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Depressive symptoms among patients with chronic obstructive pulmonary disease according to smoking status – a Danish nationwide case-control study of 21 184 patients

Jakob Hedemark Vestergaard, Pradeesh Sivapalan, Rikke Sørensen, Josefin Eklöf, Imane Achir Alispahic, Anna von Bülow, Niels Seersholm, Jens-Ulrik Stæhr Jensen
ERJ Open Research 2020; DOI: 10.1183/23120541.00036-2020
Jakob Hedemark Vestergaard
1Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
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  • For correspondence: jakob.h.vestergaard@gmail.com
Pradeesh Sivapalan
1Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
2Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
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  • ORCID record for Pradeesh Sivapalan
Rikke Sørensen
3Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, University of Copenhagen, Kobenhavn, Denmark
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Josefin Eklöf
1Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
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Imane Achir Alispahic
1Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
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Anna von Bülow
1Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
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Niels Seersholm
1Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
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Jens-Ulrik Stæhr Jensen
1Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
4PERSIMUNE, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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Abstract

Introduction Depressive symptoms appear more often among patients with chronic obstructive pulmonary disease (COPD) and are associated with reduced disease control and increased mortality. Both smoking and COPD increase the risk of depressive symptoms. Whether smoking cessation among COPD patients affects the occurrence of depressive symptoms is unknown. We hypothesised that smoking cessation in patients with COPD leads to reduced use of antidepressants and fewer admissions to psychiatric hospitals with depression, anxiety or bipolar disorder.

Methods We conducted a nationwide retrospective case-control study, in patients from The Danish Register for Chronic Obstructive Pulmonary Disease (DrCOPD) with spirometry verified COPD, age ≥40 years, a history of smoking and absence of cancer. Consistent smokers were matched 1:1 with ex-smokers using a propensity score model. Prescription fillings of antidepressants and risk of admissions to psychiatric hospitals with either depression, anxiety or bipolar disorder both descriptively was assessed by Cox proportional hazard models.

Results We included 21 184 patients. A total of n=2011 consistent smokers collected antidepressant prescriptions compared with 1821 ex-smokers. Consistent smoking was associated with increased risk of filling prescription on antidepressants (HR 1.4, 95% CI 1.3–1.5, p<0.0001). and with increased risk of psychiatric hospital admission with either depression, anxiety or bipolar disorder (HR 2.0, 95% CI 1.6–2.5). The associations persisted after adjustment for former use of antidepressants.

Conclusion Consistent smoking among COPD patients was associated with increased use of antidepressants and admissions to psychiatric hospitals with either depression, anxiety or bipolar disorder, compared to smoking cessation.

Footnotes

This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Vestergaard has nothing to disclose.

Conflict of interest: P. Sivapalan reports nonfinancial support from Novartis and honoraria for lecturing from Boehringer Ingelheim outside the submitted work.

Conflict of interest: Dr. Sørensen has nothing to disclose.

Conflict of interest: Dr. Eklöf has nothing to disclose.

Conflict of interest: Dr. Alispahic has nothing to disclose.

Conflict of interest: Dr. von Bülow has nothing to disclose.

Conflict of interest: Dr. Seersholm has nothing to disclose.

Conflict of interest: Dr. Jensen has nothing to disclose.

This is a PDF-only article. Please click on the PDF link above to read it.

  • Received January 22, 2020.
  • Accepted September 8, 2020.
  • Copyright ©ERS 2020
http://creativecommons.org/licenses/by-nc/4.0/

This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

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Depressive symptoms among patients with chronic obstructive pulmonary disease according to smoking status – a Danish nationwide case-control study of 21 184 patients
Jakob Hedemark Vestergaard, Pradeesh Sivapalan, Rikke Sørensen, Josefin Eklöf, Imane Achir Alispahic, Anna von Bülow, Niels Seersholm, Jens-Ulrik Stæhr Jensen
ERJ Open Research Jan 2020, 00036-2020; DOI: 10.1183/23120541.00036-2020

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Depressive symptoms among patients with chronic obstructive pulmonary disease according to smoking status – a Danish nationwide case-control study of 21 184 patients
Jakob Hedemark Vestergaard, Pradeesh Sivapalan, Rikke Sørensen, Josefin Eklöf, Imane Achir Alispahic, Anna von Bülow, Niels Seersholm, Jens-Ulrik Stæhr Jensen
ERJ Open Research Jan 2020, 00036-2020; DOI: 10.1183/23120541.00036-2020
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