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Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD. J Clin Med 2019; 8:jcm8091460. [PMID: 31540306 PMCID: PMC6780973 DOI: 10.3390/jcm8091460] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 01/23/2023] Open
Abstract
Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after PR, and investigated associations with PR outcomes (COPD assessment test (CAT) and St. Georges respiratory questionnaire (SGRQ)) in a subset of patients with COPD (n = 146) undergoing a 3-week inpatient PR program as part of the STAR study (Clinicaltrials.gov, ID: NCT02966561). Disease-specific fears as measured with the COPD anxiety questionnaire improved after PR. For fear of dyspnea, fear of physical activity and fear of disease progression, improvements remained significant at six-month follow-up. Patients with higher disease-specific fears at baseline showed elevated symptom burden (CAT and SGRQ Symptom scores), which persisted after PR and at follow-up. Elevated disease-specific fears also resulted in reduced improvements in Quality of Life (SGRQ activity and impact scales) after PR and at follow-up. Finally, improvement in disease-specific fears was associated with improvement in symptom burden and quality of life. Adjustment for potential confounding variables (sex, smoking status, age, lung function, and depressive symptoms) resulted in comparable effects. These findings show the role of disease-specific fears in patients with COPD during PR and highlight the need to target disease-specific fears to further improve the effects of PR.
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Ji M, Wang AH, Ye J, Shen YH, Chen CM, Yu C, Li LF. Effects of the health belief model following acute exacerbation of chronic obstructive pulmonary disease in a hospital in China. J Thorac Dis 2019; 11:3593-3598. [PMID: 31559066 DOI: 10.21037/jtd.2019.07.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to investigate the effects of education with health belief model (HBM) on anxiety and fatigue among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Patients with AECOPD admitted into Taizhou People's Hospital, Jiangsu, China between December 2012 and October 2013 were randomly selected for the present study according to random number table. A total of 99 cases with anxiety were included. These patients were divided into two groups: experimental group educated by HBM (n=47), and control group educated by conventional method (n=52). The scores for anxiety and fatigue were evaluated using the self-rating anxiety scale (SAS) and multidimensional fatigue inventory (MFI-20). Results After educational intervention by HBM, patients achieved a significant decrease in anxiety and fatigue scores, when compared to patients in the control group, who were educated by the conventional method at the time of admission, discharge, and 6 weeks after discharge (P<0.05). Conclusions HBM program effectively may alleviate anxiety and fatigue, providing necessary information for symptom management among patients with AECOPD.
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Affiliation(s)
- Mei Ji
- Department of Respiratory Medicine, Taizhou People's Hospital, Taizhou 225300, China
| | - Ai-Hong Wang
- Department of Basic Nursing, Nanjing University of Chinese Medicine, School of Nursing, Nanjing 210023, China
| | - Jun Ye
- Department of Laboratory Medicine, Taizhou People's Hospital, Taizhou 225300, China
| | - Ya-Hui Shen
- Department of Respiratory Medicine, Taizhou People's Hospital, Taizhou 225300, China
| | - Chun-Mei Chen
- Department of Respiratory Medicine, Taizhou People's Hospital, Taizhou 225300, China
| | - Chen Yu
- Department of Respiratory Medicine, Taizhou People's Hospital, Taizhou 225300, China
| | - Li-Fang Li
- Department of Nursing, Taizhou People's Hospital, Taizhou 225300, China
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Rodriguez-Lozada C, Cuervo M, Cuevas-Sierra A, Goni L, Riezu-Boj JI, Navas-Carretero S, Milagro FI, Martinez JA. Changes in Anxiety and Depression Traits Induced by Energy Restriction: Predictive Value of the Baseline Status. Nutrients 2019; 11:nu11061206. [PMID: 31141954 PMCID: PMC6627283 DOI: 10.3390/nu11061206] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 12/22/2022] Open
Abstract
Current evidence proposes diet quality as a modifiable risk factor for mental or emotional impairments. However, additional studies are required to investigate the effect of dietary patterns and weight loss on improving psychological symptoms. The aim of this investigation was to evaluate the effect of energy-restriction, prescribed to overweight and obese participants, on anxiety and depression symptoms, as well as the potential predictive value of some baseline psychological features on weight loss. Overweight and obese participants (n = 305) were randomly assigned for 16 weeks to two hypocaloric diets with different macronutrient distribution: a moderately high-protein (MHP) diet and a low-fat (LF) diet. Anthropometrical, clinical, psychological, and lifestyle characteristics were assessed at baseline and at the end of the intervention. The nutritional intervention evidenced that weight loss has a beneficial effect on trait anxiety score in women (β = 0.24, p = 0.03), depression score in all population (β = 0.15, p = 0.02), particularly in women (β = 0.22, p = 0.03) and in subjects who followed the LF diet (β = 0.22, p = 0.04). Moreover, weight loss could be predicted by anxiety status at baseline, mainly in women and in those who were prescribed a LF diet. This trial suggests that weight loss triggers an improvement in psychological traits, and that anxiety symptoms could predict those volunteers that benefit most from a balanced calorie-restricted intervention, which will contribute to individualized precision nutrition.
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Affiliation(s)
- Claudia Rodriguez-Lozada
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain.
| | - Marta Cuervo
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain.
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain.
- CIBERobn, Fisiopatología de la Obesidad y la Nutrición; Carlos III Health Institute, 28029 Madrid, Spain.
| | - Amanda Cuevas-Sierra
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain.
| | - Leticia Goni
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain.
| | - Jose Ignacio Riezu-Boj
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain.
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain.
| | - Santiago Navas-Carretero
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain.
- CIBERobn, Fisiopatología de la Obesidad y la Nutrición; Carlos III Health Institute, 28029 Madrid, Spain.
| | - Fermin Ignacio Milagro
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain.
- CIBERobn, Fisiopatología de la Obesidad y la Nutrición; Carlos III Health Institute, 28029 Madrid, Spain.
| | - Jose Alfredo Martinez
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain.
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain.
- CIBERobn, Fisiopatología de la Obesidad y la Nutrición; Carlos III Health Institute, 28029 Madrid, Spain.
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Tian L, Zhang Y, Li L, Wu Y, Li Y. The efficacy of mindfulness-based interventions for patients with COPD: a systematic review and meta-analysis protocol. BMJ Open 2019; 9:e026061. [PMID: 31142522 PMCID: PMC6549636 DOI: 10.1136/bmjopen-2018-026061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 02/23/2019] [Accepted: 03/01/2019] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease. It has adverse effects on patients' physical health, mental well-being and quality of life. The purpose of mindfulness-based interventions (MBIs) is to raise non-judgemental awareness and attention to current internal and external experiences. This means the attention is shifted from perceived and involuntary inner activities to current experience, keeping more curious, open and accepting attitudes towards current experience. Although some studies on the intervention effect of MBIs in patients with COPD have been conducted, the results are controversial, especially on dyspnoea, level of mindfulness and quality of life. Therefore, a systematic review of MBIs in patients with COPD is required to provide available evidence for further study. METHODS AND ANALYSIS In this study, different studies from various databases will be involved. Randomised controlled trials(RCTs)/quantitative studies, qualitative studies and case studies on the effect of MBIs in patients with COPD aged over 18 years will be included. We will search the literature in the databases of PubMed, Excepta Medica Base (EMBASE), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, PsycINFO and China National Knowledge Infrastructure(CNKI). The primary outcomes will include efficacy of MBIs for patients with COPD in terms of dyspnoea, depression and anxiety. The secondary outcomes will include efficacy of MBIs in terms of quality of life, mindful awareness, 6-minute walk test(6MWT) and nutritional risk index. Data extraction will be conducted by two researchers independently, and risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0. ETHICS AND DISSEMINATION Since this study is a systematic review, the findings are based on the published evidence. Therefore, examination and agreement by the ethics committee are not required in this study. We intend to publish the study results in a journal or conference presentations. PROSPERO REGISTRATION NUMBER CRD42018102323.
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Affiliation(s)
- Lingyun Tian
- Xiangya Nursing School, Central South University, Changsha, China
- School of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Ying Zhang
- Infection Control Centre, Xiangya Hospital, Central South University, Changsha, China
| | - Li Li
- Department of Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Ying Wu
- Department of Burn and Reconstruction Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yinglan Li
- Department of Nursing, Xiangya Hospital, Central South University, Changsha, China
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Rinne ST, Resnick K, Wiener RS, Simon SR, Elwy AR. VA Provider Perspectives on Coordinating COPD Care Across Health Systems. J Gen Intern Med 2019; 34:37-42. [PMID: 31011970 PMCID: PMC6542930 DOI: 10.1007/s11606-019-04971-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND More and more Veterans are receiving care from community providers, increasing the need for effective coordination across health systems. For Veterans with chronic obstructive pulmonary disease (COPD), this need is intensified by complex comorbidity patterns that often include multiple providers co-managing patient care. OBJECTIVES We sought to understand how VA providers perceive coordination with community providers for Veterans with COPD. DESIGN Qualitative study of VA providers. METHODS We selected six geographically diverse VA sites and conducted semi-structured telephone interviews with providers practicing in inpatient and/or outpatient settings who care for Veterans with COPD. MAIN MEASURES Interviews focused on communication with community providers about discharge information and clinic management. We analyzed responses according to the principles of conventional content analysis, allowing inductive themes to emerge. KEY RESULTS We interviewed 25 providers during the period of June to October 2017. Qualitative data analysis yielded five themes: (1) VA providers perceive communication challenges between VA and community providers, including difficult, inadequate, and delayed communication; (2) communication is facilitated by personal relationships across health systems; (3) the lack of electronic health record (EHR) interoperability impairs communication, resulting in transmission of unstructured data; (4) poor communication leads to duplicative efforts and wasted resources; and (5) providers frequently rely on patients to communicate about care taking place in the community. CONCLUSIONS VA providers described major challenges in coordinating with community providers, leading to perceptions of delayed, missed, or duplicative care and jeopardizing the overall quality, safety, and efficiency of Veteran care. Our study highlights the need for system-level solutions to support coordination across health systems for Veterans with COPD and may have implications for other conditions that lead to recurrent hospitalization and/or care in the community.
