만성폐쇄성폐질환 환자에서 우울과 불안심리 평가

Depression and Anxiety in Outpatients with Chronic Obstructive Pulmonary Disease

  • 류연주 (이화여자대학교 의과대학 내과학교실, 호흡기내과) ;
  • 천은미 (이화여자대학교 의과대학 내과학교실, 호흡기내과) ;
  • 심윤수 (이화여자대학교 의과대학 내과학교실, 호흡기내과) ;
  • 이진화 (이화여자대학교 의과대학 내과학교실, 호흡기내과)
  • Ryu, Yon Ju (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University) ;
  • Chun, Eun Mi (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University) ;
  • Sim, Yun Su (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University) ;
  • Lee, Jin Hwa (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University)
  • 투고 : 2006.09.29
  • 심사 : 2006.12.14
  • 발행 : 2007.01.30

초록

연구배경: 만성폐쇄성폐질환(chronic obstructive pulmonary disease, COPD) 환자군에서 우울증 및 불안장애의 유병률이 높고, 이는 치료경과 및 사망률에도 영향을 주는 것으로 알려져 있다. 저자들은 국내연구가 미비한 COPD환자들의 우울과 불안심리에 대한 평가를 하고자 하였다. 방 법: 2005년 9월부터 2006년 8월까지 이화의료원 호흡기내과에서 외래치료 중인 72명의 COPD환자와 정상 대조군 50명에서 Beck Depression Inventory (BDI)와 State-Trait Anxiety Inventory (STAI)로 설문조사를 시행하였고, 임상기록을 분석하였다. 결 과: 1) 연령과 체질량지수, 혈청 알부민 수치는 환자군과 대조군간의 유의한 차이를 보이지 않았다(p>0.05). 우울심리는 BDI점수가 환자군 16(0-37), 대조군 12(1-30)으로 환자군에서 유의하게 높았고(p=0.001), 21점 이상의 우울집단은 환자군이 36%로 대조군 6%에 비해 많았다(p<0.0001). 환자군에서는 경증군 18%(4/22), 중등증군 30%(6/20), 중증군 52%(13/25), 심한 중증군 60%(3/5)로 중증일수록 빈도가 높았다(p=0.008). 2) 불안심리는 환자군에서 SAI 점수 44(20-67), TAI점수 47(20-66)로 각각 대조군 39(26-65), 44(33-90)보다 유의하게 높았다(p=0.005, p=0.022). 환자군에서 BDI와 STAI점수는 상관관계를 보였고(p<0.001), 우울집단에서 불안점수가 유의하게 높았다. 3) COPD환자군에서 우울집단은 비우울집단보다 체질량지수, 기관지확장제후 $FEV_1$의 예측치가 유의하게 낮았고, 현재 흡연자의 비율과 중증도, STAI점수가 유의하게 높았다(p<0.05). 4) 연령과 성별을 통제한 다변량 로지스틱 회귀분석상 95% 신뢰구간으로 비차비는 체질량지수 0.9(p=0.311), 현재 흡연자 3.2(p=0.051), 중증군이상 3.9로(p=0.027), 중증이상의 중증도가 유일한 우울증 발생의 독립적 위험요인이었다. 결 론: COPD환자군에서 우울증과 불안심리가 흔하게 관찰되며, 체질량지수, 폐기능, 현재 흡연력이 우울관련 요인으로 특히 중증도가 높을수록 우울증과 불안장애의 관리가 필요함을 보여주었다.

