Elsevier

General Hospital Psychiatry

Volume 36, Issue 3, May–June 2014, Pages 277-283
General Hospital Psychiatry

Psychiatric–Medical Comorbidity
Mediterranean diet is associated on symptoms of depression and anxiety in patients with bronchiectasis,☆☆,☆☆☆,,★★

https://doi.org/10.1016/j.genhosppsych.2014.01.010Get rights and content

Abstract

Background

The aim was to measure symptoms of depression and anxiety in patients with bronchiectasis and evaluate their relationship with a Mediterranean diet.

Methods

This cross-sectional study recruited patients with bronchiectasis at four Spanish centers. Patients completed the hospital anxiety and depression scale (HADS) and the Mediterranean diet questionnaire (PREDIMED). Demographic, health and outcome data were recorded from medical charts. Logistic regression was used to determine the predictors of elevated symptoms of depression and anxiety (HADS≥11).

Results

Of the 205 participants recruited, 37 (18.0%) had elevated anxiety-related scores and 26 (12.7%) had elevated depression-related scores (HADS≥11). Increased symptoms of depression were significantly associated with being unemployed, a lower education, older age, comorbidity, major dyspnea, worse quality of life (QOL) and a lower PREDIMED score. Increased symptoms of anxiety were significantly associated with more exacerbations, worse QOL and a lower PREDIMED score. Regression analyses indicated that, after adjustment, QOL and the PREDIMED score predicted elevated symptoms of depression and QOL predicted elevated symptoms of anxiety.

Conclusions

The prevalence of elevated symptoms of depression and anxiety is high in patients with bronchiectasis and greater adherence to a Mediterranean diet is associated with a lower likelihood of having these symptoms, particularly for depression.

Introduction

Bronchiectasis is the end result of several different diseases, managed in similar ways, but that lead to pulmonary infections, chronic inflammation, loss of lung function and worsening of health-related quality of life. Care should be supervised by specialized units, at least in cases of chronic infection, recurrent exacerbations or bronchiectasis with an etiology susceptible to specific therapy. The prevalence is unknown and probably varies by population [1], [2]; in the Unites States, the estimated prevalence of bronchiectasis is 53 cases per 100,000 adults [3].

Several studies have found that patients with bronchiectasis report worse health-related quality of life than the general population, particularly those with poor lung function, more frequent exacerbations, daily bronchorrhea, chronic infection with Pseudomonas aeruginosa [4], [5], [6], [7], [8] and symptoms of depression and anxiety [9]. Furthermore, patients who have both a chronic medical condition and either depression or anxiety exhibit more medical symptoms [10], physical disability [11], worse adherence to prescribed treatments and increased health care utilization and costs, compared to patients without significant psychological symptoms [10], [12], [13]. These psychiatric disorders are often under-diagnosed [14]. Though a high prevalence of these symptoms has been reported in patients with bronchiectasis [4], [9], [15], studies have so far focused mainly on patients with cystic fibrosis (CF) [16], with small sample sizes, in highly selected populations and, in some cases, applying evaluation tests that overlap the symptoms of the chronic disease itself with those of depression and/or anxiety [15]. A previous study by our group, involving 93 patients with bronchiectasis (including 43 with CF), showed that symptoms of depression and anxiety were increased and predicted a worse health-related quality of life [9].

The Mediterranean diet is considered to represent a healthy dietary pattern, and it has been characterized by the United Nations as an intangible cultural heritage of humanity [17]. The protective role of the Mediterranean diet could be multidimensional [18], [19], encompassing anti-inflammatory functions [20], protection from oxidative stress [21] and atherothrombosis [22]. Greater adherence to a Mediterranean diet is associated with a marked improvement in health status [18], [19], a significant reduction in overall mortality [18], mortality from cardiovascular diseases [23], incidence of mortality from cancer [24], incidence of Parkinson's disease [25], dementia and cognitive impairment [26], [27] and particularly Alzheimer's disease [28], [29]. High or moderate adherence to a Mediterranean diet was also consistently associated with a reduced risk for depression [27], [30], [31], [32]. Conversely, the intake of trans fatty acids or the consumption of foods rich in this kind of fat, like those found in fast food or commercial bakery products, have been reported to be contributors to a higher risk for depression [33]. Diet might affect brain functions that are involved in the etiology of depression, including the synthesis and regulation of neurotransmitters, synaptic plasticity, membrane fluidity and neuroinflammation [27]. Depression is associated with a low-grade inflammatory status and beneficial effects are reported for lipids with anti-inflammatory properties, such as omega-3 fatty acids or virgin olive oil [32], [34], [35].