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The Correlation Between Dry Eyes, Anxiety and Depression: The Sicca, Anxiety and Depression Study. Cornea 2019; 38:684-689. [DOI: 10.1097/ico.0000000000001932] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Benzo R, McEvoy C. Effect of Health Coaching Delivered by a Respiratory Therapist or Nurse on Self-Management Abilities in Severe COPD: Analysis of a Large Randomized Study. Respir Care 2019; 64:1065-1072. [PMID: 30914491 DOI: 10.4187/respcare.05927] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Self-management of patients with COPD has received increasing attention in recent years given its association with improved outcomes. There is a scarcity of feasible interventions that can improve self-management abilities. We recently reported the positive effect of health coaching, started at the time of hospital discharge, on re-hospitalizations and emergency department visits for patients with COPD admitted for an exacerbation. In this substudy, we aimed to investigate the effects of health coaching delivered by a respiratory therapist or a nurse compared with guideline-based usual care on self-management abilities in COPD. METHODS Self-management was measured by using the Chronic Respiratory Disease Questionnaire mastery domain and was assessed at baseline, at 6 months, and at 12 months after hospitalization. RESULTS Two hundred and fifteen subjects hospitalized for a COPD exacerbation were randomized to the intervention or the control. The mean change in the Chronic Respiratory Disease Questionnaire mastery score from baseline to month 6 was Δ0.58 32 ± 1.29 on the intervention arm and Δ0.17 32 ± 1.14 on the control arm (P = .02). Of the intervention subjects, 55% had at least a 0.5-point increase in Chronic Respiratory Disease Questionnaire mastery (minimum clinically important difference) compared with 38% in the control group. Health coaching was an independent predictor of the minimum clinically important difference or greater change in the Chronic Respiratory Disease Questionnaire mastery score at 6 months after initiation of the intervention (odds ratio 1.95, 95% CI 1.01-3.79). The changes in the Chronic Respiratory Disease Questionnaire mastery score at 12 months showed a trend but did not attain statistical significance. CONCLUSIONS Health coaching delivered by a respiratory therapist or a nurse improved self-management abilities when applied to subjects with COPD after hospital discharge for an exacerbation. (ClinicalTrials.gov Identifier: NCT01058486, Mayo IRB 09-004341).
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Affiliation(s)
- Roberto Benzo
- Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Charlene McEvoy
- HealthPartners Institute for Education and Research, Bloomington, Minnesota
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Pollok J, van Agteren JEM, Esterman AJ, Carson‐Chahhoud KV. Psychological therapies for the treatment of depression in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2019; 3:CD012347. [PMID: 30838649 PMCID: PMC6400788 DOI: 10.1002/14651858.cd012347.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) has been recognised as a global health concern, and one of the leading causes of morbidity and mortality worldwide. Projections of the World Health Organization (WHO) indicate that prevalence rates of COPD continue to increase, and by 2030, it will become the world's third leading cause of death. Depression is a major comorbidity amongst patients with COPD, with an estimate prevalence of up to 80% in severe stages of COPD. Prevalence studies show that patients who have COPD are four times as likely to develop depression compared to those without COPD. Regrettably, they rarely receive appropriate treatment for COPD-related depression. Available findings from trials indicate that untreated depression is associated with worse compliance with medical treatment, poor quality of life, increased mortality rates, increased hospital admissions and readmissions, prolonged length of hospital stay, and subsequently, increased costs to the healthcare system. Given the burden and high prevalence of untreated depression, it is important to evaluate and update existing experimental evidence using rigorous methodology, and to identify effective psychological therapies for patients with COPD-related depression. OBJECTIVES To assess the effectiveness of psychological therapies for the treatment of depression in patients with chronic obstructive pulmonary disease. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2018, Issue 11), and Ovid MEDLINE, Embase and PsycINFO from June 2016 to 26 November 2018. Previously these databases were searched via the Cochrane Airways and Common Mental Disorders Groups' Specialised Trials Registers (all years to June 2016). We searched ClinicalTrials.gov, the ISRCTN registry, and the World Health Organization International Clinical Trials Registry Platform (ICTRP) to 26 November 2018 to identify unpublished or ongoing trials. Additionally, the grey literature databases and the reference lists of studies initially identified for full-text screening were also searched. SELECTION CRITERIA Eligible for inclusion were randomised controlled trials that compared the use of psychological therapies with either no intervention, education, or combined with a co-intervention and compared with the same co-intervention in a population of patients with COPD whose depressive symptoms were measured before or at baseline assessment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the titles and abstracts identified by the search to determine which studies satisfied the inclusion criteria. We assessed two primary outcomes: depressive symptoms and adverse events; and the following secondary outcomes: quality of life, dyspnoea, forced expiratory volume in one second (FEV1), exercise tolerance, hospital length of stay or readmission rate, and cost-effectiveness. Potentially eligible full-text articles were also independently assessed by two review authors. A PRISMA flow diagram was prepared to demonstrate the decision process in detail. We used the Cochrane 'Risk of bias' evaluation tool to examine the risk of bias, and assessed the quality of evidence using the GRADE framework. All outcomes were continuous, therefore, we calculated the pooled standardised mean difference (SMD) or mean difference (MD) with a corresponding 95% confidence interval (CI). We used a random-effects model to calculate treatment effects. MAIN RESULTS The findings are based on 13 randomised controlled trials (RCTs), with a total of 1500 participants. In some of the included studies, the investigators did not recruit participants with clinically confirmed depression but applied screening criteria after randomisation. Hence, across the studies, baseline scores for depressive symptoms varied from no symptoms to severe depression. The severity of COPD across the studies was moderate to severe.Primary outcomesThere was a small effect showing the effectiveness of psychological therapies in improving depressive symptoms when compared to no intervention (SMD 0.19, 95% CI 0.05 to 0.33; P = 0.009; 6 studies, 764 participants), or to education (SMD 0.23, 95% CI 0.06 to 0.41; P = 0.010; 3 studies, 507 participants).Two studies compared psychological therapies plus a co-intervention versus the co-intervention alone (i.e. pulmonary rehabilitation (PR)). The results suggest that a psychological therapy combined with a PR programme can reduce depressive symptoms more than a PR programme alone (SMD 0.37, 95% CI -0.00 to 0.74; P = 0.05; 2 studies, 112 participants).We rated the quality of evidence as very low. Owing to the nature of psychological therapies, blinding of participants, personnel, and outcome assessment was a concern.None of the included studies measured adverse events.Secondary outcomesQuality of life was measured in four studies in the comparison with no intervention, and in three studies in the comparison with education. We found inconclusive results for improving quality of life. However, when we pooled data from two studies using the same measure, the result suggested that psychological therapy improved quality of life better than no intervention. One study measured hospital admission rates and cost-effectiveness and showed significant reductions in the intervention group compared to the education group. We rated the quality of evidence as very low for the secondary outcomes. AUTHORS' CONCLUSIONS The findings from this review indicate that psychological therapies (using a CBT-based approach) may be effective for treating COPD-related depression, but the evidence is limited. Depressive symptoms improved more in the intervention groups compared to: 1) no intervention (attention placebo or standard care), 2) educational interventions, and 3) a co-intervention (pulmonary rehabilitation). However, the effect sizes were small and quality of the evidence very low due to clinical heterogeneity and risk of bias. This means that more experimental studies with larger numbers of participants are needed, to confirm the potential beneficial effects of therapies with a CBT approach for COPD-related depression.New trials should also address the gap in knowledge related to limited data on adverse effects, and the secondary outcomes of quality of life, dyspnoea, forced expiratory volume in one second (FEV1), exercise tolerance, hospital length of stay and frequency of readmissions, and cost-effectiveness. Also, new research studies need to adhere to robust methodology to produce higher quality evidence.
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Affiliation(s)
- Justyna Pollok
- The University of AdelaideFaculty of Health and Medical SciencesNorth TerraceAdelaideSouth AustraliaAustralia5005
- The University of AdelaideAdelaideAustralia
| | - Joep EM van Agteren
- Flinders UniversityCollege of Medicine and Public HealthAdelaideAustralia
- South Australian Health and Medical Research InstituteWellbeing and Resilience CentreAdelaideAustralia
| | - Adrian J Esterman
- University of South AustraliaDivision of Health SciencesAdelaideAustralia
- James Cook UniversityAustralian Institute of Tropical Health and MedicineCairnsAustralia
| | - Kristin V Carson‐Chahhoud
- University of South AustraliaSchool of Health SciencesCity East Campus, Frome RoadAdelaideAustralia5001
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Iyer AS, Holm KE, Bhatt SP, Kim V, Kinney GL, Wamboldt FS, Jacobs MR, Regan EA, Armstrong HF, Lowe KE, Martinez CH, Dransfield MT, Foreman MG, Shinozaki G, Hanania NA, Wise RA, Make BJ, Hoth KF. Symptoms of anxiety and depression and use of anxiolytic-hypnotics and antidepressants in current and former smokers with and without COPD - A cross sectional analysis of the COPDGene cohort. J Psychosom Res 2019; 118:18-26. [PMID: 30782350 PMCID: PMC6383809 DOI: 10.1016/j.jpsychores.2019.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the frequency of anxiety/depressive symptoms and use of anxiolytic-hypnotics/antidepressants in smokers with and without COPD and to identify characteristics associated with having unmedicated symptoms. METHODS Cross-sectional analysis of ambulatory, current/former smokers ≥10 pack years enrolled in the COPDGene study. We measured anxiety/depressive symptoms using the Hospital Anxiety and Depression Scale (subscales ≥8), recorded anxiolytic-hypnotic/antidepressant use, and defined unmedicated symptoms as elevated anxiety/depressive symptoms and not on medications. Regression analysis identified characteristics associated with having unmedicated symptoms. KEY RESULTS Of 5331 current/former smokers (45% with and 55% without COPD), 1332 (25.0%) had anxiety/depressive symptoms. Anxiety symptoms were similar in frequency in smokers with and without COPD (19.7% overall), while depressive symptoms were most frequent in severe-very severe COPD at 20.7% (13.1% overall). In the entire cohort, 1135 (21.2%) were on medications. Anxiolytic-hypnotic use was highest in severe-very severe COPD (range 7.6%-12.0%), while antidepressant use showed no significant variation in smokers with and without COPD (range 14.7%-17.1%). Overall, 881 (66% of those with symptoms) had unmedicated symptoms, which was associated with African American race (adjusted OR 2.95, 95% CI 2.25-3.87), male gender (adjusted OR 1.93, 95% CI 1.57-2.36), no health insurance (adjusted OR 2.38, 95% CI 1.30-4.35), severe-very severe COPD (adjusted OR 1.48, 95% CI 1.04-2.11), and higher respiratory symptoms/exacerbation history (adjusted OR 2.21, 95% CI 1.62-3.02). CONCLUSIONS Significant unmet mental health care needs exist in current and former smokers with and without COPD. One in five have unmedicated symptoms, identified by key demographic and clinical characteristics. PRIMARY FUNDING SOURCE National Institutes of Health and The COPD Foundation.
