Association between mental health and chronic obstructive pulmonary disease (COPD) outcomes: systematic review and meta-analysis.

IF 4 3区医学 Q1 RESPIRATORY SYSTEM

BMJ Open Respiratory Research Pub Date : 2026-06-18 DOI:10.1136/bmjresp-2025-003977

Sulaiman Alsaab, Michael Newnham, Alice M Turner, Hayyaf Aldossary, Abdullah Albukhary, Amanda Farley

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引用次数: 0

Abstract

Objective: To systematically synthesise evidence on the associations between presence of a mental health condition and chronic obstructive pulmonary disease (COPD) outcomes in people diagnosed with COPD, including lung function, symptom burden, functional status and clinical events.

Methods: A systematic search of MEDLINE, Embase, PubMed, PsycINFO and CINAHL identified studies comparing COPD outcomes in adults (≥18 years) with and without comorbid mental illnesses. Eligible studies reported at least one relevant outcome comparing these groups. The protocol was pre-registered and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: 58 studies including 707 037 participants were included. Comorbid mental illness was associated with worse outcomes: lower forced expiratory volume in 1 s (mean difference (MD)=-2.92%, 95% CI -4.35% to -1.48%), lower diffusing capacity of the lungs for carbon monoxide (MD=-3.79%, 95% CI -5.72% to -1.86%), reduced 6-minute walking test distance (MD=-30.42 m, 95% CI -41.03 to -19.82) and higher modified Medical Research Council scores (MD=0.64, 95% CI 0.45 to 0.84). Quality of life was worse (higher St George's Respiratory Questionnaire (MD=15.23 points, 95% CI 13.25 to 17.22), COPD Assessment Test (MD=7.28, 95% CI 5.81 to 8.74)). Mental illness increased exacerbations (MD=0.87, 95% CI 0.24 to 1.50; adjusted risk ratio=1.58, 95% CI 1.05 to 2.37; incidence rate ratio (IRR)=1.64, 95% CI 1.38 to 1.96), hospitalisations (adjusted OR=1.61, 95% CI 1.43 to 1.81; adjusted IRR=2.22, 95% CI 1.30 to 3.78) and mortality (adjusted HR=1.34, 95% CI 1.07 to 1.69). Depression and anxiety showed the strongest associations; evidence for severe mental illness was limited.

Conclusion: Comorbid mental illness in COPD is linked to worse lung function, greater symptom burden, higher risks of exacerbation, hospitalisation and possibly mortality. Addressing the causes of this and integrating mental healthcare into COPD management may improve outcomes and reduce preventable admissions.

Prospero registration number: CRD42024567680.

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心理健康与慢性阻塞性肺疾病（COPD）结局之间的关系：系统回顾和荟萃分析

目的：系统地综合慢性阻塞性肺疾病（COPD）患者的精神健康状况与COPD结局之间的关联证据，包括肺功能、症状负担、功能状态和临床事件。方法：对MEDLINE、Embase、PubMed、PsycINFO和CINAHL进行系统检索，确定了比较有和无共病精神疾病的成人（≥18岁）COPD结局的研究。符合条件的研究报告了比较这些组的至少一个相关结果。该方案预先注册并遵循系统评价和荟萃分析首选报告项目（PRISMA）指南。结果：共纳入58项研究，707037名受试者。合并精神疾病与较差的结果相关：1 s内强制呼气量较低（MD= -2.92%， 95% CI为-4.35%至-1.48%），肺部一氧化碳弥散能力较低（MD=-3.79%， 95% CI为-5.72%至-1.86%），6分钟步行测试距离缩短（MD=-30.42 m， 95% CI为-41.03至-19.82）和较高的修正医学研究委员会评分（MD=0.64, 95% CI为0.45至0.84）。生活质量较差（较高的圣乔治呼吸问卷（MD=15.23分，95% CI 13.25 ~ 17.22）， COPD评估测试（MD=7.28分，95% CI 5.81 ~ 8.74））。精神疾病增加了病情恶化（MD=0.87, 95% CI 0.24至1.50；校正风险比=1.58,95% CI 1.05至2.37；发病率比(IRR)=1.64, 95% CI 1.38至1.96）、住院（校正OR=1.61, 95% CI 1.43至1.81；校正IRR=2.22, 95% CI 1.30至3.78）和死亡率（校正HR=1.34, 95% CI 1.07至1.69）。抑郁和焦虑表现出最强的关联；严重精神疾病的证据有限。结论：慢性阻塞性肺病伴发精神疾病与肺功能恶化、症状负担加重、加重、住院和可能死亡的风险较高有关。解决这一问题的原因并将精神卫生保健纳入慢性阻塞性肺病管理可能会改善结果并减少可预防的入院。普洛斯彼罗注册号：CRD42024567680。

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来源期刊

BMJ Open Respiratory Research RESPIRATORY SYSTEM-

CiteScore

6.60

自引率

2.40%

发文量

审稿时长

12 weeks

期刊介绍： BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.