Background: Patients with chronic obstructive pulmonary disease (COPD) have often been reported to suffer from depression and anxiety possibly due to the exacerbation, hospitalization and mortality of COPD. However,scarce data are available in Korea. This study assessed degree of depression and anxiety, and evaluated the factors associated with depressive symptoms in COPD. Methods: The cross-sectional data on the lung function measurements, smoking behavior, body mass index (BMI), age, gender, depressive symptoms using Beck Depression Inventory (BDI) and anxiety using the State-Trait Anxiety Inventory (STAI) were evaluated in 72 outpatients with COPD and 50 controls without underling lung diseases from September, 2005 to October, 2006 in the Ewha medical center. Results: 1) The age, body mass index (BMI) and serum albumin levels were similar in the patients and controls. The BDI scores (16(0-37) vs. 12(1-30), p=0.001) and the prevalence of depression (36% vs. 6%, p<0.0001) were higher in the COPD patients than in the controls. In the COPD group, the prevalence of depression increased with increasing GOLD stage (p=0.008). The prevalence was 18%(4/22), in mild cases, 30%(6/20) in moderate cases, 52%(13/25) in severe cases and 60%(3/5) in very severe cases. 2) The SAI and TAI scores were higher in the COPD patients (44(20-67) and 47(20-66)) than in the healthy controls (39(26-65) and 44(33-90)). There were a significant correlation between the depression and anxiety scores (p<0.001). 3) A lower BMI, lower postbronchodilator $FEV_1$, current smoking behavior and severity of COPD were univariately associated with the depressive group in COPD, 4) while multivariate logistic analysis revealed only the severe-to-very severe group (OR 3.9, 95% CI 1.2 to 12.9) to be independently associated with depressive symptoms. Conclusion: COPD is strongly associated with depression and anxiety. Therfore, screening for psychological problems in COPD patients is essential, particularly in patients with severe-to-very severe COPD.

