Depression, anxiety and stress among chronic obstructive pulmonary disease patients in Jimma, South-West Ethiopia: Comparative cross sectional study

Abstract

Background: Chronic obstructive pulmonary disease is associated with depression, anxiety and stress which are the commonest under treated disorders resulting in significant morbidity and mortality. None of the previous studies addressed the association between depression, anxiety, and stress and chronic obstructive pulmonary disease in the present setup. Objective: The main aim of the present study was to determine the magnitude of Depression, Anxiety and Stress and associated factors among Chronic Obstructive Pulmonary Disease Patients in Jimma, South West Ethiopia, 2016. Methods: A comparative cross-sectional study was conducted at Jimma University Specialized Hospital, Jimma, South west Ethiopia among chronic obstructive pulmonary disease (COPD) patients. A total of 130 participants; 65 chronic obstructive pulmonary disease patients and the same number of relatively healthy individuals with matched age and sex characteristics were recruited. Spirometric assessment was done to evaluate severity of COPD. Depression, anxiety and stress scale (DASS 21) was used for the assessment of severity of depression, anxiety and stress. Pearson’s correlation was used for examining the relationship between depression, anxiety and stress scores and continues variables. One way ANOVA and independent T-test were used for comparing DAS scores across categories. Simple and multiple linear regression analysis were conducted to identify predictors of DAS. A significance level of p < 0.05 was used in all tests. Results: The patient group showed a statistically significant difference in the prevalence of depression, anxiety and stress (47.7%, 49.2 %, and 56.9% respectively, p < 0.001). Depression score was significantly associated with severity of COPD (p<0.01). Depression and stress scores were negatively correlated with monthly income (r=0.272,-0.303) and FEV1 (-0.402, -0.396), and positively correlated with duration of hospital admission (r=0.402, 0.344). Anxiety score was positively correlated with duration of hospital admission(r=0.420) and negatively correlated with FEV1 (r=0.298). Duration of hospital admission was a common positive predictor for depression, anxiety and stress scores (β =0.156, 0.144 and 0.123 respectively, p<0.001) while FEV1 was a negative predictor of depression (β =-4.209) and stress score (β =-3.003), p <0.001. Educational level of college and above was a negative predictor of depression (β=-7.100) and anxiety scores (β = -5.15, p<0.05). Income was a negative predictor of stress score (β = -0.002, p <0.05). Cigarette smoking was a positive predictor of both depression (β=13.39, p<0.01) and anxiety scores (β=6.75, p <0.05) while khat chewing was positive predictor of only depression score (β=5.28, p<0.05). Conclusion: In the present study, DAS was significantly higher in COPD patients than in healthy controls. Educational status, duration of admission, FEV1, khat chewing and cigarette smoking were predictors of depression score. Similarly, educational status, cigarette smoking, history and duration of admission were predictors of anxiety score. Educational status, income, duration of admission and FEV1were predictors of stress score. These high magnitudes of DAS among COPD patients need urgent intervention. Therefore, equal attention should be given in treating DAS in patients with COPD as that of COPD.