Depression control may be key to helping many patients with chronic obstructive pulmonary disease (COPD) with smoking cessation, according to study findings published in BMC Pulmonary Medicine.

Nearly 40% of people with COPD have been diagnosed with depression, according to authors of the current study, who sought to identify how depression and other factors affected smoking behavior and readiness to quit smoking in patients with COPD.

The investigators conducted a descriptive cross-sectional study using a convenience sample recruited through clinics, advertisements, and targeted outreach to patients with COPD in the rural Appalachian region of the US from February 2020 to November 2020. The study included 222 participants with self-reported COPD (50.5% women; 95% White, 1.8% Black), some of whom had a documented diagnosis. Additional comorbidities included 17% related to heart conditions, 8% peripheral vascular disease, and 14% diabetes. Data for analysis was obtained through questionnaires completed by participants. Smoking status was self-reported by participants; 2 participants reported they had never smoked, 115 quit more than 6 months ago, 4 quit within the last 6 months, and 87 (39%) currently smoked.

Participants ranged from 32 to 94 years of age (mean [SD] age, 64 [9.6] years); 21% reported annual income greater than $50,000 and 50% reported income less than $24,000. Education levels were reported as 22% with a Bachelor’s degree or higher, 31% with some college or an associate degree, and more than half of the remaining 46% completed high school.

Treatment for depression can improve COPD patient outcomes and aid in achieving smoking cessation.

Self-report tools used to assess smoking behaviors, depressive symptoms, and readiness to quit smoking included the Cigarette Dependence Scale-12 (CDS-12), the Patient Health Questionnaire-9 (PHQ-9), the Smoking Stage of Change Questionnaire (SSCQ), the Smoking Decisional Balance Questionnaire (SDBQ), and the Processes of Change Questionnaire (PCQ).

A total of 101 of the 222 participants self-reported depression and 79 participants took medication to treat depression. Based upon questionnaire answers, the investigators determined that only 18 participants had no depressive symptoms, while 76 had moderate to severe depressive symptoms, 52 had mild depressive symptoms, and 59 had minimal depressive symptoms.

Among the participants who currently smoked, 25 were thinking about quitting in the next 30 days, 32 were considering quitting within the next 6 months, and 28 were not thinking about quitting. Results of the Smoking Stage of Change Questionnaire showed 39 participants in the contemplation stage, 17 in preparation, 4 in action, 115 in maintenance, and 28 were considered to be in precontemplation.

The investigators found a significant positive correlation between COPD and depressive symptoms; the Cigarette Dependence Scale-12 showed high levels of cigarette dependence were associated with more severe depressive symptoms and the Processes of Change Questionnaire showed high use of the processes of change was associated with more severe depressive symptoms.  A nonsignificant negative correlation was found between COPD, depressive symptoms, and results of the Smoking Decisional Balance Questionnaire, which found high levels of depressive symptoms were associated with participants endorsing more cons for smoking.

Study limitations include self-reported unvalidated inclusion criteria and the sampling bias inherent in a convenience sample.

“Treatment for depression can improve COPD patient outcomes and aid in achieving smoking cessation,” the investigators concluded. Assessment of current smoking behaviors is necessary to understand an individual’s current level of depression and nicotine dependence. The study authors wrote, “Practitioners must understand patients perceived stage, pros and cons, and situations and thoughts that occur in the process of change to help achieve cessation.”

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