Factors Associated with New Onset of Depression and Anxiety Symptoms Differ by Sex in the COPDGene Study

OBJECTIVE:Examine clinical and demographic variables associated with new onset depression and anxiety symptoms and assess moderation by sex in COPDGene, a cohort study of current and former smokers at risk for or with chronic obstructive pulmonary disease (COPD). METHODS:In the COPDGene study, 2653 adults had the hospital anxiety (HADS-A) and depression (HADS-D) scales available at phase 2 and 3, as well as clinical and demographic variables available at 2 and non-elevated HADS at phase 2. We defined new onset depression symptoms as HADS-D elevated at phase 3 (HADS-D ≥ 8) versus no new onset as HADS-D not elevated at either phase (HADS-D < 8). New onset anxiety symptoms were defined identically using HADS-A. We used logistic regression models among all participants and stratified by sex and assessed sex interactions for variables associated with the outcome for only one sex. RESULTS:Among males, COPD Assessment test (CAT) score was positively associated with new onset depression (β = 0.08, p = 1.9 × 10-5) and anxiety (β = 0.06, p = 1.4 × 10-3) symptoms. Among females, the modified Medical Research Council (mMRC) dyspnea was positively associated with new onset anxiety symptoms (β = 0.33, p = 1.4 × 10-3). We found sex by CAT score (β = -0.06, p = 0.02) and sex by mMRC dyspnea (β = 0.42, p = 5.1 × 10-3) interactions on new onset anxiety symptoms, and sex by CAT score interaction (β = -0.05, p = 0.04) on new onset depression symptoms. CONCLUSIONS:These findings highlight the importance of understanding factors that increase risk for depression and anxiety among smokers at risk for or with COPD and are moderated by sex.