The prevalence and implications of depression and anxiety in patients with bronchiectasis: a systematic review and meta-analysis

Background Comorbidities significantly affect bronchiectasis prognosis. Depression and anxiety are frequently encountered psychological comorbidities that have the greatest impact on bronchiectasis. This systematic review aimed to identify the prevalence of depression and anxiety and describe their implications for bronchiectasis. Methods Three databases were searched from their inception to October 2023 for studies reporting the prevalence and/or clinical implications of depression and anxiety in patients with bronchiectasis. Two independent reviewers rated the quality of the evidence presented in the studies using the risk of bias tool for prevalence studies. Results Of the 50 studies identified, 17 studies with 2637 patients were included. The overall risk of bias was classified as low (10 studies) or moderate (seven studies). The pooled prevalence of depression and anxiety was 31% (95% CI 24-38%) and 34% (95% CI 28-40%), respectively. Depression was significantly higher in female compared to male patients (risk difference 10%, 95% CI 0-21%) and associated with bronchiectasis exacerbation (adjusted odds ratio 1.72, 95% CI 1.28-2.15). Depression and anxiety are closely associated with poor health-related quality of life. However, clinical outcomes including dyspnoea symptoms, severity index, computed tomography score, lung function and physical activity were not associated with depression or anxiety. Conclusion This study revealed a high prevalence of depression and anxiety among patients with bronchiectasis. Depression was more prevalent in females and is significantly associated with bronchiectasis exacerbation. Depression and anxiety were associated with poor health-related quality of life.