The association of depression and preferences for life-sustaining treatments in veterans with chronic obstructive pulmonary disease.

Context: Depressive symptoms are common among patients with chronic obstructive pulmonary disease (COPD) and may modify patients' preferences for life-sustaining therapy. Examining the relationship between patient preferences for life-sustaining treatments and depressive symptoms is important for clinicians engaging in end-of-life care discussions.

Objectives: To assess whether a history of depression or active depressive symptoms is associated with preferences for life-sustaining therapies among veterans with COPD.

Methods: This was a cross-sectional study of 376 veterans who participated in a randomized trial to improve the occurrence and quality of end-of-life communication between providers and patients. Depressive symptoms were assessed by self-reported history and the Mental Health Index-5 survey. Preferences for mechanical ventilation (MV) and cardiopulmonary resuscitation (CPR) were assessed using standardized instruments. Multivariate logistic regression was conducted to adjust for potential confounding factors.

Results: Participants were older men with severe COPD. A substantial proportion of participants noted that they would want MV (64.2%) or CPR (77.8%). Depressive history and active symptoms were not associated with preferences for MV and CPR either before or after adjusting for confounding variables.

Conclusion: Depressive history and active symptoms among veterans with severe COPD were not associated with their decisions for life-sustaining treatments. Clinicians caring for patients with COPD should understand the importance of assessing and treating patients with depressive symptoms, yet recognize that depressive symptoms may not be predictive of a patient declining life-sustaining treatments.