The effects of tele-based interventions for depression and anxiety symptoms in patients with Chronic Obstructive Pulmonary Disease (COPD): A systematic review and meta-analysis

Depression and anxiety are common psychiatric symptoms in patients with Chronic Obstructive Pulmonary Disease (COPD). While face-to-face psychotherapy is a common option, tele-based interventions provide a more accessible alternative. However, a comprehensive synthesis of evidence from clinical trials for COPD patients has yet to be conducted. This study aims to evaluate the effects of tele-based interventions in reducing depressive and anxiety symptoms in patients with COPD. A systematic search of PubMed, EMBASE, the Cochrane Library, Web of Science, PsycINFO, and MEDLINE databases was conducted from inception to May 5, 2024. Eligible studies included Randomized Controlled Trials (RCTs) of people with COPD patients receiving tele-based interventions reporting on the outcomes of depression or anxiety. Data extraction and quality assessment were performed independently by two researchers. The quality of the included studies was assessed using the Cochrane risk-of-bias tool. Meta-analysis was performed using RevMan (version 5.4) and Stata (version 18.0) software. Following the search, 9 RCTs with a total of 2064 patients with COPD were included. The meta-analysis revealed that tele-based interventions reduced depressive symptoms in patients with COPD (Standardized Mean Difference [SMD] = −0.15, 95 % CI −0.24 to −0.06; P  = 0.001). The subgroup analysis indicated that the PHQ-9 (SMD = −0.24, 95 % CI −0.37 to −0.10; P =  0.001) was better at detecting changes in depressive symptoms compared to other scales; the first 3 months of intervention (SMD = −0.36, 95 % CI −0.52 to −0.19; P   <  0.001) was the most pronounced improvement; and telehealth interventions were more effective (SMD = −0.30, 95 % CI −0.46 to −0.15; P <  0.001) than telemonitoring interventions. Tele-based interventions also reduced anxiety symptoms in patients with COPD (SMD = −0.12, 95 % CI −0.22 to −0.02; P  = 0.02). The evidence supports the efficacy of tele-based interventions in alleviating depression and anxiety symptoms in COPD patients. However, further large-scale and rigorously designed studies are warranted to strengthen the evidence.