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Affiliation(s)
- Anand S Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Health Services, Outcomes, and Effectiveness Research Training Program, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Kristen E Holm
- Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine Philadelphia, PA, USA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Frederick S Wamboldt
- Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Michael R Jacobs
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine Philadelphia, PA, USA
| | - Elizabeth A Regan
- Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Hilary F Armstrong
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine E Lowe
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Marilyn G Foreman
- Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Gen Shinozaki
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Nicola A Hanania
- Division of Pulmonary/Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Karin F Hoth
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Department of Pulmonary, Critical Care, and Sleep Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
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Mathew AR, Guzman M, Bridges C, Yount S, Kalhan R, Hitsman B. Assessment of Self-Management Treatment Needs Among COPD Helpline Callers. COPD 2019; 16:82-88. [PMID: 30789041 PMCID: PMC7135910 DOI: 10.1080/15412555.2019.1575350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 02/01/2023]
Abstract
Telephone quitlines are an effective population-based strategy for smoking cessation, particularly among individuals with tobacco-related diseases such as chronic obstructive pulmonary disease (COPD). Expanding quitline services to provide COPD-focused self-management interventions is potentially beneficial; however, data are needed to identify specific treatment needs in this population. We conducted a telephone-based survey (N = 5,772) to examine educational needs, behavioral health characteristics, and disease-related interference among individuals with COPD who received services from the American Lung Association (ALA) Lung Helpline. Most participants (73.7%) were interested in COPD-focused information, and few had received prior instruction in breathing exercises (33.9%), energy conservation (26.5%), or airway clearing (32.1%). About one-third of participants engaged in regular exercise, 16.3% followed a special diet, and 81.4% were current smokers. Most participants (78.2%) reported COPD-related interference in daily activities and 30.8% had been hospitalized within the past six months for their breathing. Nearly half of participants (45.4%) reported current symptoms of anxiety or depression. Those with vs. without anxiety/depression had higher rates of COPD-related interference (83.9% vs. 73.5%, p < .001) and past six-month hospitalization (33.4% vs. 28.3%, p < .001). In conclusion, this survey identified strong interest in disease-focused education; a lack of prior instruction in specific self-management strategies for COPD; and behavioral health needs in the areas of exercise, diet, and smoking cessation. Anxiety and depression symptoms were common and associated with greater disease burden, underscoring the importance of addressing coping with negative emotions. Implications for self-management treatments that target multiple behavioral needs of COPD patients are discussed.
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Affiliation(s)
- Amanda R. Mathew
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Miriam Guzman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Susan Yount
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ravi Kalhan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Pollok J, van Agteren JEM, Carson‐Chahhoud KV. Pharmacological interventions for the treatment of depression in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2018; 12:CD012346. [PMID: 30566235 PMCID: PMC6517114 DOI: 10.1002/14651858.cd012346.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Studies report that up to 80% of individuals with chronic obstructive pulmonary disease (COPD) may struggle with symptoms of depression. However, this major comorbidity in COPD is rarely managed effectively. A number of recent studies indicate that left untreated, COPD-related depression is associated with worse quality of life, worse compliance with COPD treatment plan, increased exacerbations, hospital admissions, and healthcare costs when compared to individuals with COPD without depression. Regrettably, COPD practice guidelines do not provide conclusive treatment recommendations for the use of antidepressants in patients with COPD, and base their guidelines on findings from trials in the general population. This may be problematic, as there is an elevated risk of respiratory issues associated with antidepressant treatment and COPD. Evaluating effectiveness and safety of pharmacological interventions specifically for patients with COPD and depression was therefore paramount. OBJECTIVES To assess the effectiveness and safety of pharmacological interventions for the treatment of depression in patients with COPD. SEARCH METHODS The last search was performed on 26 November 2018. We initially searched the following databases via the Specialised Trials Registers of the Cochrane Airways and Common Mental Disorders Groups (to June 2016): MEDLINE, Embase, PsycINFO, CINAHL, AMED, and the Cochrane Library trials register (CENTRAL). Searches from June 2016 to November 2018 were performed directly on Ovid MEDLINE, Embase, PsycINFO and the Cochrane Library (Issue 11, 2018). We searched ClinicalTrials.gov, the ISRCTN registry, and the World Health Organization International Clinical Trials Registry Platform to 26 November 2018. We searched the grey literature databases to identify studies not indexed in major databases and the reference lists of studies initially identified for full-text screening. SELECTION CRITERIA All published and unpublished randomised controlled trials (RCTs) comparing the efficacy of pharmacological interventions with no intervention, placebo or co-intervention in adults with diagnosed COPD and depression were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed articles identified by the search for eligibility. Our primary outcomes were change in depressive symptoms and adverse events. The secondary outcomes were: change in quality of life, change in dyspnoea, change in forced expiratory volume in one second (FEV1), change in exercise tolerance, change in hospital utilisation (length of stay and readmission rates), and cost-effectiveness. For continuous outcomes, we calculated the pooled mean difference (MD) or standardised mean difference (SMD) with 95% confidence interval (CI) as appropriate. For dichotomous outcomes, we calculated the pooled odds ratio (OR) and corresponding 95% CI using a random-effects model. We assessed the quality of evidence using the GRADE framework. MAIN RESULTS Of the 1125 records screened for eligibility, four RCTs (N = 201 participants), and one on-going study, met the inclusion criteria. Two classes of antidepressants were investigated in two separate comparisons with placebo: a tricyclic antidepressant (TCA) and selective serotonin reuptake inhibitors (SSRIs).TCA versus placeboOnly one RCT (N = 30 participants) provided results for this comparison.Primary outcomesThe TCA (nortriptyline) reduced depressive symptoms post-treatment compared to placebo (MD -10.20, 95% CI -16.75 to -3.65; P = 0.007; very low-quality evidence), as measured by the Hamilton Depression Rating Scale (HAM-D). Three participants withdrew from the trial due to adverse events related to the tested antidepressant (dry mouth, sedation, orthostatic hypotension).Secondary outcomesThe overall results post-treatment indicated that nortriptyline was not effective in improving the quality of life of individuals with COPD, as measured by the Sickness Impact Profile (MD -2.80, 95% CI -11.02 to 5.42; P = 0.50; very low-quality evidence).The results for the change in dyspnoea for the domains examined (e.g. dyspnoea scores for 'most day-to-day activities') post-treatment showed no improvement in the intervention group (MD 9.80, 95% CI -6.20 to 25.80; P = 0.23; very low-quality evidence).No data were reported for change in FEV1, change in exercise tolerance, change in hospital utilisation, or cost-effectiveness. The TCA study provided short-term results, with the last follow-up data collection at 12 weeks.The quality of the evidence for all the outcomes evaluated was very low due to a small sample size, imprecision, attrition, and selection and reporting bias.SSRIs versus placeboThree RCTs (N = 171 participants) provided results for this comparison.Primary outcomesThe pooled results for two studies showed no difference for the change in depressive symptoms post-intervention (SMD 0.75, 95% CI -1.14 to 2.64; 148 participants; 2 studies; P = 0.44; very low-quality evidence). High heterogeneity was observed (I² = 95%), limiting the reliability of these findings.While it was not possible to meta-analyse the total adverse events rates across the studies, it was possible to combine the results for two medication-specific adverse effects: nausea and dizziness. There were no significant post-treatment group differences for nausea (OR 2.32, 95% CI 0.66 to 8.12; 171 participants; 3 studies; P = 0.19; very low-quality evidence) or dizziness (OR 0.61, 95% CI 0.09 to 4.06; 143 participants; 2 studies; P = 0.61; very low-quality evidence).Secondary outcomesThe pooled analysis of two trials reporting data for the change in quality of life did not show improvement post-treatment in the intervention group compared to placebo (SMD 1.17, 95% CI -0.80 to 3.15; 148 participants; 2 studies; P = 0.25; very low-quality evidence).There was no difference between groups in change in FEV1 post-treatment (MD 0.01, 95% CI -0.03 to 0.05; 148 participants; 2 studies; P = 0.60; low-quality evidence). However, two trials reported improvement in exercise tolerance in the SSRI group versus the placebo group (MD 13.88, 95% CI 11.73 to 16.03; 148 participants; 2 studies; P < 0.001; very low-quality evidence).The trials included in this comparison did not report data related to the change in dyspnoea, hospital utilisation rates, or cost-effectiveness. AUTHORS' CONCLUSIONS There is insufficient evidence to make definitive statements about the efficacy or safety of antidepressants for treating COPD-related depression. New RCTs are needed; with better methodological quality and more accurate reporting of the methods used. Moreover, longer-term follow-up data collection is needed, including outcomes such as adverse events, hospital utilisation and cost-effectiveness.
