Depression, anxiety comorbidity, and disability in tuberculosis and chronic obstructive pulmonary disease patients: applicability of GHQ-12 Ismail Orhan Aydin, M.D. a , Aylin Ulus ¸ahin, M.D. b, * a Bas ¸kent University, Faculty of Medicine, Department of Psychiatry, Ankara, Turkey b Hacettepe University, Faculty of Medicine, Department of Psychiatry, Ankara, Turkey Abstract Our aim was to study anxiety and/or depression comorbidity and the influence of these comorbid conditions on disability for 3 clinical groups of pulmonary tuberculosis and chronic obstructive pulmonary disease (COPD). We also investigated the applicability of General Health Questionnaire 12 (GHQ12) for these clinical groups as a simple screening test for psychiatric comorbidity. A total of 157 male inpatients were included in the study: 42 with recently diagnosed (RDtb), 39 with defaulted (Dtb), 39 with multidrug resistant tuberculosis (MDRtb) and 38 with COPD. The presence of depression and anxiety was assessed by Composite International Diagnostic Interview (CIDI). Disability was evaluated by Brief Disability Questionnaire. The validity of GHQ12 for the study groups was examined in order to determine a functional cut-off point. Depression and/or anxiety comorbidity was 19% for RDtb, 21.6% for Dtb, 25.6% for MDRtb and 47.3% for COPD. Patients with psychiatric comorbidity had higher disability scores than the group without psychiatric comorbidity. For the tuberculosis group a 3/4 cut-off point of GHQ had 80.7% sensitivity and 87.1% specificity while a 5/6 cut-off point with 83.3% sensitivity and 80% specificity was applicable to the COPD group. © 2001 Elsevier Science Inc. All rights reserved. Keywords: Pulmonary tuberculosis; Chronic obstructive pulmonary disease; Depression; Anxiety; Disability; General Health Questionnaire 1. Introduction With the growing interest in psychiatric comorbidity in medical and surgical patients, its consequences have been understood better. In early studies, it was reported that 25–35% of patients admitted to surgical or medical depart- ments of general hospitals had psychiatric comorbidity, although only half of them could be recognized [1]. A recent two-phase epidemiological survey in a general hospital re- vealed that about one quarter had a formal ICD-10 mental disorder and an additional 11.7% had a subthreshold psy- chiatric disorder [2]. It is a well known fact that psychiatric comorbidity in general medical illness lengthens the pa- tient’s hospital stay, increases his/her exposure to diagnostic procedures, increases the cost of the treatment and reduces the efficacy of medical and surgical treatment [3]. Lung disease is among the chronic medical conditions that are strongly associated with psychiatric disorders [4]. Despite the high prevalence and morbidity of respiratory disorders their psychological aspects have not received the same attention as other areas of general medicine such as heart diseases or cancer. Recently, the HIV epidemic has focused the attention on pulmonary tuberculosis, which had been a neglected area of research for many decades, al- though tuberculosis has always been a major health concern in certain parts of the world. In Turkey, according to the 1997 figures of the Ministry of Health 20.778 cases of pulmonary tuberculosis were diagnosed within one year and the incidence rate was 0.0331% [5]. Early psychiatric studies on tuberculosis were focused on the personality traits that may predispose one to tuberculo- sis, but were unable to specify a “tuberculosis prone” per- sonality. The role of emotional stresses was also associated with immunological responsiveness and the reactivation of the bacillus [6]. Some studies examining psychiatric mor- bidity in tuberculosis patients showed high rates of depres- sion and anxiety in tuberculosis [7–10]. A retrospective cohort analysis of 440 tuberculosis patients revealed psy- chiatric disorders, alcoholism and drug addiction among the causes of poor compliance, which led to relapse [11]. The * Corresponding author. Tel.: +90-312-310-86-93; fax: +90-312-310- 19-38. E-mail address: ulusahn@ato.org.tr (A. Ulus ¸ahin). General Hospital Psychiatry 23 (2001) 77– 83 0163-8343/01/$ – see front matter © 2001 Elsevier Science Inc. All rights reserved. PII: S0163-8343(01)00116-5