Introduction: Bronchiectasis is associated with psychological comorbidity and poor quality of life (QoL), yet guidelines lack focus on psychological morbidity.

Objective: Examine the link between anxiety/depression and physical disease severity, QoL, and long-term outcomes in bronchiectasis.

Methods: CT-confirmed bronchiectasis patients enrolled in the BronchUK study with Hospital Anxiety and Depression Scale (HADS-A/D) data were studied. HADS-A/D scores?8 indicated caseness of anxiety/depression. QoL measured by St George?s Respiratory Questionnaire (SGRQ) and QoL-Bronchiectasis Questionnaire (QoL-B). Exacerbations during annual follow-up were analysed by negative binomial regression with time in study as an offset adjusted for age, BMI, sex, Pseudomonas infection, diabetes and FEV₁. Cox regression determined probability of hospitalisation using Time-to-First exacerbation.

Results: 1341 patients included; 418 had anxiety (31%), 269 (20%) had depression and 201 (15%) had both conditions. HADS-A/D?8 associated with worse QoL across all SGRQ and QoL-B domains (p<0.0001) and clinical severity e.g., Bronchiectasis Severity Index, FEV₁ and MRC dyspnoea score (all p<0.01). HADS-A/D?8 each associated with exacerbation (RR 1.42 95%CI1.32-1.52 for HADS-A; RR 1.45 95%CI1.34-1.56 HADS-D, both p<0.0001) and hospitalisation risk (RR 1.58 95%CI1.29-1.92 HADS-A; RR 1.76 95%CI1.43-2.17 HADS-D, both p<0.001). HADS-A/D?8 each predicted future hospitalisation (HR 1.30 95%CI0.98-1.72, p=0.067 HADS-A; HR 1.40 95%CI1.04-1.88, p=0.027 HADS-D).

Conclusion: Anxiety and depression are common in bronchiectasis, correlate with disease severity, and predict poor outcomes. Psychological support is important in bronchiectasis care.