Factors associated with new onset of depression and anxiety symptoms differ by sex in the COPDGene study

Objective

Examine clinical and demographic variables associated with new onset depression and anxiety symptoms and assess moderation by sex in COPDGene, a cohort study of current and former smokers at risk for or with chronic obstructive pulmonary disease (COPD).

Methods

In the COPDGene study, 2653 adults had the hospital anxiety (HADS-A) and depression (HADS-D) scales available at phase 2 and 3, as well as clinical and demographic variables available at 2 and non-elevated HADS at phase 2. We defined new onset depression symptoms as HADS-D elevated at phase 3 (HADS-D ≥ 8) versus no new onset as HADS-D not elevated at either phase (HADS-D < 8). New onset anxiety symptoms were defined identically using HADS-A. We used logistic regression models among all participants and stratified by sex and assessed sex interactions for variables associated with the outcome for only one sex.

Results

Among males, COPD Assessment test (CAT) score was positively associated with new onset depression (β = 0.08, p = 1.9 × 10⁻⁵) and anxiety (β = 0.06, p = 1.4 × 10⁻³) symptoms. Among females, the modified Medical Research Council (mMRC) dyspnea was positively associated with new onset anxiety symptoms (β = 0.33, p = 1.4 × 10⁻³). We found sex by CAT score (β = −0.06, p = 0.02) and sex by mMRC dyspnea (β = 0.42, p = 5.1 × 10⁻³) interactions on new onset anxiety symptoms, and sex by CAT score interaction (β = −0.05, p = 0.04) on new onset depression symptoms.

Conclusions

These findings highlight the importance of understanding factors that increase risk for depression and anxiety among smokers at risk for or with COPD and are moderated by sex.