{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T12:38:22Z","timestamp":1782304702178,"version":"3.54.5"},"reference-count":48,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Psychological distress is a common comorbidity in chronic obstructive pulmonary disease (COPD), yet its relationship with disease severity remains incompletely understood. This study aimed to assess depression, anxiety, and stress using the Depression Anxiety Stress Scales\u201321 (DASS-21) and to examine their distribution across COPD severity stages. Methods: This multicenter, cross-sectional observational study included 285 clinically stable COPD patients enrolled between 2023 and 2025. COPD severity was classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Multinomial and binary logistic regression models were constructed to identify independent predictors of COPD severity and clinically significant psychological distress, adjusting for demographic and clinical covariates. Bayesian independent sample analyses and ANOVA effect size estimates were additionally performed. Results: Smoking exposure was independently associated with advanced COPD stages (GOLD 4 vs. GOLD 1\u20133: aOR 1.05, p &lt; 0.001), as was dyspnea severity (mMRC: aOR 14.66, p &lt; 0.001). In multivariable models examining psychological outcomes, COPD severity was not independently associated with clinically significant depression (p = 0.899), anxiety (p = 0.460), or stress (p = 0.843). In contrast, symptom burden measured using the COPD Assessment Test (CAT) score was consistently associated with depression (aOR 1.133, p &lt; 0.001), anxiety (aOR 1.179, p &lt; 0.001), and stress (aOR 1.144, p &lt; 0.001). ANOVA effect sizes across GOLD stages were small (\u03b72 \u2264 0.047), and Bayesian analyses provided moderate to strong evidence supporting minimal differences in DASS-21-R scores between severity groups. Conclusions: Psychological distress is prevalent across all COPD severity stages and is not independently determined by airflow limitation. Symptom burden rather than spirometric severity appears to be more closely associated with emotional outcomes.<\/jats:p>","DOI":"10.3390\/medsci14010147","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T08:54:37Z","timestamp":1773910477000},"page":"147","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Psychological Distress in COPD Assessed by DASS-21-R: Multivariable Regression and Bayesian Analysis Across GOLD Stages"],"prefix":"10.3390","volume":"14","author":[{"given":"Adina","family":"Deliu","sequence":"first","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luana","family":"Alexandrescu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Gastroenterology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"},{"name":"Department of Internal Medicine, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan","family":"Cimpineanu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Nephrology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana Cristina","family":"Arghir","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Pneumology Department, Pneumo-Phthisiology Hospital Palazu Mare, 40 Santinelei Street, 900002 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanda","family":"Jurja","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioan Tiberiu","family":"Tofolean","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Gastroenterology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodica Gabriela","family":"Enache","sequence":"additional","affiliation":[{"name":"Faculty of Psychology and Educational Sciences, \u201cOvidius\u201d University, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"Gherghisan","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Pneumology Department, Pneumo-Phthisiology Hospital Palazu Mare, 40 Santinelei Street, 900002 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ionela","family":"Preotesoiu","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9701-4438","authenticated-orcid":false,"given":"Ionut Valentin","family":"Stanciu","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Pneumology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5872-4381","authenticated-orcid":false,"given":"Andreea","family":"Nelson Twakor","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0212-7500","authenticated-orcid":false,"given":"Monica","family":"Cordos","sequence":"additional","affiliation":[{"name":"Nephrology Department, Clinical Emergency County Hospital Saint John the New in Suceava, 720229 Suceava, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Herlo","sequence":"additional","affiliation":[{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daria Maria","family":"Alexandrescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Titu Maiorescu University, 040051 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doina Ecaterina","family":"Tofolean","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"},{"name":"Pneumology Department, \u201cSf. 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