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Affiliation(s)
- Justyna Pollok
- The University of AdelaideFaculty of Health and Medical SciencesNorth TerraceAdelaideSouth AustraliaAustralia5005
| | - Joep EM van Agteren
- Flinders UniversityCollege of Medicine and Public HealthAdelaideAustralia
- South Australian Health and Medical Research InstituteWellbeing and Resilience CentreAdelaideAustralia
| | - Kristin V Carson‐Chahhoud
- The University of South AustraliaSchool of Health SciencesCity East Campus, Frome RoadAdelaideAustralia5001
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Leão T, Perelman J. Depression symptoms as mediators of inequalities in self-reported health: the case of Southern European elderly. J Public Health (Oxf) 2018; 40:756-763. [PMID: 29294060 PMCID: PMC6927867 DOI: 10.1093/pubmed/fdx173] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/12/2017] [Accepted: 11/27/2017] [Indexed: 11/13/2022] Open
Abstract
Background Inequalities in the distribution of self-reported health (SRH) have been widely reported. Its higher expressivity among women, elderly and least educated groups has been partly attributed to differences in their health perceptions. However, this subjectivity may be masking the burden of mental illness in these groups. Thus, we sought to understand if depression symptoms mediate inequalities in SRH. Methods SHARE waves 4 and 6, pertaining to Spain, Italy and Portugal, were used (n2011 = 8517, n2015 = 11 046). Inequalities in SRH were calculated, comparing the risk amongst education level, gender and age groups, adjusting for chronic diseases, functional limitations and country fixed effects. We then tested depression symptoms as mediators. Results Depression symptoms were associated with poor SRH (odds ratio (OR)2011 = 1.379, OR2015 = 1.384, P < 0.001). Their inclusion reduced the magnitude of the association between SRH and education, annulled the statistical significance for age, and reversed the gender effect. As expected, chronic diseases and functional limitations remained significant predictors of poor SRH. Conclusions Depression symptoms, together with chronic diseases and functional limitations, explain the poorer SRH of the least educated, female and older groups in the Southern European population. Therefore, tackling inequalities in SRH must require focusing on mental health issues, which disproportionately affect the most vulnerable groups.
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Affiliation(s)
- T Leão
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - J Perelman
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
- Centro de Investigação em Saúde Pública, Lisboa, Portugal
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Abstract
Interoception, the multidimensional ability to sense the physiological condition of the body, is a key mechanism in emotional processing. However, the relationships between interoceptive dimensions and depressed mood and anxiety have not been widely studied. The aim of this secondary analysis, correlational and cross-sectional study, was to determine the relationships among interoceptive accuracy, interoceptive sensibility, depressed mood, and anxiety in adults with hypertension. The sample consisted of 76 adults, predominately African American women. Correlational analysis showed that most participants had low levels of interoceptive accuracy and relatively high levels of interoceptive sensibility. Interoceptive sensibility was negatively associated with depressed mood and anxiety. Interoceptive accuracy and interoceptive sensibility were not associated between each other. Further examination of the dimensions of interoception is needed to better understand the mechanisms by which it is associated with emotions that are known to have an influence on health behaviors and quality of life.
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Affiliation(s)
| | - Shirley Moore
- 2 Edward J. and Louise Mellen Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Zhou Z, Zhou A, Zhao Y, Duan J, Chen P. A comparison of the assessment of health status between CCQ and CAT in a Chinese COPD clinical population: a cross-sectional analysis. Int J Chron Obstruct Pulmon Dis 2018; 13:1675-1682. [PMID: 29872285 PMCID: PMC5973380 DOI: 10.2147/copd.s161225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Both the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ) were recommended as comprehensive symptom measures by the Global Initiative for Chronic Obstructive Lung disease. The main objective of this work was to compare the evaluation of symptom severity with the CAT and the CCQ and find a cutoff value of the CCQ for the Chinese clinical population. Methods Patients diagnosed with stable COPD in the outpatient department who completed the CAT and CCQ were enrolled from November 2015 to December 2016. Scores of 0-10, 11-20, 21-30, and 31-40 represent low, medium, high, and very high impact level, respectively, by CAT. Scores of the CCQ can be considered as acceptable (CCQ<1), acceptable for moderate disease (1≤CCQ<2), instable-severe limited (2≤CCQ<3), and very instable-very severe limited (CCQ≥3). Results According to the CAT, only 20.4% of patients belonged to the high (21≤CAT≤30) and very high (31≤CAT≤40) impact levels, which were statistically lower than those of the CCQ, which classified over half of the population (51.1%) into the instable-severe limited (2≤CCQ<3) and very instable-very severe limited (CCQ≥3) categories (P<0.001). The kappa of agreement for the symptom groups by CAT and CCQ (cutoff point 1.5) was 0.495, but only slight agreement (0.144) was found between the CAT and CCQ with the cutoff point of 1.0. The CAT and the total CCQ had a strong correlation (rho=0.776, P<0.01). The CCQ 1.0 and 1.5 corresponded to CAT 4.2 and 9.7, respectively. The CAT 10.0 was equivalent to 1.53 of the CCQ. In addition, with higher scores of the CAT and CCQ, subjects displayed more impairment in lung function, higher levels on modified Medical Research Council, and higher exacerbation rates in the last year (P<0.001). Similarly, patients with more exacerbations presented worse scores on the CAT and total CCQ as well as its 3 domains (P<0.001). Conclusion Compared with the CAT, the CCQ was more likely to classify the patients into more severe categories, and 1.5 might be a better cutoff point for the CCQ than 1.0. Both the CAT and the overall CCQ with its 3 domains were able to discriminate between groups of patients that differ in COPD severity.
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Affiliation(s)
- Zijing Zhou
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Aiyuan Zhou
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Yiyang Zhao
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Jiaxi Duan
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Ping Chen
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
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Depression, Suicidal Behaviour, and Mental Disorders in Older Aboriginal Australians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030447. [PMID: 29510527 PMCID: PMC5876992 DOI: 10.3390/ijerph15030447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/20/2018] [Accepted: 02/28/2018] [Indexed: 12/24/2022]
Abstract
Aboriginal Australians experience higher levels of psychological distress, which may develop from the long-term sequelae of social determinants and adversities in early and mid-life. There is little evidence available on the impact of these on the mental health of older Aboriginal Australians. This study enrolled 336 Aboriginal Australian participants over 60 years from 5 major urban and regional areas in NSW, utilizing a structured interview on social determinants, and life-time history of physical and mental conditions; current psychosocial determinants and mental health. Univariate and multivariate analyses were utilized to examine the link between these determinants and current depressive scores and suicidality. There was a high rate of life-time depression (33.3%), current late-life depression (18.1%), and suicidal ideation (11.1%). Risk factors strongly associated with late-life depression included sleep disturbances, a history of suicidal behaviour, suicidal ideation in late-life and living in a regional location. This study supports certain historical and psychosocial factors predicting later depression in old age, and highlights areas to target for prevention strategies.
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Panagioti M, Skevington SM, Hann M, Howells K, Blakemore A, Reeves D, Bower P. Effect of health literacy on the quality of life of older patients with long-term conditions: a large cohort study in UK general practice. Qual Life Res 2018; 27:1257-1268. [PMID: 29322478 PMCID: PMC5891567 DOI: 10.1007/s11136-017-1775-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 12/21/2022]
Abstract
Purpose The levels of health literacy in patients with long-term conditions (LTCs) are critical for better disease management and quality of life (QoL). However, the impact of health literacy on QoL in older adults with LTCs is unclear. This study examined the association between health literacy and domains of QoL in older people with LTCs, investigating key socio-demographic and clinical variables, as confounders. Methods A prospective cohort study was conducted on older adults (n = 4278; aged 65 years and over) with at least one LTC, registered in general practices in Salford, UK. Participants completed measures of health literacy, QoL, multi-morbidity, depression, social support, and socio-demographic characteristics. Multivariate linear regressions were performed to examine the effects of health literacy on four QoL domains at baseline, and then changes in QoL over 12 months. Results At baseline, poor health literacy was associated with lower scores in all four QoL domains (physical, psychological, social relationships and environment), after adjusting for the effects of multi-morbidity, depression, social support and socio-demographic factors. At 12-month follow-up, low health literacy significantly predicted declines in the physical, psychological and environment domains of QoL, but not in social relationships QoL. Conclusions This is the largest, most complete assessment of the effects of health literacy on QoL in older adults with LTCs. Low health literacy is an independent indicator of poor QoL older patients with LTCs. Interventions to improve health literacy in older people with LTCs are encouraged by these findings.
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Affiliation(s)
- Maria Panagioti
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Suzanne M. Skevington
- Division of Psychological Sciences and Mental Health, Manchester Centre for Health Psychology and International Hub for Quality of Life Research, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Mark Hann
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Kelly Howells
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Amy Blakemore
- Division of Nursing, Social Work and Midwifery, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - David Reeves
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
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Hahn C, Oh JH, Joo SH, Jeong JE, Chae JH, Lee CU, Kim TS. Association between mental health status and bone mineral density: Analysis of the 2008-2010 Korea national health and nutrition examination survey. PLoS One 2017; 12:e0187425. [PMID: 29131866 PMCID: PMC5683604 DOI: 10.1371/journal.pone.0187425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/19/2017] [Indexed: 02/03/2023] Open
Abstract
The current study aimed to investigate the association between mental health status and bone mineral density (BMD) using data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2008–2010. We enrolled 15,876 South Korean participants (4,010 postmenopausal females, 4,836 premenopausal females, and 7,016 males, all aged 20 years or older). BMD was measured using dual-energy radiography absorptiometry at the femoral neck (NK), lumbar spine (LSP), and total femur (TFM). Mental health status data were obtained from a self-report questionnaire that assessed psychological stress, depressed mood, and suicidal ideation. Psychological stress was negatively correlated with BMD in the LSP, NK, and TFM for the male group. Depressed mood was associated with lower BMD in the LSP, NK and TFM for the premenopausal female group, and in the LSP for the male group. Suicidal ideation was associated with lower BMD in the NK and TFM for the male group. Mental health problems were associated with lower BMD, especially in premenopausal females and males. Future investigations should focus on the shared pathophysiology between mental health problems and BMD, and the interrelationship between increased BMD and recovery from mental health problems.
