Journal of General Internal Medicine

, Volume 23, Issue 11, pp 1757–1762 | Cite as

Prevalence and Risk Factors for Depressive Symptoms in Persons with Chronic Obstructive Pulmonary Disease

  • Rebecca E. Schane
  • Prescott G. Woodruff
  • Alexis Dinno
  • Ken E. Covinsky
  • Louise C. Walter



Although depression is a risk factor for adverse outcomes in chronic illness, little is known about the prevalence or risk factors for depressive symptoms in chronic obstructive pulmonary disease (COPD).


To determine the prevalence of depressive symptoms in COPD as compared to other chronic illnesses and to identify risk factors for depressive symptoms in COPD.

Design and Patients

Cross-sectional study of 18,588 persons (1,736 subjects with self-reported COPD), representing a sample of the US population aged ≥50 years who participated in the 2004 Health and Retirement Survey.


Presence of COPD and other chronic conditions was defined by self-report. Presence of depressive symptoms was assessed using the CES-D8 scale. Participants with a score ≥3 on CES-D8 were classified as having clinically significant depressive symptoms.

Main Results

Of 1,736 participants with COPD, 40% had ≥3 depressive symptoms. Depressive symptoms were more common in COPD than in coronary heart disease, stroke, diabetes, arthritis, hypertension, and cancer. Risk factors for ≥3 depressive symptoms in COPD: younger age (OR 1.02/per year younger, 95% CI [1.02–1.03]), female gender (1.2 [1.1–1.3]), current smoking (1.5 [1.3–1.7]), marital status [divorced/separated (1.8 [1.6–2.1]), widowed (1.8 [1.6–2]), never married (1.4 [1.1–1.8]), ≤high school degree (1.6 [1.5–1.8]), dyspnea (2.3 [2.1–2.6]), difficulty walking (2.8 [2.5–3.2]), and co-morbid diabetes (1.2 [1.1–1.4]), arthritis (1.3 [1.2–1.5]) or cancer (1.2 [1.1–1.4]).


Depressive symptoms are common in COPD and are more likely to occur in COPD than in other common chronic illnesses. The risk factors identified may be used for targeted depression screening in COPD patients.


chronic obstructive pulmonary disease (COPD) depressive symptoms risk factors 



The Institute for Social Research at the University of Michigan collects HRS data that is principally funded by the National Institutes on Aging.

Dr. Schane is a recipient of an NIH Training Grant T32 HL007185.

Dr. Woodruff is a recipient of an NIH Training Grant HL074431.

Dr. Covinsky is a recipient of a grant from the National Institute on Aging (R01AG023626).

Dr. Dinno is a recipient of an NIH Training Grant 1 R25 CA113710-02.

Dr. Walter is a recipient of the Veteran’s Affairs Advanced Research Career Development Award in Health Services Research and Development and a Robert Wood Johnson Physician Faculty Scholar.

Conflict of Interest

The funding sources had no role in the design and conduct of the study, or in the collection, management, analysis, and interpretation of the data or in the preparation, review, or approval of the manuscript. Dr. Schane had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Dinno performed the statistical analysis for this study. The views expressed in this article are those of the authors and do not necessarily reflect the position or the policy of the University of California.


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Rebecca E. Schane
    • 1
    • 3
  • Prescott G. Woodruff
    • 1
  • Alexis Dinno
    • 3
  • Ken E. Covinsky
    • 2
  • Louise C. Walter
    • 2
  1. 1.Department of Medicine, Division of Pulmonary-Critical Care Medicine, the Cardiovascular Research InstituteUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of Medicine, Division of Geriatrics, San Francisco VA Medical CenterUniversity of CaliforniaSan FranciscoUSA
  3. 3.Department of Medicine, Center for Tobacco Control Research and Education, the Cardiovascular Research InstituteUniversity of CaliforniaSan FranciscoUSA

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