (BDI ≥ 17; n = 7) and 26.2% (HADS-D ≥ 7; n = 16) of the patients. Dyspnea severity (mMRC) was moderately associated with anxiety scores (Spearman’s ρ = 0.407, p = 0.001) and had a weaker, borderline association with depressive symptoms (ρ = 0.251, p = 0.051). Smoking status was correlated with depressive symptoms (BDI: p = 0.025; HADS-D: p = 0.012). Pack-years correlated weakly but significantly with anxiety (ρ = 0.371, p = 0.005) and depression (ρ = 0.309, p = 0.022). No association was detected between FEV1% and the psychological scale scores. Conclusion: Dyspnea severity and smoking exposure were associated with greater psychological distress in patients with COPD. These findings support the integration of routine psychological screening into comprehensive COPD management strategies.

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