Adherence to a Mediterranean diet has also been suggested to be protective against respiratory disorders [36], [37] and a high consumption of fruit, greens and fish has been associated with a lower risk of developing chronic obstructive pulmonary disease [38]. In patients with bronchiectasis, high plasma levels of inflammatory cytokines have been described, and these increases may be associated with nutritional status [39], [40]. The protective role of the Mediterranean diet could be a result of its anti-inflammatory functions [18], [19], [20], [21].

No studies have yet addressed the relationship of dietary patterns and depression among bronchiectasis patients.

The hypothesis of this study was that a Mediterranean diet could modulate the prevalence of symptoms of depression and anxiety in this population. Accordingly, the aim of this multicenter study was to measure symptoms of depression and anxiety in a large sample of patients with bronchiectasis and evaluate their relationship to the Mediterranean diet.

Section snippets

Patients and methods

This cross-sectional multicenter study included patients aged 16 years or older who met the diagnostic criteria for bronchiectasis [1], [2] and attended a specific bronchiectasis unit at one of four Spanish university hospitals for routine monitoring and treatment, over a recruitment period of 8 months. In all cases, bronchiectasis was diagnosed by high-resolution computed tomography of the chest, with the use of a 1- to 1.5-mm window every 10 mm and acquisition times of 1 s during full

Results

A total of 218 patients with bronchiectasis were approached for the study and 205 agreed to participate. Of the 13 patients who were excluded, 3 had problems understanding the questionnaires and 10 declined participation.

The mean age of the participants was 57.2 years (range, 17–86) and 62.8% were women. The mean FEV1% was 68.3±22.2% (range, 15–123%). Table 1 shows the main characteristics of the participants. Antidepressants were being taken by 19 (9.2%), and anxiolytics, by 28 (13.6%)

Discussion

The results of this study indicate that the prevalence of elevated symptoms of depression and anxiety was high in patients with bronchiectasis in comparison with the data reported for the general population [12], [14], [53], [54], [55], [56], and Mediterranean diet was associated with a lower likelihood of having these symptoms, particularly depression. As expected, patients with bronchiectasis reported higher rates of elevated symptoms (HADS≥11) of depression (12.68%) and anxiety (18%) than

Strengths and weaknesses

The strengths of this study lie in the use of a large sample of patients with bronchiectasis and the use of validated measures to assess the Mediterranean diet, psychological symptoms and quality of life, as well as the ability to adjust for a wide range of sociodemographic and clinical factors. Nevertheless, the study is not exempt from limitations. First, the study used a cross-sectional design, which precluded our ability to examine causal relationships between a Mediterranean diet and

Conclusions

In summary, the results indicate that the prevalence of elevated symptoms of depression and anxiety is high in patients with bronchiectasis and greater adherence to a Mediterranean diet is associated with a lower likelihood of having these symptoms, particularly for depression. Further studies could evaluate whether a Mediterranean diet in patients with bronchiectasis may have a protective influence against the presence of psychological symptoms, especially for depression.

Acknowledgments

This study is included in the PII of Bronchiectasis of SEPAR.

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  • Cited by (0)

    The work was performed at Malaga Regional University Hospital, Málaga; Instituto de Investigación la Princesa Hospital, Madrid; Dr. Trueta University Hospital, Girona; and Polytechnic and University La Fe Hospital, Valencia, Spain.

    ☆☆

    This study is included in the PII of Bronchiectasis of SEPAR (Spanish Society of Pulmonology and Thoracic Surgery).

    ☆☆☆

    Funding: This study was supported by a grant from SEPAR (31/2011).

    Contributions of authors: C. Olveira and G. Olveira contributed to the conception and design of the study; acquisition, analysis and interpretation of the data; and statistical analysis and drafting of the manuscript. Both authors are the guarantor of the paper, taking responsibility for the integrity of the word as a whole from inception to published article. Francisco Espíldora, Rosa-María Girón, Montserrat Vendrell, Antonio Dorado and Miguel-Ángel Martínez-García contributed to acquisition of the data and critical revision of the manuscript.

    ★★

    Other contributions: Gerard Muñoz [Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital, Girona, Spain] and Nuria Porras (Endocrinology and Nutrition Service, Málaga Regional University Hospital, Málaga, Spain) have also participated in this study.

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