키워드

참고문헌

  1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997;349:1498-504 https://doi.org/10.1016/S0140-6736(96)07492-2
  2. Kim DS, Kim YS, Jung KS, Chang JH, Lim CM, Lee JH, et al. Prevalence of chronic obstructive pulmonary disease in Korea: a population-based spirometry survey. Am J Respir Crit Care Med 2005;172:842-7 https://doi.org/10.1164/rccm.200502-259OC
  3. Dahlen I, Janson C. Anxiety and depression are related to the outcome of emergency treatment in patients with obstructive pulmonary disease. Chest 2002;122:1633-7 https://doi.org/10.1378/chest.122.5.1633
  4. Gudmundsson G, Gislason T, Janson C, Lindberg E, Hallin R, Ulrik CS, et al. Risk factors for rehospitalisation in COPD: role of health status, anxiety and depression. Eur Respir J 2005;26:414-9 https://doi.org/10.1183/09031936.05.00078504
  5. Crockett AJ, Cranston JM, Moss JR, Alpers JH. The impact of anxiety, depression and living alone in chronic obstructive pulmonary disease. Qual Life Res 2002;11:309-16 https://doi.org/10.1023/A:1015517606893
  6. Stage KB, Middelboe T, Pisinger C. Depression and chronic obstructive pulmonary disease (COPD): impact on survival. Acta Psychiatr Scand 2005;111: 320-3 https://doi.org/10.1111/j.1600-0447.2004.00497.x
  7. Light RW, Merrill EJ, Despars JA, Gordon GH, Mutalipassi LR. Prevalence of depression and anxiety in patients with COPD: relationship to functional capacity. Chest 1985;87:35-8 https://doi.org/10.1378/chest.87.1.35
  8. Kunik ME, Roundy K, Veazey C, Souchek J, Richardson P, Wray NP, et al. Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest 2005;127:1205-11
  9. Wagena EJ, Arrindell WA, Wouters EF, van Schayck CP. Are patients with COPD psychologically distressed? Eur Respir J 2005;26:242-8 https://doi.org/10.1183/09031936.05.00010604
  10. van Ede L, Yzermans CJ, Brouwer HJ. Prevalence of depression in patients with chronic obstructive pulmonary disease: a systematic review. Thorax 1999;54: 688-92 https://doi.org/10.1136/thx.54.8.688
  11. Borson S, Claypoole K, McDonald GJ. Depression and chronic obstructive pulmonary disease: treatment trials. Semin Clin Neuropsychiatry 1998;3:115-30
  12. Chung KH, Kim JH, Hah ES, Kim SJ, Lee KJ, Lee SH, et al. Frequency and clinical characteristics of depression and anxiety disorder in COPD patients. Tuberc Respir Dis 2005;59(Suppl 2):62 https://doi.org/10.4046/trd.2005.59.1.62
  13. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-71 https://doi.org/10.1001/archpsyc.1961.01710120031004
  14. Han HM, Yum TH, Shin YW, Kim KH, Yoon DJ, Chung KJ. A standardization study of back depression inventory in Korea. Neuropsychiatry 1986;25:487-98
  15. Spielberger CD, Gorsuch RL, Lushene RE. State-trait anxiety inventory for adults(form x). CA: Consulting Psychologistspress 1970
  16. Chavannes NH, Huibers MJ, Schermer TR, Hendriks A, van Weel C, Wouters EF, et al. Associations of depressive symptoms with gender, body mass index and dyspnea in primary care COPD patients. Fam Pract 2005;22:604-7 https://doi.org/10.1093/fampra/cmi056
  17. Gudmundsson G, Gislason T, Janson C, Lindberg E, Suppli Ulrik C, Brondum E, et al. Depression, anxiety and health status after hospitalisation for COPD: a multicentre study in the Nordic countries. Respir Med 2006;100:87-93 https://doi.org/10.1016/j.rmed.2005.04.003
  18. 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;57:412-6 https://doi.org/10.1136/thorax.57.5.412
  19. 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: 1256-76 https://doi.org/10.1164/ajrccm.163.5.2101039
  20. Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 1988;8:77-100 https://doi.org/10.1016/0272-7358(88)90050-5
  21. Kim JT, Shin DK. A Study Based on the Standardization of the STAI for Korea. New Med J 1978;21:69-75
  22. Yohannes AM, Baldwin RC, Connolly MJ. Depression and anxiety in elderly outpatients with chronic obstructive pulmonary disease: prevalence, and validation of the BASDEC screening questionnaire. Int J Geriatr Psychiatry 2000;15:1090-6 https://doi.org/10.1002/1099-1166(200012)15:12<1090::AID-GPS249>3.0.CO;2-L
  23. Dowson C, Laing R, Barraclough R, Town I, Mulder R, Norris K, et al. The use of the Hospital Anxiety and Depression Scale (HADS) in patients with chronic obstructive pulmonary disease: a pilot study. N Z Med J 2001;114:447-9
  24. Klein DF. Testing the suffocation false alarm theory of panic disorder. Anxiety 1994;1:1-7 https://doi.org/10.1002/anxi.3070010103
  25. Ley R. Pulmonary function and dyspnea/suffocation theory of panic. J Behav Ther Exp Psychiatry 1998;29:1-11 https://doi.org/10.1016/S0005-7916(97)00033-5
  26. Suhara T, Sudo Y, Yoshida K, Okubo Y, Fukuda H, Obata T, et al. Lung as reservoir for antidepressants in pharmacokinetic drug interactions. Lancet 1998; 351:332-5 https://doi.org/10.1016/S0140-6736(97)07336-4
  27. Wagena EJ, Kant I, van Amelsvoort LG, Wouters EF,van Schayck CP, Swaen GM. Risk of depression and anxiety in employees with chronic bronchitis: the modifying effect of cigarette smoking. Psychosom Med 2004;66:729-34 https://doi.org/10.1097/01.psy.0000138127.00991.cf
  28. de Godoy DV, de Godoy RF. A randomized controlled trial of the effect of psychotherapy on anxiety and depression in chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2003;84:1154-7 https://doi.org/10.1016/S0003-9993(03)00239-9
  29. Simon GE, von Korff M, Lin E. Clinical and functional outcomes of depression treatment in patients with and without chronic medical illness. Psychol Med 2005;35:271-9 https://doi.org/10.1017/S0033291704003071