Anxiety and Depressive Symptoms Among Patients with Chronic Obstructive Pulmonary Disease Attending a Tertiary Pulmonary Clinic in Damascus, Syria: A Cross-Sectional Study of Spirometric and Patient-Reported Correlates
- 1Faculty of Medicine, Syrian Private University, Damascus, Syrian Arab Republic
- 2Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
Abstract
Background: Anxiety and depressive symptoms are common but often underrecognized in chronic obstructive pulmonary disease (COPD), while evidence from resource-limited settings remains scarce. This study assessed their prevalence and correlates among patients with COPD attending a tertiary pulmonary clinic in Damascus, Syria.
Methods: This cross-sectional, single-center convenience-sample study included 249 patients with COPD at Al-Mouwassat Hospital. Anxiety and depressive symptoms were assessed using validated Arabic versions of the GAD-7 and PHQ-9. Clinically relevant symptoms were defined as GAD-7 ≥10 and PHQ-9 ≥10. Spirometric impairment was characterized using FEV1% predicted. The GAD-specific challenge burden score ranged from 0 to 4 and was modeled as a continuous predictor. Bivariate analyses were followed by multinomial logistic regression for GAD-7 severity and proportional-odds ordinal logistic regression for PHQ-9 severity, with sensitivity analyses using GOLD-based FEV1 categories and binary symptom thresholds.
Results: Clinically relevant anxiety and depressive symptoms were present in 30.9% and 73.9% of participants, respectively. Each one-point increase in the GAD-specific challenge burden score was associated with mild anxiety (adjusted OR, 7.07; 95% CI, 3.36–14.89) and moderate-to-severe anxiety (adjusted OR, 26.95; 95% CI, 10.32–70.41). Older age and lower FEV1% predicted were additionally associated with moderate-to-severe anxiety. Greater depressive symptom severity was associated with lower FEV1% predicted, COPD duration ≥1 year, and difficulty performing daily tasks. Sensitivity analyses showed consistent findings.
Conclusion: Anxiety and depressive symptoms were common in this outpatient cohort. Both spirometric impairment and patient-reported symptom and functional burden were associated with psychological symptom severity, supporting multidimensional COPD assessment.
Related
- A Cross-Sectional Study on the Prevalence of Asthma-Chronic Obstructive Pulmonary Disease Overlap in Patients Attending the Pulmonology Outpatient Department at Apollo Institute of Medical Sciences and Research, Chittoor, India
- Effective Connectivity and Clinical Correlates in Chronic Obstructive Pulmonary Disease.
- A cross-sectional study of the prevalence and correlates of post-traumatic stress among people attending acceptance and commitment therapy for chronic pain
- Functional fitness, perceived barriers and exercise health belief domains as correlates of physical activity in older adults attending a Third Age University: a cross-sectional study
- Prevalence of anxiety and depressive symptoms among men attending infertility services in Africa: a systematic review and meta-analysis
BibTeX
@article{alkhatib2026anxiety,
title = {{Anxiety and Depressive Symptoms Among Patients with Chronic Obstructive Pulmonary Disease Attending a Tertiary Pulmonary Clinic in Damascus, Syria: A Cross-Sectional Study of Spirometric and Patient-Reported Correlates}},
author = {Ibrahim Alkhatib and Mohammad Alaa Aldakak and Othman Alawad Almlhem and Lama Alsaoub and Hussam Al-Bardan},
journal = {International Journal of Chronic Obstructive Pulmonary Disease},
year = {2026},
month = oct,
doi = {10.2147/copd.s637954},
url = {https://doi.org/10.2147/copd.s637954},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Anxiety and Depressive Symptoms Among Patients with Chronic Obstructive Pulmonary Disease Attending a Tertiary Pulmonary Clinic in Damascus, Syria: A Cross-Sectional Study of Spirometric and Patient-Reported Correlates
AU - Ibrahim Alkhatib
AU - Mohammad Alaa Aldakak
AU - Othman Alawad Almlhem
AU - Lama Alsaoub
AU - Hussam Al-Bardan
PY - 2026
DA - 2026/10/30
JO - International Journal of Chronic Obstructive Pulmonary Disease
DO - 10.2147/copd.s637954
UR - https://doi.org/10.2147/copd.s637954
AB - Background: Anxiety and depressive symptoms are common but often underrecognized in chronic obstructive pulmonary disease (COPD), while evidence from resource-limited settings remains scarce. This study assessed their prevalence and correlates among patients with COPD attending a tertiary pulmonary clinic in Damascus, Syria. Methods: This cross-sectional, single-center convenience-sample study included 249 patients with COPD at Al-Mouwassat Hospital. Anxiety and depressive symptoms were assessed using validated Arabic versions of the GAD-7 and PHQ-9. Clinically relevant symptoms were defined as GAD-7 ≥10 and PHQ-9 ≥10. Spirometric impairment was characterized using FEV1% predicted. The GAD-specific challenge burden score ranged from 0 to 4 and was modeled as a continuous predictor. Bivariate analyses were followed by multinomial logistic regression for GAD-7 severity and proportional-odds ordinal logistic regression for PHQ-9 severity, with sensitivity analyses using GOLD-based FEV1 categories and binary symptom thresholds. Results: Clinically relevant anxiety and depressive symptoms were present in 30.9% and 73.9% of participants, respectively. Each one-point increase in the GAD-specific challenge burden score was associated with mild anxiety (adjusted OR, 7.07; 95% CI, 3.36–14.89) and moderate-to-severe anxiety (adjusted OR, 26.95; 95% CI, 10.32–70.41). Older age and lower FEV1% predicted were additionally associated with moderate-to-severe anxiety. Greater depressive symptom severity was associated with lower FEV1% predicted, COPD duration ≥1 year, and difficulty performing daily tasks. Sensitivity analyses showed consistent findings. Conclusion: Anxiety and depressive symptoms were common in this outpatient cohort. Both spirometric impairment and patient-reported symptom and functional burden were associated with psychological symptom severity, supporting multidimensional COPD assessment.
SN - 1176-9106
SN - 1178-2005
ER -