Tailored psychological intervention for anxiety or depression in COPD (TANDEM): a randomised controlled trial

Stephanie J C Taylor*, Ratna Sohanpal, Liz Steed, Karen Marshall, Claire Chan, Nahel Yaziji, Amy C Barradell, Paulino Font-Gilabert, Andrew Healey, Richard Hooper, Moira J Kelly, Kristie-Marie Mammoliti, Stefan Priebe, Arvind Rajasekaran, C Michael Roberts, Vickie Rowland, Sally J Singh, Melanie Smuk, Martin Underwood, Sarah WaseemPatrick White, Vari Wileman, Hilary Pinnock

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

BACKGROUND: The TANDEM multicentre, pragmatic, randomised controlled trial evaluated whether a tailored psychological intervention based on a cognitive behavioural approach for people with COPD and symptoms of anxiety and/or depression improved anxiety or depression compared with usual care (control).

METHODS: People with COPD and moderate to very severe airways obstruction and Hospital Anxiety and Depression Scale subscale scores indicating mild to moderate anxiety (HADS-A) and/or depression (HADS-D) were randomised 1.25:1 (242 intervention and 181 control). Respiratory health professionals delivered the intervention face-to-face over 6-8 weeks. Co-primary outcomes were HADS-A and HADS-D measured 6 months post-randomisation. Secondary outcomes at 6 and 12 months included: HADS-A and HADS-D (12 months), Beck Depression Inventory II, Beck Anxiety Inventory, St George's Respiratory Questionnaire, social engagement, the EuroQol instrument five-level version (EQ-5D-5L), smoking status, completion of pulmonary rehabilitation, and health and social care resource use.

RESULTS: The intervention did not improve anxiety (HADS-A mean difference -0.60, 95% CI -1.40-0.21) or depression (HADS-D mean difference -0.66, 95% CI -1.39-0.07) at 6 months. The intervention did not improve any secondary outcomes at either time-point, nor did it influence completion of pulmonary rehabilitation or healthcare resource use. Deaths in the intervention arm (13/242; 5%) exceeded those in the control arm (3/181; 2%), but none were associated with the intervention. Health economic analysis found the intervention highly unlikely to be cost-effective.

CONCLUSION: This trial has shown, beyond reasonable doubt, that this cognitive behavioural intervention delivered by trained and supervised respiratory health professionals does not improve psychological comorbidity in people with advanced COPD and depression or anxiety.

Original languageEnglish
JournalEuropean Respiratory Journal
Issue number5
Early online date24 Aug 2023
Publication statusPublished - 2 Nov 2023


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