Key result
Increased depressive symptoms linked to ~41% higher risk of pre-COPD phenotypes like PRISm.
Why the study?
Depression is common in COPD and linked to worse prognosis, but its association with lung health in individuals with pre-COPD remains unknown.
Are increased depressive symptoms associated with worse respiratory outcomes and higher mortality in individuals with pre-COPD?
Observational (n=10,941)
Yes
Are increased depressive symptoms associated with worse respiratory outcomes and higher mortality in individuals with pre-COPD?
Odds Ratio: 1.41 (95% CI 1.07–1.85)
Increased depressive symptoms are associated with a higher risk of pre-COPD phenotypes, respiratory symptoms, and all-cause mortality in non-COPD individuals.
Depressive symptoms were associated with PRISm; hypothesis-generating for bidirectional links, prospective studies needed before screening implications.
BACKGROUND: Depression is a common comorbidity of chronic obstructive pulmonary disease (COPD) and is associated with worse prognosis. However, its association with lung health in individuals with pre-COPD remains unknown. We examined associations of increased depressive symptoms with respiratory symptoms, pre-COPD, and mortality. METHODS: We analysed data from the National Health and Nutrition Examination Survey (NHANES 2007-2012). Non-COPD individuals with available spirometry and Patient Health Questionnaire-9 (PHQ-9) data were included. Pre-COPD phenotypes included small airway dysfunction (SAD), preserved ratio impaired spirometry (PRISm) and nonobstructive chronic bronchitis (NOCB). Logistic and Cox regression models assessed associations of increased depressive symptoms with respiratory outcomes and all-cause mortality, respectively. RESULTS: Among 10 941 participants, increased depressive symptoms were associated with higher risk of PRISm (adjusted OR (aOR) [95% CI] 1.41[1.07,1.85]), NOCB (aOR [95% CI] 1.90[1.49,2.42]), cough (aOR [95% CI] 2.17[1.72,2.73]), phlegm production (aOR [95% CI] 2.86[2.23,3.67]), exertional dyspnoea (aOR [95% CI] 2.53[2.04,3.13]) and wheeze (aOR [95% CI] 1.86[1.51,2.30]). A one-unit increase in PHQ-9 score was also associated with higher risks of respiratory symptoms and pre-COPD. Additionally, increased depressive symptoms were independently associated with higher all-cause mortality risk among participants with pre-COPD, including SAD (aHR [95% CI] 2.85[1.02,7.95]), PRISm (aHR [95% CI] 2.02[1.01,4.01]) and NOCB (aHR [95% CI] 2.45[1.24,4.84]). Similar associations were observed across depression scores and pre-COPD populations. CONCLUSIONS: Increased depressive symptoms were associated with a higher risk of pre-COPD phenotypes, respiratory symptoms, and mortality. Increased depressive symptoms may be a treatable trait that can help mitigate adverse outcomes in participants with pre-COPD.
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Wu et al. (2026) conducted an observational in pre-COPD (n=10,941). Increased depressive symptoms vs. Lower depressive symptoms was evaluated on Preserved ratio impaired spirometry (PRISm) (aOR 1.41, 95% CI 1.07-1.85). Increased depressive symptoms were associated with a higher risk of pre-COPD phenotypes, including PRISm (aOR 1.41; 95% CI 1.07-1.85) and NOCB (aOR 1.90; 95% CI 1.49-2.42).
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