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Open Access Highly Accessed Research article

Increased risk and related factors of depression among patients with COPD: a population-based cohort study

Tzung-Yi Tsai123, Hanoch Livneh4, Ming-Chi Lu56, Pang-Yau Tsai27, Pei-Chun Chen8 and Fung-Chang Sung27*

Author Affiliations

1 Department of Medical Research, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan

2 Department of Public Health, China Medical University, Taichung, Taiwan

3 Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan

4 Department of Special Education and Counselor Education, Portland State University, Portland, Oregon, USA

5 Division of Allergy, Immunology and Rheumatology, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan

6 School of Medicine, Tzu Chi University, Hualien, Taiwan

7 Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

8 Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan

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BMC Public Health 2013, 13:976  doi:10.1186/1471-2458-13-976

Published: 19 October 2013



Depression is a common and mostly undertreated problem in patients with chronic diseases. However, population-based studies on the association between chronic obstructive pulmonary disease (COPD) and subsequent depression are limited in Asian populations. This study evaluated the incidence and risk factors of depression for patients with COPD in Taiwan.


Using the claims data from the National Health Insurance of Taiwan, we identified 38,010 COPD patients newly diagnosed in 2000–2004 and 38,010 subjects without COPD frequency, matched by sex, age and index date. The incidence rate and hazard ratio for depression were estimated by the end of 2008.


The incidence rate of depression was 1.88 folds higher in the COPD cohort than in the non-COPD cohort (12.2 versus 6.47 per 1,000 person-years, p < 0.0001). The depression risk was the greatest within the first year following COPD diagnosis and tended to decline with follow-up time. Among COPD patients, multivariate analysis showed that younger women and low-income patients were at higher risk of depression. Hospitalization and comorbidities such as hypertension, arthritis, cancer, and heart disease were also significant predictors for depression risk.


This population-based cohort study demonstrated a strong relationship between COPD and subsequent depression. These findings could assist healthcare providers to pinpoint individuals with a higher predisposition to having depression, which could then facilitate the provision of culturally appropriate rehabilitation within the first year after the diagnosis of COPD.

Chronic obstructive pulmonary disease; Depression; Cohort study