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Academic Medical
Center-University of Amsterdam, Division of Public Health, Department
of General Practice/Family Medicine, Meibergdreef 9, 1105 AZ Amsterdam,
The Netherlands
Correspondence to: Dr C J Yzermans.
Received 26 November 1998; Returned to authors 1 February 1999; Revised version received 7 April 1999; Accepted for publication 30 April 1999
BACKGROUND
Patients
with chronic obstructive pulmonary disease (COPD) have repeatedly been
characterised as a population of chronically ill patients with a higher
than normal prevalence of depression. Susceptibility for depression has
been noted in patients with certain other chronic conditions. This
systematic review was conducted to achieve a more definite answer to
the question: do patients with COPD show a higher than normal
prevalence of depression?
METHODSStudies
in English language journals were retrieved by an electronic search
over the period from 1966 to December 1997 and by an extended search of
reference lists, and were included or excluded according to a system of
diagnostic and methodological criteria.
RESULTSTen studies
were included, of which only four had a case-control design. Three of
the case-control studies reported an increased prevalence of depression
among patients with COPD which was statistically significant in only
one. The fourth controlled study found a significantly increased
depression score among COPD patients. Of the remaining six uncontrolled
studies three found a high baseline prevalence of depression among
their study group.
CONCLUSIONSAn
association between COPD and depression was found in the four
controlled studies. The two methodologically best conducted studies
that did not detect a statistically significant higher prevalence
lacked power. The two studies that did find a significant association
used a questionable depression measure. The prevalence of depression
was high compared with general population figures in three of six
non-controlled studies. The empirical evidence for a significant risk
of depression in patients with COPD remains inconclusive, due to the
poor methodological quality of most of the published studies, the lack
of studies with an adequate sample size, and variability in instruments
and cut off scores used to measure depression.
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