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Chronic Bronchitis, Cigarette Smoking, and the Subsequent Onset of Depression and Anxiety: Results From a Prospective Population-Based Cohort Study

From the Pulmonary Rehabilitation Centre Hornerheide, Horn, The Netherlands (E.J.W.); Department of Respiratory Medicine, University Hospital Maastricht, Maastricht, The Netherlands (E.J.W., E.F.M.W.); and Department of Epidemiology, Maastricht University, Maastricht, The Netherlands (L.G.P.M.v.A., I.K.).

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

Objective: The authors used data from a prospective, population-based cohort study to examine: (a) whether the presence of chronic bronchitis predicts the subsequent onset of depression or anxiety, and (b) if the incidence of depressed or anxious cases was different for smokers compared with nonsmokers.

Materials and Methods: For studying the relation between chronic bronchitis and anxiety or depression, we used data from respectively 4468 and 4520 respondents.

Results: The number of incident anxious (19.1%, n = 17) and depressed (14.0%, n = 13) cases was highest in employees with chronic bronchitis compared with employees without respiratory complaints (4.3%, n = 189 and 3.3%, n = 145, respectively). The presence of chronic bronchitis was associated with a significant increase in anxious and depressed cases (odds ratio (OR) for anxiety = 5.09, 95% confidence interval (CI) 2.91, 8.89; OR for depression = 4.38, 95% CI 2.35, 8.16). The incidence of anxiety as well as depression was strongest in the smokers group (OR for anxiety = 8.94, 95% CI 4.08, 19.59; OR for depression = 7.56, 95% CI 3.37, 16.96).

Conclusions: This prospective study shows significantly higher levels of anxiety as well as depression in employees with chronic bronchitis. Results also seem to indicate that smoking cigarettes modifies this association, resulting in an increased risk of depression and anxiety in employees with chronic bronchitis who smoke.

Key Words: chronic bronchitis • depression • anxiety • cigarette smoking • prospective cohort

Abbreviations: COPD = chronic obstructive pulmonary disease; HADS = Hospital Anxiety and Depression Scale; HADS-A = HADS anxiety subscale; HADS-D = HADS depression subscale.

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