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Anxiety and/or depression are common in fibrotic interstitial lung disease (ILD) but with unclear treatment implications. A prospective multicentre registry of 4009 patients was used to evaluate the association of depression and/or anxiety with clinical features and outcomes in fibrotic ILD.Anxiety and/or depression was associated with female sex and worse dyspnoea and cough but not lung function or ILD medication intolerance. Having anxiety and/or depression was associated with greater odds of patients declining referral for lung transplant assessment.Patients with anxiety and/or depression experience worse ILD symptoms and are more likely to decline referral for lung transplant assessment.