The Effect of Complex Interventions on Depression and Anxiety in Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

BackgroundDepression and anxiety are very common in people with chronic obstructive pulmonary disease (COPD) and are associated with excess morbidity and mortality. Patients prefer non-drug treatments and clinical guidelines promote non-pharmacological interventions as first line therapy for depression and anxiety in people with long term conditions. However the comparative effectiveness of psychological and lifestyle interventions among COPD patients is not known. We assessed whether complex psychological and/or lifestyle interventions are effective in reducing symptoms of anxiety and depression in patients with COPD. We then determined what types of psychological and lifestyle interventions are most effective. Methods and FindingsSystematic review of randomised controlled trials of psychological and/or lifestyle interventions for adults with COPD that measured symptoms of depression and/or anxiety. CENTRAL, Medline, Embase, PsychINFO, CINAHL, ISI Web of Science and Scopus were searched up to April 2012. Meta-analyses using random effects models were undertaken to estimate the average effect of interventions on depression and anxiety. Thirty independent comparisons from 29 randomised controlled trials (n = 2063) were included in the meta-analysis. Overall, psychological and/or lifestyle interventions were associated with small reductions in symptoms of depression (standardised mean difference −0.28, 95% confidence interval −0.41 to −0.14) and anxiety (standardised mean difference −0.23, 95% confidence interval −0.38 to −0.09). Multi-component exercise training was the only intervention subgroup associated with significant treatment effects for depression (standardised mean difference −0.47, 95% confidence interval −0.66 to −0.28), and for anxiety (standardised mean difference −0.45, 95% confidence interval −0.71 to −0.18). ConclusionsComplex psychological and/or lifestyle interventions that include an exercise component significantly improve symptoms of depression and anxiety in people with COPD. Furthermore, multi-component exercise training effectively reduces symptoms of anxiety and depression in all people with COPD regardless of severity of depression or anxiety, highlighting the importance of promoting physical activity in this population.研究背景：慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）患者群体中，抑郁与焦虑症状极为常见，且与更高的发病率和死亡率相关。患者更倾向于非药物治疗方案，临床指南也推荐将非药物干预作为长期疾病患者抑郁与焦虑的一线治疗手段。但目前尚不明确针对COPD患者的心理干预与生活方式干预的相对疗效。本研究首先评估复合式心理干预及/或生活方式干预能否有效缓解COPD患者的抑郁与焦虑症状，随后明确何种类型的心理干预与生活方式干预疗效最佳。 研究方法与结果：本研究为系统综述，纳入针对成年COPD患者的心理干预及/或生活方式干预的随机对照试验（randomised controlled trial, RCT），且研究均测量了抑郁及/或焦虑症状。检索了Cochrane对照试验中心注册库（CENTRAL）、Medline、Embase、PsychINFO、CINAHL、ISI Web of Science以及Scopus数据库，检索时限截至2012年4月。本研究采用随机效应模型进行meta分析，以评估干预措施对抑郁与焦虑症状的平均效应量。本次meta分析共纳入29项随机对照试验，包含30个独立对照，总样本量为2063例。整体而言，心理干预及/或生活方式干预可小幅缓解患者的抑郁症状（标准化均数差（standardised mean difference, SMD）为-0.28，95%置信区间（95% confidence interval, 95%CI）为-0.41至-0.14）与焦虑症状（SMD为-0.23，95%CI为-0.38至-0.09）。多组分运动训练是唯一一类对抑郁（SMD为-0.47，95%CI为-0.66至-0.28）与焦虑（SMD为-0.45，95%CI为-0.71至-0.18）均具有显著治疗效果的干预亚组。 研究结论：包含运动组分的复合式心理干预及/或生活方式干预，可显著改善COPD患者的抑郁与焦虑症状。此外，无论患者初始抑郁或焦虑症状严重程度如何，多组分运动训练均可有效缓解其焦虑与抑郁症状，这凸显了在该患者群体中推广体育运动的重要性。