Interaction of Depression and Nicotine Addiction on the Severity of Chronic Obstructive Pulmonary Disease: A Prospective Cohort Study
Background: Depression and smoking decrease health status in Chronic Obstructive Pulmonary Disease (COPD), but the combined effect of the two factors is unknown. This study aimed to assess the interactive effects of depression and smoking on the severity of patients with COPD.
Methods: A prospective cohort study including 2,268 patients with COPD was conducted in seven rural communities from May 2008 to May 2012. The relationships between the BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index and depression and nicotine addiction were assessed. The product of depression and smoking was added to the logistic regression model to evaluate the multiplicative interaction and relative excess risk of interaction (RERI). The Attributable Proportion (AP) of interaction and the synergy index (S) was applied to evaluate the additive interaction of two factors.
Results: The severity of COPD in patients with depressive symptoms who never smoked was increased 1.74-fold and in smoking patients it increased by 6.08-fold. Highly addicted smokers with depressive symptoms had a nearly 40-fold increase in severity (all P<0.001). The increased values of the BODE index, HADS-D and Fagerström score also correlated positively (P<0.001). The co-presence of depressive symptoms and smoking significantly increased the BODE index by 11.99-fold with significant biological interactions, relative excess risk of interaction (RERI) was 12.12, the biological interactions were increased with increasing nicotine addiction.
Conclusions: Patients with depressive symptoms who also smoke have an increased risk of severity from COPD interaction effects. The risk for severity of COPD and depressive symptoms increased with increasing the severity of nicotine addiction.
Global initiative for chronic obstructive pul-mo¬nary disease (2011). Global strategy for the diagno¬sis, management, and preven-tion of chronic obstructive pulmonary dis-ease. Availa¬ble from:
Nussbaumer-Ochsner Y, Rabe KF(2011). Sys¬temic manifestations of COPD. Chest, 139(1):165–73.
Mikkelsen RL, Middelboe T'P, Pisinger C, Stage KB (2004). Anxiety and depression in patients with chronic obstructive pul-monary disease (COPD). A review. Nord J Psychiatry, 58(1): 65-70.
Omachi TA, Katz PP, Yelin EH, Gregorich SE, Iribarren C, Blanc PD, Eisner MD (2009). Depression and health related qual-ity of life in chronic obstructive pulmonary disease. Am J Med, 122(8):778 e9-5.
Barrueco M, Torracchi AM, Martínez L, Cordovilla R, Gonzalez-Ruiz JM, Doblare G(2014). Nicotine Dependence, Consumption Pattern,and Biological Markers in Smokers with COPD. Chest, 145 (3 Suppl):612A.
American Psychiatric Association (1994). Di-agnostic and statistical manual of mental disorders (DSM-IV).4th ed,Washington DC: American Psychiatric Association.
Benowitz NL (2009). Pharmacology of nico-tine: addiction, smoking-induced disease, and therapeutics. Annu Rev Pharmacol Toxi-col, 49:57-71.
Kim DK, Hersh CP, Washko GR, Hokanson JE, Lynch DA, Newell JD, Murphy JR, Crapo JD, Silverman EK; COPD Gene Investigators (2011). Epidemiology, radi-ology, and genetics of nicotine depend-ence in COPD. Respir Res, 12(1):9.
Fletcher C, Peto R (1997). The natural history of chronic airflow obstruction. Br Med J, 1:1645e8.
Geijer RM, Sachs AP, Verheij TJ, Kerstjens HA, Kuyvenhoven MM, Hoes AW(2007).Quality of life in smokers: focus on functional limitations rather than on lung function? . Br J Gen Pract, 57(539):477-82.
Doll R, Peto R, Boreham J, Sutherland I(2004). Mortality in relation to smoking: 50 years’ observations on British male doctors. BMJ, 328(7455):1519.
Engel GL (1977). The need for a new medi-cal model: a challenge for biomedicine. Sci-ence, 196:129-136.
Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, Pinto Pla-ta V, Cabral HJ(2004)．The body mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstruc-tive pulmonary disease. N Engl J Med, 350:1005–1012.
Lou P, Zhu Y, Chen P, Zhang P, Yu J, Zhang N, Chen N, Zhang L, Wu H, Zhao J (2012). Vulnerability, beliefs, treatments and economic burden of chronic obstruc-tive pulmonary disease in rural areas in China: a cross-sectional study. BMC Public Health, 12:287.
Zigmond AS, Snaith RP(1983). The hospital anxiety and depression scale. Acta Psychiatr Scand, 67(6):361-370.
Zheng LL, Wang YL, Li HL(2003). Applica-tion of hospital anxiety and depression scale in general hospital: an analysis in reli-ability and validity. Shanghai Arch Psychiat, 15: 264-6.
Zhou Y, Hu G, Wang D, Wang S, Wang Y, Liu Z, Hu J, Shi Z, Peng G, Liu S, Lu J, Zheng J, Wang J, Zhong N, Ran P(2010). Community based integrated intervention for prevention and management of chronic obstructive pulmonary disease (COPD) in Guangdong, China: cluster randomised controlled trial. BMJ, 341:c6387.
Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO (1991). The Fagerström test for nicotine dependence: a revision of the Fagerström tolerance questionnaire. Br J Addict, 86:1119e27.
The World Health Organization Collaborat-ing Center for Tobacco or Health, the Tobacco control office of Chinese Center for Disease Control and Prevention, the Professional Committee of Hospital To-bacco Control of Chinese Association on Tobacco Control (2008). The Clinical Guidebooks of Smoking Cessation of China (2007 Edition) Int J Respire, 28(16):961-70.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002). ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 166: 111-17.
Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA(1999). Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pul-monary disease. Thorax, 54:581-58.
Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, Pinto Pla-ta V, Cabral HJ(2004). The body-mass in-dex, airflow obstruction, dyspnea, and ex-ercise capacity index in chronic obstructive pulmonary disease. N Engl J Med, 350:1005-12.
Koblízek V, Salajka F, Cermáková E, Tomsová M, Pohnetalová D, Papousek P, Bartos V, Dobesová T, Paráková Z, Ruta J, Sedlák V(2009). Relationship between quality of life and BODE index of stable ex-smokers with chronic obstructive pul-monary disease. Vnitr Lek, 55(10):940-47.
Lou P, Chen P, Zhang L, Zhang P, Yu J, Zhang N, Wu H, Zhao J(2012). Relation study of sleep quality and sleep duration to type 2 diabetes: a population-based cross-sectional survey. BMJ Open 2012; 2:e000956.
Zhang L, Lou P, Zhu Y, Chen P, Zhang P, Yu J, Zhang N, Chen N, Wu H, Zhao J(2013). Impact of risk factors, activities and psychological disorders on the health of patients with chronic obstructive pulmonary disease in China: a cross-sectional study. BMC Public Health, 13:627
Cooperative Meta-analysis Group of China Obesity Task Force (2002). Predictive val-ues of body mass index and waist circum-ference to risk factors of related disease in Chinese adult population. Chin J Epidemiol, 23: 5-10.
Ahlbom A, Alfredsson L(2005). Interaction: a word with two meanings creates confu-sion. Eur J Epidemiol, 20:563–564
Andersson T, Alfredsson L, Kallberg H, Zdravkovic S, Ahlbom A(2005). Calculat-ing measures of biological interaction. Eur J Epidemiol, 20:575–579.
Knol MJ, VanderWeele TJ, Groenwold RH, Klungel OH, Rovers MM, Grobbee DE(2011). Estimating measures of interac-tion on an additive scale for preventive exposures. Eur J Epidemiol, 26(6):433–38.
Kim DK, Hersh CP, Washko GR, Hokanson JE, Lynch DA, Newell JD, Murphy JR, Crapo JD, Silverman EK; COPD Gene Investigators(2011). Epidemiology, radiol-ogy,and genetics of nicotine dependence in COPD. Respir Res, 12:9.
Goodwin RD, Lavoie KL, Lemeshow AR, Jenkins E, Brown ES, Fedoronko DA(2012). Depression, Anxiety, and COPD: The Unexamined Role of Nico-tine Dependence. Nicotine Tobacco Res, 14(2): 176–83.
Moylan S, Jacka FN, Pasco JA, Berk M(2012). Cigarette smoking, nicotine dependence and anxiety disorders: a systematic review of population-based, epidemiological stud-ies. BMC Med, 10:123.
Fehr C, Yakushev I, Hohmann N et al. (2008). Association of low striatal dopa-mine D2 receptor availability with nicotine dependence similar to that seen with other drugs of abuse. Am J Psychiatr, 165(4):507–14.
Malhi GS, Berk M (2007). Does dopamine dysfunction drive depression? Acta Psychi-atr Scand Suppl, 433:116–24.
Das I (1985). Raised C-reactive protein levels in serum from smokers. Clin Chim Ac-ta,153 (1):9–13.
Berk M, Wadee AA, Kuschke RH, O'Neill-Kerr A (1997). Acute phase proteins in major depression. J Psychosom Res, 43:529–34.
Thomsen M, Dahl M, Lange P, Vestbo J, Nordestgaard BG(2012). Inflammatory biomarkers and co-morbidities in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 186:982–8.
Pietras T, Witusik A, Panek M, Szemraj J, Górski P(2011). Anxiety, depression and methods of stress coping in patients with nicotine dependence syndrome. Med Sci Monit,17 (5): CR272-6.
Breslau N, Kilbey MM, Andreski P (1993). Nicotine dependence and major depres-sion. New evidence from a prospective investigation. Arch Gen Psychiatr, 50(1):31–5.
Ferguson DM (1996). Comorbidity between depressive disorders and nicotine depend-ence in a cohort of 16 year olds. Arch Gen Psychiatr, 53:1043–7.
McKenzie M, Olsson CA, Jorm AF, Roma-niuk H, Patton GC (2010). Association of adolescent symp¬toms of depression and anxiety with daily smoking and nicotine depen¬dence in young adulthood: findings from a 10-year longitudinal study. Addic-tion, 105(9): 1652–9.
Zhang X, Li J, Wang D, Li Z,Fu S,Han Y,Zhou H,Shen M,Zhao J,Sun X,Pu L,Ma D,Wang L,He X,Sun J,Wu L,Chen D,Yu X,Xu L,Zhao G,Liu S,Liu D,Nie F,Zhang L,Wen D,Wang X(2011). Lung functions in 7,515 smokers from Liaoning province. Shanghai Med J, 34:302-5.
Cleland JA, Lee AJ, Hall S (2007). Associa-tions of depression and anxiety with gen-der, age, health-related quality of life and symptoms in primary care COPD pa-tients. Fam Pract, 24(3):217-23.
Goodwin RD, Lavoie KL,Lemeshow AR, Jenkins E, Brown ES, Fedoronko DA(2012). Depression, Anxiety, and COPD: The Unexamined Role of Nico-tine Dependence. Nicotine Tob Res, 14(2):176–183.
Minas M, Verrou-Katsarou I, Mystridou P, Apostolidou E, Hatzoglou C, Gour-goulianis KI(2012). Two-year mortality of patients with COPD in primary health care: an observational study. Int J Gen Med, 5:815–22.
|Issue||Vol 45 No 2 (2016)|
|Chronic obstructive pulmonary disease Smoking Depression|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|