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Affiliation(s)
- Changtae Hahn
- Department of Psychiatry, Daejeon St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Deajeon, Republic of Korea
| | - Ji Hoon Oh
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo-Hyun Joo
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jo-Eun Jeong
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Uk Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Suk Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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Black DR. Preparing the workforce for integrated healthcare: A systematic review. SOCIAL WORK IN HEALTH CARE 2017; 56:914-942. [PMID: 28862917 DOI: 10.1080/00981389.2017.1371098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Integrated healthcare is recommended to deliver care to individuals with co-occurring medical and mental health conditions. This literature review was conducted to identify the knowledge and skills required for behavioral health consultants in integrated settings. A review from 1999 to 2015 identified 68 articles. Eligible studies examined care to the U.S. adult population at the highest level of integration. The results provide evidence of specific knowledge of medical and mental health diagnoses, screening instruments, and intervention skills in integrated primary care, specialty medical, and specialty mental health. Further research is required to identify methods to develop knowledge/skills in the workforce.
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Affiliation(s)
- Denise R Black
- a College of Social Work , University of Tennessee , Knoxville , TN , USA
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Oates GR, Hamby BW, Stepanikova I, Knight SJ, Bhatt SP, Hitchcock J, Schumann C, Dransfield MT. Social Determinants of Adherence to Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease. COPD 2017; 14:610-617. [PMID: 29020525 DOI: 10.1080/15412555.2017.1379070] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adherence to pulmonary rehabilitation (PR) is low. Previous studies have focused on clinical predictors of PR completion. We aimed to identify social determinants of adherence to PR. A cross-sectional analysis of a database of COPD patients (N = 455) in an outpatient PR program was performed. Adherence, a ratio of attended-to-prescribed sessions, was coded as low (<35%), moderate (35-85%), and high (>85%). Individual-level measures included age, sex, race, BMI, smoking status, pack-years, baseline 6-minute walk distance (6MWD: <150, 150-249, ≥250), co-morbidities, depression, and prescribed PR sessions (≤20, 21-30, >30). Fifteen area-level measures aggregated to Census tracts were obtained from the U.S. Census after geocoding patients' addresses. Using exploratory factor analysis, a neighborhood socioeconomic disadvantage index was constructed, which included variables with factor loading >0.5: poverty, public assistance, households without vehicles, cost burden, unemployment, and minority population. Multivariate regression models were adjusted for clustering on Census tracts. Twenty-six percent of patients had low adherence, 23% were moderately adherent, 51% were highly adherent. In the best fitted full model, each decile increase in neighborhood socioeconomic disadvantage increased the risk of moderate vs high adherence by 14% (p < 0.01). Smoking tripled the relative risk of low adherence (p < 0.01), while each increase in 6MWD category decreased that risk by 72% (p < 0.01) and 84% (p < 0.001), respectively. These findings show that, relative to high adherence, low adherence is associated with limited functional capacity and current smoking, while moderate adherence is associated with socioeconomic disadvantage. The distinction highlights different pathways to suboptimal adherence and calls for tailored intervention approaches.
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Affiliation(s)
- Gabriela R Oates
- a Preventive Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Bryant W Hamby
- b Sociology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Irena Stepanikova
- b Sociology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Sara J Knight
- a Preventive Medicine , University of Alabama at Birmingham , Birmingham , AL , USA.,c Birmingham Veterans Affairs Medical Center , Birmingham , AL , USA
| | - Surya P Bhatt
- d Lung Health Center and Pulmonary, Allergy and Critical Care Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Jason Hitchcock
- e Cardiopulmonary Rehabilitation , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Christopher Schumann
- e Cardiopulmonary Rehabilitation , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Mark T Dransfield
- c Birmingham Veterans Affairs Medical Center , Birmingham , AL , USA.,d Lung Health Center and Pulmonary, Allergy and Critical Care Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
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Nishida Y, Takahashi Y, Tezuka K, Yamazaki K, Yada Y, Nakayama T, Asai S. A comprehensive analysis of association of medical history with airflow limitation: a cross-sectional study. Int J Chron Obstruct Pulmon Dis 2017; 12:2363-2371. [PMID: 28848337 PMCID: PMC5557123 DOI: 10.2147/copd.s138103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Multiple comorbidity is common and increases the complexity of the presentation of patients with COPD. This study was a comprehensive analysis of the relationship between a medical history of 22 disease categories and the presence of airflow limitation (AL) without any history of asthma or bronchiectasis, compatible with COPD. Methods A total of 11,898 Japanese patients aged ≥40 years, who underwent spirometry tests, comprising patients with AL (n=2,309) or without AL (n=9,589), were evaluated. Generalized estimating equations were used to assess the relationship between the presence of AL and each disease. The model was adjusted for age, sex, body mass index (BMI) and pack-years of smoking. Results In multivariate analysis, female sex (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.52–0.67), age (OR for 10-year age increase: 1.99; CI: 1.90–2.09), BMI (OR for 1 kg/m2 increase: 0.96; CI: 0.95–0.98) and smoking history (<15 vs 15–24, 25–49 and ≥50 pack-years; OR: 1.78, 2.6 and 3.69, respectively; CI: 1.46–2.17, 2.24–3.0 and 3.15–4.33, respectively) were significantly associated with the presence of AL. In addition, a history of tuberculosis (OR: 1.72; CI: 1.39–2.11), primary lung cancer (OR: 1.50; CI: 1.28–1.77), myocardial infarction (OR: 1.22; CI: 1.01–1.48), heart failure (OR: 1.53; CI: 1.29–1.81), arrhythmia (OR: 1.19; CI: 1.03–1.38) or heart valve disorder (OR: 1.33; CI: 1.14–1.56) was significantly associated with the presence of AL, after adjustment. Conclusion This study suggests that a history of heart disease leading to abnormal cardiac function may be associated with AL and that the presence of certain types of heart disease provides a rationale to assess lung status and look for respiratory impairment, including COPD.
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Affiliation(s)
- Yayoi Nishida
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center
| | - Yasuo Takahashi
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center
| | - Kotoe Tezuka
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center
| | - Keiko Yamazaki
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center
| | - Yoichi Yada
- Division of Pharmacology, Department of Biomedical Sciences
| | - Tomohiro Nakayama
- Division of Companion Diagnostics.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Satoshi Asai
- Division of Pharmacology, Department of Biomedical Sciences
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Aras YG, Tunç A, Güngen BD, Güngen AC, Aydemir Y, Demiyürek BE. The effects of depression, anxiety and sleep disturbances on cognitive impairment in patients with chronic obstructive pulmonary disease. Cogn Neurodyn 2017; 11:565-571. [PMID: 29147148 DOI: 10.1007/s11571-017-9449-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 07/08/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022] Open
Abstract
The purpose of this study was to investigate the effects of depression, anxiety and sleep disturbances on cognitive functions in chronic obstructive pulmonary disease (COPD) patients. In this prospective case-control study, demographic data, smoking history, depression, anxiety, sleep quality and cognitive status of 48 COPD patients and 36 healthy volunteers aged 40-90 years were recorded. The Beck depression inventory (BDI), the Beck anxiety inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI) were used to assess depression, anxiety and sleep quality, respectively in COPD patients. Cognitive performance was studied by the mini-mental state examination. The mean age of patients with COPD was 65.3 ± 9.4 years, and disease duration was 9.6 ± 7.8 years. Male sex ratio, smoking, BDI score, BAI score, total PSQI score, sleep latency, sleep duration, average use of sleep aids and sleep disturbances in patients with COPD were significantly higher than the control group (p < 0.05). When cognitive impairment was compared by age, FVC, FEV, FEV/FVC, PEF values and smoking, no statistically significant relationship was found (p > 0.05). A statistically significant relationship was established between cognitive impairment and severity of disease, presence of anxiety, presence of depression and sleep quality. In our study, we found that sleep disorders, depression and anxiety comorbid with COPD increased cognitive impairment as well as the severity of disease. We believe that this finding is important in terms of reducing the risk of cognitive impairment, preventing misdiagnosis and treatment of the aforementioned comorbid diseases.
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Affiliation(s)
- Yesim Güzey Aras
- Department of Neurology, Research and Training Hospital, Sakarya University, 54100 Adapazarı, Sakarya Turkey
| | - Abdülkadir Tunç
- Department of Neurology, Bezmi Alem Vakıf University, İstanbul, İstanbul Turkey
| | - Belma Doğan Güngen
- Department of Neurology, Research and Training Hospital, Sakarya University, 54100 Adapazarı, Sakarya Turkey
| | - Adil Can Güngen
- Department of Pulmonology, Research and Training Hospital, Sakarya University, Adapazarı, Sakarya Turkey
| | - Yusuf Aydemir
- Department of Pulmonology, Research and Training Hospital, Sakarya University, Adapazarı, Sakarya Turkey
| | - Bekir Enes Demiyürek
- Department of Neurology, Research and Training Hospital, Sakarya University, 54100 Adapazarı, Sakarya Turkey
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Muntingh ADT, Gerritsen S, Batelaan NM, Bogaard HJ. Pathways to experiencing mental problems and need for mental support in patients with pulmonary arterial hypertension. Pulm Circ 2017; 7:609-616. [PMID: 28730927 PMCID: PMC5841906 DOI: 10.1177/2045893217724750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) affects the physical and emotional wellbeing of patients. More information is needed regarding mental problems and preferences for support. Qualitative interviews were used to explore mental problems and preference for support of PAH patients. Additionally, a survey was used to assess the presence of mental problems (Problem List), distress (Distress Thermometer) and the need for mental support. In 24 semi-structured interviews, the following problem themes were identified: energy balance; loss of abilities; feeling misunderstood; and handling of worries and emotions. Need for support was based on an interplay between resilience to psychological distress, additional life problems, age, disease status, attitude towards professional help, and experienced support from significant others. The results from the survey highlight the need for professional support, as 50.8% of the 67 patients who completed the survey would consider support when offered, specifically when offered by a pulmonary hypertension (PH) professional. Younger age (odds ratio [OR] = 0.97, P = 0.04), depression (OR = 11.435, P = 0.001) and possibly anxiety (OR = 3.831, P = 0.069) were related to need for support. In conclusion, many patients with PAH are in need of mental support, which should be offered by a PH professional and tailored to phase of the disease and personal characteristics.
