Leonard Turnier1, Michelle Eakin1, Han Woo1, Mark Dransfield2, Trisha Parekh2, Jerry A Krishnan3, Richard Kanner4, Christopher B Cooper5, Prescott G Woodruff6, Robert Wise1, MeiLan K Han7, Karina Romero1, Laura M Paulin1, Stephen Peters8, Brad Drummond9, Eugene R Bleecker8, Russell Bowler10, Alejandro P Comellas11, David Couper12, Robert Paine4, Fernando Martinez13, Graham Barr14, Nirupama Putcha1, Nadia N Hansel1. 1. Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America. 2. University of Alabama Birmingham, Birmingham, Alabama, United States of America. 3. University of Illinois, Chicago, Illinois, United States of America. 4. University of Utah School of Medicine, Salt Lake City, Utah, United States of America. 5. University of California at Los Angeles, Los Angeles, California, United States of America. 6. University of California at San Francisco, San Francisco, California, United States of America. 7. University of Michigan, Ann Harbor, Michigan, United States of America. 8. Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America. 9. University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America. 10. National Jewish Health, Denver, Colorado, United States of America. 11. University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America. 12. University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America. 13. Weill Medical College, New York, New York, United States of America. 14. Columbia University Medicine Center, New York, New York, United States of America.
Abstract
BACKGROUND: The purpose of this study was to explore the association between perceived social support and COPD outcomes and to determine whether the associations are mediated by depressive symptoms. METHODS: Subjects with COPD who were enrolled as part of SPIROMICS were included in this analysis. Questionnaires relating to quality of life, symptom burden, and functional status were administered at annual clinic visits for over a 3 year period. In both cross-sectional and longitudinal analyses, we examined the association of social support as measured by the FACIT-F with COPD outcomes. Cross sectional analyses used multivariable linear or logistic regression, adjusting for covariates. For longitudinal analyses, generalized linear mixed models with random intercepts were used. Models were adjusted with and without depressive symptoms and mediation analyses performed. RESULTS: Of the 1831 subjects with COPD, 1779 completed the FACIT- F questionnaire. In adjusted cross-sectional analysis without depressive symptoms, higher perceived social support was associated with better quality of life, well-being, 6 minute walk distance, and less dyspnea. When also adjusting for depressive symptoms, all associations between social support and COPD outcomes were attenuated and no longer statistically significant. Mediation analysis suggested that depressive symptoms explained the majority (> = 85%) of the association between social support and measured COPD outcomes. Results of the longitudinal analysis were consistent with the cross-sectional analyses. There was no association between social support and odds of exacerbations. CONCLUSION: Higher social support was associated with better COPD outcomes across several measures of morbidity including quality of life, respiratory symptoms, and functional status. In addition, these associations were largely attenuated when accounting for depressive symptoms suggesting that the beneficial association of social support with COPD outcomes may be largely mediated by the association between social support and depression. TRIAL REGISTRATION: SPIROMICS was approved by Institutional Review Boards at each center and all participants provided written informed consent (clinicaltrials.gov: NCT01969344).
BACKGROUND: The purpose of this study was to explore the association between perceived social support and COPD outcomes and to determine whether the associations are mediated by depressive symptoms. METHODS: Subjects with COPD who were enrolled as part of SPIROMICS were included in this analysis. Questionnaires relating to quality of life, symptom burden, and functional status were administered at annual clinic visits for over a 3 year period. In both cross-sectional and longitudinal analyses, we examined the association of social support as measured by the FACIT-F with COPD outcomes. Cross sectional analyses used multivariable linear or logistic regression, adjusting for covariates. For longitudinal analyses, generalized linear mixed models with random intercepts were used. Models were adjusted with and without depressive symptoms and mediation analyses performed. RESULTS: Of the 1831 subjects with COPD, 1779 completed the FACIT- F questionnaire. In adjusted cross-sectional analysis without depressive symptoms, higher perceived social support was associated with better quality of life, well-being, 6 minute walk distance, and less dyspnea. When also adjusting for depressive symptoms, all associations between social support and COPD outcomes were attenuated and no longer statistically significant. Mediation analysis suggested that depressive symptoms explained the majority (> = 85%) of the association between social support and measured COPD outcomes. Results of the longitudinal analysis were consistent with the cross-sectional analyses. There was no association between social support and odds of exacerbations. CONCLUSION: Higher social support was associated with better COPD outcomes across several measures of morbidity including quality of life, respiratory symptoms, and functional status. In addition, these associations were largely attenuated when accounting for depressive symptoms suggesting that the beneficial association of social support with COPD outcomes may be largely mediated by the association between social support and depression. TRIAL REGISTRATION: SPIROMICS was approved by Institutional Review Boards at each center and all participants provided written informed consent (clinicaltrials.gov: NCT01969344).