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Risk of Depression and Anxiety in Employees With Chronic Bronchitis: The Modifying Effect of Cigarette Smoking

From the Department of General Practice, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands (E.J.W., C.P.v.S.); the Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands (I.K., L.G.P.M.v.A., G.M.H.S.); and the Department of Respiratory Medicine, University Hospital Maastricht, Maastricht, The Netherlands (E.F.M.W.).

Address correspondence and reprint requests to E. J. Wagena, MA, Pulmonary Rehabilitation Centre Hornerheide, PO Box 4080, 6080 AB Haelen, The Netherlands. E-mail: edwinwageha{at}proteion.nl

OBJECTIVE: The present study evaluates whether smoking status modifies the association between chronic bronchitis and depression or anxiety in a population-based sample. Furthermore, we tested whether these associations are different in people without any respiratory complaints and those with asthma.

METHODS: For this study, we used cross-sectional data form the Maastricht Cohort Study, a population-based cohort study among Dutch employees.

RESULTS: In total, 7482 employees completed and returned the questionnaire (92.7%). In employees with chronic bronchitis, the prevalence of depression and anxiety was significantly higher compared with healthy employees and employees with asthma. Results indicate that the odds of having comorbid depression or anxiety for employees with chronic bronchitis compared with healthy employees is highest in current and past smokers, indicating that smoking status modifies this association.

CONCLUSION: Chronic bronchitis is strongly associated with depression and anxiety. Because depression and/or anxiety may not only interfere with an attempt to stop smoking but also contribute significantly to experiencing low quality of life, it is important to consider these disorders and chronic bronchitis as different disease entities. Prospective longitudinal studies are needed to elucidate the mechanisms underlying the association among chronic bronchitis, psychiatric disorders, and cigarette smoking.

Key Words: chronic bronchitis, • depression, • anxiety.

Abbreviations: COPD = chronic obstructive pulmonary disease;; HADS = Hospital Anxiety and Depression Scale;; OR = odds ratio;; CI = confidence interval.

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