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

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  • Peter A Coventry
  • Peter Bower
  • Christopher Keyworth
  • Cassandra Kenning
  • Jasmin Knopp
  • Charlotte Garrett
  • Daniel Hind
  • Alice Malpass
  • Chris Dickens

Abstract

Background: Depression 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 Findings: Systematic 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). Conclusions: Complex 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.

Suggested Citation

  • Peter A Coventry & Peter Bower & Christopher Keyworth & Cassandra Kenning & Jasmin Knopp & Charlotte Garrett & Daniel Hind & Alice Malpass & Chris Dickens, 2013. "The Effect of Complex Interventions on Depression and Anxiety in Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 8(4), pages 1-22, April.
    • Handle: RePEc:plo:pone00:0060532
    DOI: 10.1371/journal.pone.0060532
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    References listed on IDEAS

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    1. Alessandro Liberati & Douglas G Altman & Jennifer Tetzlaff & Cynthia Mulrow & Peter C Gøtzsche & John P A Ioannidis & Mike Clarke & P J Devereaux & Jos Kleijnen & David Moher, 2009. "The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-28, July.
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    Cited by:

    1. Peng-Ching Hsiao & Chi-Ming Chu & Pei-Yi Sung & Wann-Cherng Perng & Kwua-Yun Wang, 2014. "Differences in COPD Patient Care by Primary Family Caregivers: An Age-Based Study," PLOS ONE, Public Library of Science, vol. 9(9), pages 1-10, September.
    2. Coventry, Peter A. & Dickens, Chris & Todd, Chris, 2014. "How does mental–physical multimorbidity express itself in lived time and space? A phenomenological analysis of encounters with depression and chronic physical illness," Social Science & Medicine, Elsevier, vol. 118(C), pages 108-118.
    3. Feng‐Lien Lin & Mei‐Ling Yeh & Yeur‐Hur Lai & Kuan‐Chia Lin & Chong‐Jen Yu & Jung‐San Chang, 2019. "Two‐month breathing‐based walking improves anxiety, depression, dyspnoea and quality of life in chronic obstructive pulmonary disease: A randomised controlled study," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(19-20), pages 3632-3640, October.

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