Objective To investigate whether there is a correlation between brain corpuscular volume (HCV), neutrophil-to-lymphocyte ratio (NLR) and chronic obstructive pulmonary comorbid anxiety and/or depression. Methods Ninety-eight patients with chronic obstructive pulmonary disease (COPD) were hospitalized in the Department of Respiratory and Critical Care Medicine of the Third People's Hospital of Yunnan Province from September 2023 to August 2024 were selected for observation, including 34 patients in Group A (COPD-only group) and 64 patients in Group B (COPD-combined with anxiety and/or depression group). The clinical data and HCV and NLR levels of the two groups were recorded and compared. Clinical data and HCV and NLR levels were recorded and compared between the two groups, and logistic regression modeling was used to analyze the influencing factors of COPD combined with anxiety and/or depression, followed by further plotting of subject operating characteristic (ROC) curves to assess the predictive efficacy. Results The number of smokers, N, NLR, CRP, and IL-6 levels were higher in the COPD combined with anxiety and/or depression group than in the COPD alone group, and the FEV1%pred, FEV1/FVC%, and HCV levels were lower than those in the COPD alone group, with the differences being statistically significant (P<0.05). The results of multifactorial regression analysis showed that NLR and HCV were the influencing factors of combined anxiety and/or depression in patients with chronic obstructive pulmonary disease (P<0.05). The results of ROC curves showed that the AUCs of HCV, NLR, and the combination of the two were 0.720, 0.848, and 0.869, respectively. The best sensitivity and specificity for HCV, NLR, and the combination of the two were derived from the optimal cut-off point, and the sensitivity was 70.6%, 82.0%, and 82.5%, respectively. The sensitivity of the combination of the two was 0.720, 0.848, and 0.889, respectively. The sensitivities were 70.6%, 82.8% and 92.2%, and the specificities were 70.3%, 79.4% and 70.6%, respectively. HCV, NLR and the combination of the two had a certain predictive ability for the occurrence of anxiety and/or depression in patients with chronic obstructive pulmonary disease (P＜0.05). Conclusion The occurrence of anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) is related to a variety of factors, and the combination of HCV and NLR is valuable for the diagnosis of COPD with anxiety and depression