A nationwide analysis of anonymized Lithuanian outpatient records found that 11,608 of 64,246 adults with chronic obstructive pulmonary disease (COPD) had at least one recorded anxiety or depressive diagnosis between January 2020 and December 2024.
That represents 18.1% of the group. The finding points to a substantial mental-health burden among people receiving outpatient COPD care, while also requiring careful interpretation: the study measured diagnosis codes, not results from mental-health screening questionnaires.
What the records showed
Anxiety disorders were recorded in 9,615 patients, or 15.0% of the study population. Depressive disorders were recorded in 2,983 patients, or 4.6%. A total of 990 people had both types of diagnosis, accounting for 8.5% of those with either diagnosis.
Women were more likely than men to have a recorded anxiety or depressive disorder. The rate was 26.8% among women compared with 12.1% among men. After adjustment for age and calendar year, women had 2.40 times the odds of any recorded anxiety or depressive diagnosis and 3.53 times the odds of a recorded depressive disorder.
Older age was also associated with slightly higher odds of a recorded diagnosis, with an adjusted odds ratio of 1.015 for each additional year of age.
Prescribing patterns
Among the 11,608 patients with a diagnosis, 7,190, or 61.9%, received a psychotropic prescription. The medication groups could overlap, meaning that patients may have received more than one type of medicine.
- 89.9% of treated patients received an anxiolytic.
- 85.0% received a benzodiazepine.
- 37.0% received an antidepressant.
- 25.6% received a neuroleptic.
Family physicians prescribed medication to 82.5% of treated patients, while psychiatrists prescribed medication to 32.4%. Some patients saw both types of clinician. Family physicians had higher odds of prescribing an anxiolytic and a benzodiazepine, while psychiatrists were more likely to prescribe antidepressants and neuroleptics.
Among all patients with a recorded anxiety or depressive diagnosis, benzodiazepine prescribing increased from 40.0% in 2020 to 46.0% in 2024. Antidepressant prescribing rose from 15.3% to 22.7% over the same period.
Why the numbers do not show the whole picture
A recorded diagnosis is not the same as the presence of symptoms identified through screening. The researchers noted that diagnosis codes may underestimate the number of people experiencing anxiety or depression. Some differences between women and men may also reflect differences in recognition or diagnosis, rather than differences in distress alone.
The analysis used outpatient records, so hospital diagnoses and prescriptions were not included. It also lacked information on COPD severity, lung function, flare-ups, smoking, oxygen use and income. Because there was no COPD-free comparison group, the study cannot establish that COPD caused the mental-health diagnoses.
Recorded diagnoses rose until 2022 and then fell in 2023 and 2024. However, neither anxiety nor depression showed a significant straight-line trend across the five-year period. The reported trend P values were 0.284 for anxiety and 0.238 for depression.
The authors suggested that social stress related to the COVID-19 period, the war in neighboring Ukraine and changes in access to care might have influenced the pattern. The study design cannot test those explanations.
What the benzodiazepine finding means
The high proportion of benzodiazepine prescriptions deserves context, but the records cannot explain why each prescription was issued. Some may have been for sleep or other reasons. The study did not report dose or treatment duration, and prescriptions were counted regardless of when they were written in relation to the diagnosis.
A separate Ontario study cited in the source found that new benzodiazepine users aged 66 and older with COPD had a 45% higher risk of outpatient-treated respiratory flare-ups and a 92% higher risk of emergency-room visits for COPD or pneumonia than non-users. Hospitalization risk was not significantly higher in that analysis. These findings come from a different health system and do not prove that every benzodiazepine prescription causes a respiratory problem.
People taking a benzodiazepine should not stop it suddenly, because abrupt discontinuation can cause withdrawal. Any medication change should be planned with the prescribing clinician.
A reason to ask about mental health in COPD care
The Lithuanian findings suggest that anxiety and depression are common enough in COPD care to merit routine attention, even though recorded diagnoses likely do not capture everyone affected. Patients can ask their healthcare professional how symptoms such as persistent worry, low mood or sleep problems fit into their overall care.
The study also highlights why treatment decisions need to consider both mental-health symptoms and respiratory risks. The prescribing patterns are specific to Lithuania, and its healthcare system and benzodiazepine rules may differ from those in other countries.
AI tools were used to assist with the preparation of this article.
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