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Affiliation(s)
- Anna D T Muntingh
- 1 Department of Psychiatry, VU University Medical Centre and GGZ inGeest, Amsterdam, the Netherlands
| | - Sylvia Gerritsen
- 1 Department of Psychiatry, VU University Medical Centre and GGZ inGeest, Amsterdam, the Netherlands.,2 Department of Medical Humanities, VU University Medical Centre, Amsterdam, the Netherlands
| | - Neeltje M Batelaan
- 1 Department of Psychiatry, VU University Medical Centre and GGZ inGeest, Amsterdam, the Netherlands
| | - Harm Jan Bogaard
- 3 Department of Pulmonary Medicine, Institute for Cardiovascular Research (ICaR-VU)/VU University Medical Centre, Amsterdam, the Netherlands
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Benzo R, Vickers K, Novotny PJ, Tucker S, Hoult J, Neuenfeldt P, Connett J, Lorig K, McEvoy C. Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization. A Randomized Study. Am J Respir Crit Care Med 2017; 194:672-80. [PMID: 26953637 DOI: 10.1164/rccm.201512-2503oc] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Hospital readmission for chronic obstructive pulmonary disease (COPD) has attracted attention owing to the burden to patients and the health care system. There is a knowledge gap on approaches to reducing COPD readmissions. OBJECTIVES To determine the effect of comprehensive health coaching on the rate of COPD readmissions. METHODS A total of 215 patients hospitalized for a COPD exacerbation were randomized at hospital discharge to receive either (1) motivational interviewing-based health coaching plus a written action plan for exacerbations (the use of antibiotics and oral steroids) and brief exercise advice or (2) usual care. MEASUREMENTS AND MAIN RESULTS We evaluated the rate of COPD-related hospitalizations during 1 year of follow-up. The absolute risk reductions of COPD-related rehospitalization in the health coaching group were 7.5% (P = 0.01), 11.0% (P = 0.02), 11.6% (P = 0.03), 11.4% (P = 0.05), and 5.4% (P = 0.24) at 1, 3, 6, 9, and 12 months, respectively, compared with the control group. The odds ratios for COPD hospitalization in the intervention arm compared with the control arm were 0.09 (95% confidence interval [CI], 0.01-0.77) at 1 month postdischarge, 0.37 (95% CI, 0.15-0.91) at 3 months postdischarge, 0.43 (95% CI, 0.20-0.94) at 6 months postdischarge, and 0.60 (95% CI, 0.30-1.20) at 1 year postdischarge. The missing value rate for the primary outcome was 0.4% (one patient). Disease-specific quality of life improved significantly in the health coaching group compared with the control group at 6 and 12 months, based on the Chronic Respiratory Disease Questionnaire emotional score (emotion and mastery domains) and physical score (dyspnea and fatigue domains) (P < 0.05). There were no differences between groups in measured physical activity at any time point. CONCLUSIONS Health coaching may represent a feasible and possibly effective intervention designed to reduce COPD readmissions. Clinical trial registered with www.clinicaltrials.gov (NCT01058486).
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Affiliation(s)
- Roberto Benzo
- 1 Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine
| | | | - Paul J Novotny
- 3 Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Sharon Tucker
- 4 University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Johanna Hoult
- 1 Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine
| | - Pamela Neuenfeldt
- 5 HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - John Connett
- 6 Academic Health Center, University of Minnesota, Minneapolis, Minnesota; and
| | - Kate Lorig
- 7 Stanford Patient Education Research Center, Palo Alto, California
| | - Charlene McEvoy
- 5 HealthPartners Institute for Education and Research, Bloomington, Minnesota
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Usmani ZA, Carson KV, Heslop K, Esterman AJ, De Soyza A, Smith BJ. Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017; 3:CD010673. [PMID: 28322440 PMCID: PMC6464539 DOI: 10.1002/14651858.cd010673.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) (commonly referred to as chronic bronchitis and emphysema) is a chronic lung condition characterised by the inflammation of airways and irreversible destruction of pulmonary tissue leading to progressively worsening dyspnoea. It is a leading international cause of disability and death in adults. Evidence suggests that there is an increased prevalence of anxiety disorders in people with COPD. The severity of anxiety has been shown to correlate with the severity of COPD, however anxiety can occur with all stages of COPD severity. Coexisting anxiety and COPD contribute to poor health outcomes in terms of exercise tolerance, quality of life and COPD exacerbations. The evidence for treatment of anxiety disorders in this population is limited, with a paucity of evidence to support the efficacy of medication-only treatments. It is therefore important to evaluate psychological therapies for the alleviation of these symptoms in people with COPD. OBJECTIVES To assess the effects of psychological therapies for the treatment of anxiety disorders in people with chronic obstructive pulmonary disease. SEARCH METHODS We searched the specialised registers of two Cochrane Review Groups: Cochrane Common Mental Disorders (CCMD) and Cochrane Airways (CAG) (to 14 August 2015). The specialised registers include reports of relevant randomised controlled trials from The Cochrane Library, MEDLINE, Embase, and PsycINFO. We carried out complementary searches on PsycINFO and CENTRAL to ensure no studies had been missed. We applied no date or language restrictions. SELECTION CRITERIA We considered all randomised controlled trials (RCTs), cluster-randomised trials and cross-over trials of psychological therapies for people (aged over 40 years) with COPD and coexisting anxiety disorders (as confirmed by recognised diagnostic criteria or a validated measurement scale), where this was compared with either no intervention or education only. We included studies in which the psychological therapy was delivered in combination with another intervention (co-intervention) only if there was a comparison group that received the co-intervention alone. DATA COLLECTION AND ANALYSIS Two review authors independently screened citations to identify studies for inclusion and extracted data into a pilot-tested standardised template. We resolved any conflicts that arose through discussion. We contacted authors of included studies to obtain missing or raw data. We performed meta-analyses using the fixed-effect model and, if we found substantial heterogeneity, we reanalysed the data using the random-effects model. MAIN RESULTS We identified three prospective RCTs for inclusion in this review (319 participants available to assess the primary outcome of anxiety). The studies included people from the outpatient setting, with the majority of participants being male. All three studies assessed psychological therapy (cognitive behavioural therapy) plus co-intervention versus co-intervention alone. We assessed the quality of evidence contributing to all outcomes as low due to small sample sizes and substantial heterogeneity in the analyses. Two of the three studies had prespecified protocols available for comparison between prespecified methodology and outcomes reported within the final publications.We observed some evidence of improvement in anxiety over 3 to 12 months, as measured by the Beck Anxiety Inventory (range from 0 to 63 points), with psychological therapies performing better than the co-intervention comparator arm (mean difference (MD) -4.41 points, 95% confidence interval (CI) -8.28 to -0.53; P = 0.03). There was however, substantial heterogeneity between the studies (I2 = 62%), which limited the ability to draw reliable conclusions. No adverse events were reported. AUTHORS' CONCLUSIONS We found only low-quality evidence for the efficacy of psychological therapies among people with COPD with anxiety. Based on the small number of included studies identified and the low quality of the evidence, it is difficult to draw any meaningful and reliable conclusions. No adverse events or harms of psychotherapy intervention were reported.A limitation of this review is that all three included studies recruited participants with both anxiety and depression, not just anxiety, which may confound the results. We downgraded the quality of evidence in the 'Summary of findings' table primarily due to the small sample size of included trials. Larger RCTs evaluating psychological interventions with a minimum 12-month follow-up period are needed to assess long-term efficacy.
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Affiliation(s)
- Zafar A Usmani
- The Queen Elizabeth HospitalDepartment of Respiratory Medicine4A, Main Building, 28 Woodville RoadWoodville SouthAdelaideAustraliaSA 5011
- The University of AdelaideSchool of MedicineAdelaideAustralia
| | | | - Karen Heslop
- Newcastle upon Tyne NHS Hospitals Foundation TrustChest ClinicRVI Hospital, Queen Victoria RoadNewcastle upon TyneTyne & WearUKNE1 4LP
| | - Adrian J Esterman
- University of South AustraliaDivision of Health SciencesAdelaideAustralia
| | | | - Brian J Smith
- The University of AdelaideSchool of MedicineAdelaideAustralia
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Schlosser RJ, Gage SE, Kohli P, Soler ZM. Burden of illness: A systematic review of depression in chronic rhinosinusitis. Am J Rhinol Allergy 2017; 30:250-6. [PMID: 27456594 DOI: 10.2500/ajra.2016.30.4343] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression has been reported in patients with chronic rhinosinusitis (CRS), but its prevalence varies across studies, and uncertainty remains regarding the association with baseline disease severity and treatment outcomes. OBJECTIVE To systematically assess the prevalence of depression in CRS and to review its relationship to baseline disease severity and outcomes after treatment. METHODS A systematic review of the prevalence of possible depression was performed by using the available methods to diagnose depression, and the results were pooled. Studies that examined the relationship of depression on baseline disease severity and treatment outcomes were organized and reported individually. RESULTS Thirteen studies met inclusion criteria for prevalence analysis. The prevalence of possible or likely depression in patients with CRS ranged from 11.0 to 40.0%, depending on the method of diagnosis and sensitivity of various depression instruments. Positive depression screening was consistently associated with worse CRS-specific quality of life (QOL), medication usage, and health care utilization, but there were no reliable CRS-specific factors to predict the presence of depression. Patients with possible depression who underwent medical or surgical treatment for CRS tended to have improvements in CRS-specific QOL but did not achieve the same degree of QOL as patients who were not depressed. Depression-specific QOL seemed to improve after treatment for CRS. CONCLUSION Positive depression screening was common in patients with CRS and had a negative association on the entire spectrum of QOL, health care utilization, and productivity. CRS-specific treatments were still beneficial in patients who seemed to be depressed and improved both depression-specific and CRS-specific QOL.
