Depression and Anxiety Among Patients with COPD: A Nationwide Study from Lithuania.

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is frequently accompanied by depression and anxiety, which may exacerbate disease outcomes, reduce treatment adherence, and impair quality of life. Despite their clinical significance, these comorbidities remain frequently underdiagnosed and undertreated. This study examined the diagnosed prevalence of depression and anxiety, as well as the patterns of psychotropic medication use among patients with COPD in Lithuania.

Materials and methods: A retrospective observational study was conducted using anonymized outpatient administrative data from the Lithuanian State Data Agency, comprising adult patients with COPD (ICD-10 J44.x) between 2020 and 2024. Mental health comorbidities were identified according to ICD-10 codes for anxiety disorders (F41.x), depressive episodes (F32.x), and recurrent depressive disorders (F33.x). Associations between categorical variables and sex differences were analyzed using contingency tables. Crude odds ratios (ORs) and adjusted odds ratios (aORs) from multivariable logistic regression analyses were calculated.

Results: Among 64,246 unique patients with COPD, 18.1% had a diagnosed psychiatric disorder, with a higher diagnosed prevalence among women than men (26.8% vs 12.1%; aOR = 2.40, 95% CI 2.32-2.48, p < 0.001). Anxiety disorders were identified in 15.0% of patients, and depressive disorders in 4.6%; women had significantly higher odds of depressive disorders compared with men (aOR = 3.53, 95% CI 3.36-3.72, p < 0.001). Psychotropic medications were prescribed to 61.9% of affected individuals, with women being more likely to receive any psychotropic medication than men (aOR = 0.687 for men vs women, 95% CI 0.644-0.732, p < 0.001). Anxiolytics represented 89.9% of all psychotropic prescriptions, with benzodiazepines accounting for 85.0% of this category. Family physicians were significantly more likely to prescribe anxiolytics than psychiatrists (OR = 10.66, p < 0.001). Antidepressant and neuroleptic prescribing showed statistically significant increasing trends over the study period (p = 0.007 and p = 0.005, respectively), whereas benzodiazepine prescribing rates also increased significantly (p = 0.004).

Conclusion: Anxiety and depression are common psychiatric comorbidities among patients with COPD in Lithuania and exhibit notable gender differences. Psychotropic medications were predominantly prescribed in primary care, with benzodiazepines accounting for the majority of anxiolytic treatments. These findings provide updated nationwide data on psychiatric comorbidity and psychotropic prescribing patterns among patients with COPD in Lithuania.