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Original Research (Preprint)

Vol. 1 No. 2 (2025): Regular Issue

Depression, Anxiety, and Physiological Dysfunction in COPD: Associations with Gas Exchange Impairment and Pulmonary Hypertension

Submitted
December 3, 2025
Published
December 15, 2025

Abstract

Depression and anxiety are common yet often underrecognized in patients with chronic obstructive pulmonary disease (COPD). Although airflow limitation measured by percent predicted FEV₁ has been considered the principal marker of disease severity, FEV₁ alone may not capture the heterogeneity of symptoms or patient-reported outcomes, including psychological distress. This study investigated the prevalence of depressive and anxiety symptoms and their associations with physiological parameters – %FEV₁, diffusing capacity (%DLCO/VA), estimated systolic pulmonary arterial pressure (esPAP), and body mass index (BMI) – in Japanese outpatients with COPD.
In a single-center cross-sectional study, 56 clinically stable COPD outpatients (mean age 73 years, 87.5% male) were assessed. Depressive and anxiety symptoms were measured using the Self-Rating Depression Scale (SDS) and the State–Trait Anxiety Inventory (STAI). Physiological parameters included %FEV₁, %DLCO/VA, esPAP, and BMI. Associations were examined using correlation and multivariable regression analyses.
Clinically relevant depressive symptoms were present in 46.5% of patients, including 16.1% moderate and 5.4% severe, and 41.1% exhibited elevated state anxiety, with 12.5% severe. Higher SDS scores correlated with lower %DLCO/VA (r = −0.396), higher esPAP (r = 0.415), and lower BMI (r = −0.376) (all p < 0.01). State anxiety correlated positively with esPAP (r = 0.369, p = 0.006). In multivariable models, %DLCO/VA and esPAP independently predicted depressive symptoms, while esPAP predicted state anxiety.
Depression and anxiety are highly prevalent in Japanese COPD outpatients and are independently associated with impaired gas exchange and pulmonary hypertension, underscoring the need for integrative psychophysiological management.

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