Association Observed Between Depressive Disorders, Respiratory Disorders

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There is a link between depressive disorders and respiratory disorders among those with self-reported chronic obstructive pulmonary disease (COPD) and asthma, according to new findings, though this is not seen in objective diagnoses based upon spirometry.¹

These new data resulted from a study conducted to assess potential links between ventilatory disorders, spirometric indices, and self-reported diseases of the respiratory system to psychiatric conditions. The team ensured that confounding variables were included in their assessment.

The research was led by Brice Touilloux, from Lausanne University Hospital’s respiratory medicine department at the University of Lausanne in Switzerland. Touilloux and colleagues noted that individuals with depressive symptoms often show elevated inflammation cytokines, some of which are connected to weakened bronchodilation responses and airway neutrophilia.²

“Using data from a population-based cohort, the purpose of the present paper is to evaluate the association between lung volumes, spirometric ventilatory disorders and self-reported respiratory diseases and major depressive episode (MDE) and anxiety disorders, controlling for potential confounders,” Touilloux and colleagues wrote.

Background and Methods

The investigators’ data was drawn from the prospective CoLaus/PsyCoLaus cohort study, investigating the link between mental disorders and cardiovascular risk factors within a community setting. The cohort was made up of 6734 individuals within the age range of 35 - 75 years who had been recruited from Lausanne, Switzerland in the period between 2003 - 2006.

Evaluations during follow-up meetings had been carried out about 5 (labeled ‘FU1,’ 5064 subjects), 9 (FU2, 4881 subjects), and 13 years (FU3) following the point of baseline. The PneumoLaus spirometry research was done from June 2014 - August 2017, coinciding with the FU2 physical assessment and taking place a single year prior to the FU2 psychiatric evaluation.

Among the 3351 individuals taking part in PneumoLaus and the 3493 individuals in the FU2 psychiatric assessment, the investigators’ analysis aimed at the 2774 subjects who finished both assessments. The methodology used in Pneumolaus had been previously disclosed in detail.³

The research team defined ventilatory disorders through GLI-2012 references, whereas major depressive episodes and anxiety disorders were defined by the team according to DSM-IV criteria.

Using face-to-face interviews, the investigators evaluated respiratory symptoms, risk factors, and prior diagnoses, involving respiratory practitioners on the day of subjects’ spirometry. Cough, sputum production, and breathlessness were symptoms that were recorded and identified through the use of the modified Medical Research Council (mMRC) dyspnea scale.

Findings

Overall, 22.7% of the study subjects ended up presenting with a recent major depressive episode (MDE), the investigators found. They also noted that reversible cases of obstructive ventilatory disorders had associations with recent episodes (OR=1.94, 95% CI, 1.10-3.43) and recent anxiety disorders (2.21 [1.16-4.22]) only within the team’s unadjusted model.

The research team noted that self-reported cases of asthma and COPD were found to be linked to major depressive episodes, with adjusted ORs of 1.56 (95% CI, 1.04-2.35) and 2.49 (95% CI, 1.19-5.27), respectively. The team also reported that potential restrictive ventilatory impairment had a positive correlation with anxiety disorders occurring recently (OR=2.46, 1.10-5.51).

Despite these findings, the investigators found that the Z-scores of FEV1, FVC, and maximum mid-expiratory flow (MMEF) ended up having no associations to psychiatric conditions. In the adjusted models used by the team, they identified no association between ventilatory disorders and major depressive episodes.

“People with low spirometry values might not have participated in our cohort due to their symptom burden,” they wrote. “Moreover, this was a cross-sectional study, therefore it was only possible to confirm a temporal association between mental disorders and airways impairment, without being able to analyse a potential causality due to a period of only one year between the spirometry and the psychiatric assessment.”

Nevertheless, the team’s research represents the first population-based study focused on the connection between ventilatory disorders, spirometry indices, and psychiatric conditions through the use of a semi-structured interview.

References

1. ^{Brice Touilloux, Alessio Casutt, Marie-Pierre F. Strippoli, et al. Associations of depressive and anxiety disorders with pulmonary disorders in the community – the PneumoLaus and PsyCoLaus studies. Respiration 2024; https://doi.org/10.1159/000537918.}
2. ^{Zhang L, Zhang X, Zheng J, Liu Y, Wang J, Wang G, et al. Depressive symptom-associated IL-1beta and TNFalpha release correlates with impaired bronchodilator response and neutrophilic airway inflammation in asthma. Clin Exp Allergy. 2019 Jun;49(6):770-80.}
3. ^{Lenoir A, Fitting JW, Marques-Vidal PM, Vollenweider P, Nicod LP. GLI 2012 equations define few spirometric anomalies in the general population: the PneumoLaus study. Respir Res. 2018 Dec 13;19(1):250.}