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Affiliation(s)
- Rodney J Schlosser
- Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
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Dong XY, Wang L, Tao YX, Suo XL, Li YC, Liu F, Zhao Y, Zhang Q. Psychometric properties of the Anxiety Inventory for Respiratory Disease in patients with COPD in China. Int J Chron Obstruct Pulmon Dis 2016; 12:49-58. [PMID: 28053516 PMCID: PMC5191851 DOI: 10.2147/copd.s117626] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anxiety is a common comorbidity in patients with COPD in China, and it can significantly decrease patients' quality of life. Almost all anxiety measurements contain somatic items that can overlap with symptoms of COPD and side effects of medicines, which can lead to bias in measuring anxiety in patients with COPD. Therefore, a brief and disease-specific non-somatic anxiety measurement scale, the Anxiety Inventory for Respiratory Disease (AIR), which has been developed and validated in its English version, is needed for patients with COPD in China. METHODS A two-center study was conducted in two tertiary hospitals in Tianjin, China. A total of 181 outpatients with COPD (mean age 67.21±8.10 years, 32.6% women), who met the inclusion and exclusion criteria, were enrolled in the study. Test-retest reliability was examined using intraclass correlation coefficients. The internal consistency was calculated by Cronbach's α. Content validity was examined using the Content Validity Index (CVI), scale-level CVI/universal agreement, and scale-level CVI/average agreement (S-CVI/Ave). Besides, convergent validity and construct validity were also examined. RESULTS The AIR-C (AIR-Chinese version) scale had high test-retest reliability (intraclass correlation coefficient =0.904) and internal consistency (Cronbach's α=0.914); the content validity of the AIR-C scale was calculated by CVI, scale-level CVI/universal agreement, and S-CVI/Ave at values of 0.89-1, 0.90, and 0.98, respectively. Meanwhile, the AIR-C scale had good convergent validity, correlating with the Hospital Anxiety and Depression Scale-Anxiety (r=0.81, P<0.01), and there were significant correlations between the AIR-C and Clinical COPD Questionnaire (CCQ; r=0.44, P<0.01) and Activities of Daily Living Scale (ADLS; r=0.36, P<0.01). A two-factor model of general anxiety and panic symptoms in the AIR-C scale had the best fit according to Confirmatory Factor Analysis (CFA). CONCLUSION The AIR-C scale had a good reliability and validity for patients with COPD and can be used as a user-friendly and valid tool for measuring anxiety symptoms among patients with COPD in China.
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Affiliation(s)
| | - Lan Wang
- School of Nursing, Tianjin Medical University
| | - Yan-Xia Tao
- School of Nursing, Tianjin Medical University
| | - Xiu-Li Suo
- Department of Respiratory Care, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Yue-Chuan Li
- Department of Respiratory Care, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Fang Liu
- School of Nursing, Tianjin Medical University
| | - Yue Zhao
- School of Nursing, Tianjin Medical University
| | - Qing Zhang
- School of Nursing, Tianjin Medical University
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Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2016; 13:197-203. [PMID: 26599286 DOI: 10.1513/annalsats.201507-439oc] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and health care costs, and hospitals in the United States are now penalized by the Centers for Medicare and Medicaid Services for excessive readmissions. Identifying patients at risk of readmission is important, but modifiable risk factors have not been clearly established, and the potential contributing role of psychological disease has not been examined adequately. We hypothesized that depression and anxiety would increase the risk of both short- and long-term readmissions for acute exacerbation of COPD. OBJECTIVES To characterize the associations between depression and anxiety and COPD readmission risk. METHODS We examined the medical records for all patients with a primary diagnosis of acute exacerbation of COPD by International Classification of Diseases, Ninth Revision codes admitted to the University of Alabama at Birmingham Hospital between November 2010 and October 2012. Those who did not meet the standardized study criteria for acute exacerbation of COPD and those with other respiratory illnesses as the primary diagnosis were excluded. Comorbidities were recorded on the basis of physician documentation of the diagnosis and/or the use of medications in the electronic medical record. Multivariable regression analyses identified factors associated with readmission for acute exacerbation of COPD at 1 year and within 30 and 90 days. MEASUREMENTS AND MAIN RESULTS Four hundred twenty-two patients were included, with 132 readmitted in 1 year. Mean age was 64.8 ± 11.7 years, and mean percent predicted FEV1 was 48.1 ± 18.7%. On univariate analysis, readmitted patients had lower percent predicted FEV1 (44.9 ± 17.3% vs. 50.2 ± 19.4%; P = 0.05) and a higher frequency of depression (47.7% vs. 23.4%; P < 0.001). On multivariable analysis, 1-year readmission was independently associated with depression (adjusted odds ratio [OR], 2.67; 95% confidence interval [CI], 1.59-4.47) and in-hospital tobacco cessation counseling (adjusted OR, 0.34; 95% CI, 0.18-0.66). Depression also predicted readmission at 30 days (adjusted OR, 3.83; 95% CI, 1.84-7.96) and 90 days (adjusted OR, 2.47; 95% CI, 1.34-4.55). CONCLUSIONS Depression is an independent risk factor for both short- and long-term readmissions for acute exacerbation of COPD and may represent a modifiable risk factor. In-hospital tobacco cessation counseling was also associated with reduced 1-year readmission.
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Emotional Intelligence: A Novel Outcome Associated with Wellbeing and Self-Management in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2016; 13:10-6. [PMID: 26501370 DOI: 10.1513/annalsats.201508-490oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Individuals with chronic obstructive pulmonary disease (COPD) often struggle with diminished autonomy and quality of life. Emotional factors play a crucial role in the well-being of patients with COPD; they are independently associated with critical outcomes such as dyspnea, quality of life, and health care use. Emotional intelligence is the capacity to understand and manage personal thoughts and feelings, as well as to positively influence interpersonal communication and social well-being. Emotional intelligence is a trainable skill that is extensively used in corporate business to improve well-being and performance, and it may also be significant in the self-management of emotions in patients with chronic disease. Importantly, research supports the proposition that emotional intelligence may be developed and learned at any time or any age, and training programs have been associated with increased well-being and better emotional regulation in patients with chronic disease. However, to date, no research has been done to investigate its value in patients with COPD. OBJECTIVES We aimed to investigate the association between emotional intelligence and two meaningful outcomes in COPD: quality of life and self-management abilities. METHODS Participants with moderate to severe COPD completed a disease-specific quality of life tool (Chronic Respiratory Questionnaire), the Trait Emotional Intelligence Questionnaire, the Self-Management Abilities Scale, the modified Medical Research Council Dyspnea Scale, and pulmonary function tests, and also provided information about living conditions and self-reported health care use. MEASUREMENTS AND MAIN RESULTS A total of 310 patients with COPD (mean age, 69 ± 9 yr; 40% female; mean FEV1%, 42.4 ± 15.8) participated in the study. Emotional intelligence was significantly and independently associated with self-management abilities (P < 0.0001) and all domains of quality of life assessed (dyspnea, fatigue, emotions, and mastery; P < 0.0001) after adjusting for age, degree of bronchial obstruction, breathlessness, and other significant confounders. CONCLUSIONS Emotional intelligence may represent an important attribute in COPD, as it is associated with self-management abilities and all domains of quality of life, regardless of age or disease severity. Emotional intelligence can be learned and may complement existing rehabilitation efforts. Attention to it may address the current gap that exists in the treatment of emotional components of COPD responsible for decreased quality of life and increased health care use.
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79
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Christensen VL, Rustøen T, Cooper BA, Miaskowski C, Henriksen AH, Bentsen SB, Holm AM. Distinct symptom experiences in subgroups of patients with COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:1801-9. [PMID: 27536092 PMCID: PMC4976817 DOI: 10.2147/copd.s105299] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background In addition to their respiratory symptoms, patients with COPD experience multiple, co-occurring symptoms. Objectives The aims of this study were to identify subgroups of COPD patients based on their distinct experiences with 14 symptoms and to determine how these subgroups differed in demographic and clinical characteristics and disease-specific quality of life. Patients and methods Patients with moderate, severe, and very severe COPD (n=267) completed a number of self-report questionnaires. Latent class analysis was used to identify subgroups of patients with distinct symptom experiences based on the occurrence of self-reported symptoms using the Memorial Symptom Assessment Scale. Results Based on the probability of occurrence of a number of physical and psychological symptoms, three subgroups of patients (ie, latent classes) were identified and named “high”, “intermediate”, and “low”. Across the three latent classes, the pairwise comparisons for the classification of airflow limitation in COPD were not significantly different, which suggests that measurements of respiratory function are not associated with COPD patients’ symptom burden and their specific needs for symptom management. While patients in both the “high” and “intermediate” classes had high occurrence rates for respiratory symptoms, patients in the “high” class had the highest occurrence rates for psychological symptoms. Compared with the “intermediate” class, patients in the “high” class were younger, more likely to be women, had significantly more acute exacerbations in the past year, and reported significantly worse disease-specific quality of life scores. Conclusion These findings suggest that subgroups of COPD patients with distinct symptom experiences can be identified. Patients with a higher symptom burden warrant more detailed assessments and may have therapeutic needs that would not be identified using current classifications based only on respiratory function.
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Affiliation(s)
- Vivi L Christensen
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Ullevål; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo; Lovisenberg Diaconal University College
| | - Tone Rustøen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo; Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - Anne H Henriksen
- Department of Circulation and Medical Imaging, St Olav's University Hospital, Trondheim
| | - Signe B Bentsen
- Department of Health Studies, University of Stavanger, Stavanger
| | - Are M Holm
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo; Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Koehorst-Ter Huurne K, Kort S, van der Palen J, van Beurden WJ, Movig KL, van der Valk P, Brusse-Keizer M. Quality of life and adherence to inhaled corticosteroids and tiotropium in COPD are related. Int J Chron Obstruct Pulmon Dis 2016; 11:1679-88. [PMID: 27555758 PMCID: PMC4968688 DOI: 10.2147/copd.s107303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Poor adherence to inhaled medications in COPD patients seems to be associated with an increased risk of death and hospitalization. Knowing the determinants of nonadherence to inhaled medications is important for creating interventions to improve adherence. Objectives To identify disease-specific and health-related quality of life (HRQoL) factors, associated with adherence to inhaled corticosteroids (ICS) and tiotropium in COPD patients. Methods Adherence of 795 patients was recorded over 3 years and was deemed optimal at >75%–≤125%, suboptimal at ≥50%–<75%, and poor at <50% (underuse) or >125% (overuse). Health-related quality of life was measured with the Clinical COPD Questionnaire and the EuroQol-5D questionnaire. Results Patients with a higher forced expiratory volume in 1 second (FEV1)/vital capacity (VC) (odds ratio [OR] =1.03) and ≥1 hospitalizations in the year prior to inclusion in this study (OR =2.67) had an increased risk of suboptimal adherence to ICS instead of optimal adherence. An increased risk of underuse was predicted by a higher FEV1/VC (OR =1.05). Predictors for the risk of overuse were a lower FEV1 (OR =0.49), higher scores on Clinical COPD Questionnaire-question 3 (anxiety for dyspnea) (OR =1.26), and current smoking (OR =1.73). Regarding tiotropium, predictors for suboptimal use were a higher FEV1/VC (OR =1.03) and the inability to perform usual activities as asked by the EuroQol-5D questionnaire (OR =3.09). A higher FEV1/VC also was a predictor for the risk of underuse compared to optimal adherence (OR =1.03). The risk of overuse increased again with higher scores on Clinical COPD Questionnaire-question 3 (OR =1.46). Conclusion Several disease-specific and quality of life factors are related to ICS and tiotropium adherence, but a clear profile of a nonadherent patient cannot yet be outlined. Overusers of ICS and tiotropium experience more anxiety.
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Affiliation(s)
| | | | - Job van der Palen
- Department of Pulmonary Medicine; Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, the Netherlands
| | | | - Kris Ll Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente
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Ranjita R, Badhai S, Hankey A, Nagendra HR. A randomized controlled study on assessment of health status, depression, and anxiety in coal miners with chronic obstructive pulmonary disease following yoga training. Int J Yoga 2016; 9:137-44. [PMID: 27512321 PMCID: PMC4959324 DOI: 10.4103/0973-6131.183714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
CONTEXT Psychological comorbidities are prevalent in coal miners with chronic obstructive pulmonary disease (COPD) and contribute to the severity of the disease reducing their health status. Yoga has been shown to alleviate depression and anxiety associated with other chronic diseases but in COPD not been fully investigated. AIM This study aimed to evaluate the role of yoga on health status, depression, and anxiety in coal miners with COPD. MATERIALS AND METHODS This was a randomized trial with two study arms (yoga and control), which enrolled 81 coal miners, ranging from 36 to 60 years with stage II and III stable COPD. Both groups were either on conventional treatment or combination of conventional care with yoga program for 12 weeks. RESULTS Data were collected through standardized questionnaires; COPD Assessment Test, Beck Depression Inventory and State and Trait Anxiety Inventory at the beginning and the end of the intervention. The yoga group showed statistically significant (P < 0.001) improvements on all scales within the group, all significantly different (P < 0.001) from changes observed in the controls. No significant prepost changes were observed in the control group (P > 0.05). CONCLUSION Yoga program led to greater improvement in physical and mental health status than did conventional care. Yoga seems to be a safe, feasible, and effective treatment for patients with COPD. There is a need to conduct more comprehensive, high-quality, evidence-based studies to shed light on the current understanding of the efficacy of yoga in these chronic conditions and identify unanswered questions.
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Affiliation(s)
- Rajashree Ranjita
- Division of Yoga and Life Science, Swami Vivekananda Yoga Anusandhana Samsthana Yoga University, Bengaluru, Karnataka, India
| | - Sumati Badhai
- Division of Yoga and Life Science, Swami Vivekananda Yoga Anusandhana Samsthana Yoga University, Bengaluru, Karnataka, India
| | - Alex Hankey
- Division of Yoga and Life Science, Swami Vivekananda Yoga Anusandhana Samsthana Yoga University, Bengaluru, Karnataka, India
| | - Hongasandra R Nagendra
- Division of Yoga and Life Science, Swami Vivekananda Yoga Anusandhana Samsthana Yoga University, Bengaluru, Karnataka, India
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Dueñas-Espín I, Demeyer H, Gimeno-Santos E, Polkey MI, Hopkinson NS, Rabinovich RA, Dobbels F, Karlsson N, Troosters T, Garcia-Aymerich J. Depression symptoms reduce physical activity in COPD patients: a prospective multicenter study. Int J Chron Obstruct Pulmon Dis 2016; 11:1287-95. [PMID: 27354787 PMCID: PMC4910613 DOI: 10.2147/copd.s101459] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The role of anxiety and depression in the physical activity (PA) of patients with COPD is controversial. We prospectively assessed the effect of symptoms of anxiety and depression on PA in COPD patients. Methods We evaluated anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), PA (Dynaport® accelerometer), and other relevant characteristics in 220 COPD patients from five European countries at baseline and at 6 and 12 months of follow-up. HADS score was categorized as: no symptoms (score 0–7), suggested (8–10), and probable (>11) anxiety or depression. We estimated the association between anxiety and depression at t (baseline and 6 months) and PA at t+1 (6 and 12 months) using regression models with a repeated measures approach. Results Patients had a mean (standard deviation) age of 67 (8) years, forced expiratory volume in 1 second 57 (20)% predicted. At baseline, the prevalence of probable anxiety and depression was 10% and 5%, respectively. In multivariable models adjusted by confounders and previous PA, patients performed 81 fewer steps/day (95% confidence interval, −149 to −12, P=0.02) per extra point in HADS-depression score. HADS-anxiety symptoms were not associated with PA. Conclusion In COPD patients, symptoms of depression are prospectively associated with a measurable reduction in PA 6 months later.
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Affiliation(s)
- Iván Dueñas-Espín
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBEREpidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Secretaría Nacional de Educación Superior, Ciencia, Tecnología e Innovación del Ecuador (SENESCYT), Quito, Ecuador; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Elena Gimeno-Santos
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBEREpidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Roberto A Rabinovich
- ELEGI Colt Laboratory, Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Niklas Karlsson
- Health Economics and Outcomes Research, AstraZeneca R&D, Mölndal, Sweden
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Judith Garcia-Aymerich
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBEREpidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Frequent Exacerbator: The Phenotype at Risk of Depressive Symptoms in Geriatric COPD Patients. Lung 2016; 194:665-73. [PMID: 27140193 DOI: 10.1007/s00408-016-9887-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 04/22/2016] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Depression is associated with a poorer quality of life and higher rate of COPD exacerbations and mortality. However, with multiple confounding factors, 'independent' risk factor for depression among COPD patients remains ambiguous. Our study aims to identify independent risk factors for depression by specifically evaluating for any independent relationship between frequent exacerbations and various domains of the BODE index on depression. METHODS This study is a cross-sectional study, conducted in Hong Kong SAR. Age and comorbidity-matched COPD and control subjects were recruited. Depressive symptoms were measured by a validated Chinese version of the Geriatric Depression Scale (GDS-15 items). Prevalence rates of depressive symptoms were compared between COPD and control groups. Predictors for depression (GDS ≥ 8) were determined using univariate and multivariate analyses. RESULTS A total of 161 patients (89 and 72 patients, mean ages 75.2 and 75.6 in COPD and control group, respectively) were recruited. Higher prevalence rate of significant depressive symptoms was seen in COPD patients (20.2 vs. 4.2 %, p = 0.006*). Univariate analysis suggested that predictors for depression in COPD patients included (i) exacerbation frequencies in prior year, (ii) dyspnea level, (iii) BMI, (iv) functional status (Barthel index, 6MWD, activity domain of SGRQ), and (v) BODE index. In multivariate analysis, only the 'exacerbation frequencies in prior year' (OR 1.46, p = 0.042*) and 'dyspnea level' (MMRC) (OR 2.75, p = 0.001*) remained significant independent predictors for depression in COPD patients. CONCLUSIONS A high prevalence of depressive symptoms was observed in COPD patients. 'Frequent exacerbation phenotype' remained a significant independent predictor for depressive symptoms in COPD. Among the BODE index domains, dyspnea level is the most important predictor for depression in COPD patients.
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Sharma BB, Singh V. Assessment of the mind in chronic obstructive pulmonary disease: Mind or never mind. Lung India 2016; 33:125-8. [PMID: 27051096 PMCID: PMC4797427 DOI: 10.4103/0970-2113.177462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Bharat Bhushan Sharma
- Department of Medicine, Division of Allergy and Pulmonary Medicine, SMS Medical College Hospital, Jaipur, Rajasthan, India. E-mail:
| | - Virendra Singh
- Department of Respiratory Medicine, Asthma Bhawan, Jaipur, Rajasthan, India
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Doyle C, Dunt D, Ames D, Fearn M, You E(C, Bhar S. Study protocol for a randomized controlled trial of telephone-delivered cognitive behavior therapy compared with befriending for treating depression and anxiety in older adults with COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:327-34. [PMID: 26929616 PMCID: PMC4760208 DOI: 10.2147/copd.s100859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND COPD is an umbrella term to describe chronic lung diseases that cause limitations in lung airflow, including emphysema and chronic bronchitis. The prevalence of depression and anxiety in people with COPD is high, although these comorbidities are often undiagnosed, untreated, or undertreated. There is a need to identify efficacious treatments for depression and anxiety in people with COPD. Cognitive behavior therapy (CBT) for the treatment of anxiety and depression has a strong evidence base. There has been some success delivering this treatment over the telephone in limited studies. The aim of this study is to evaluate the efficacy of both telephone-administered CBT and befriending on outcomes for patients with diagnosed COPD who have at least mild levels of depression and/or anxiety. METHODS The protocol described in this paper is of a pragmatic randomized controlled trial comparing eight sessions of telephone CBT to an active social control, referred to as befriending. Primary outcome measures will include depression and anxiety symptoms, and secondary outcome measures will include quality of life, self-efficacy, and COPD symptom severity. Participants' satisfaction with the intervention and therapeutic alliance will also be assessed. Measures will be taken pre- and postdelivery of the intervention and again at 8 weeks following the intervention. CONCLUSION People with COPD often have limitations to their mobility because of their breathlessness. They are often already attending many medical appointments and could be reluctant to attend for face-to-face psychological treatment. The results of this study should identify the relative efficacy of CBT delivered over the telephone to this population, which, if successful, may be a cost-effective and more palatable alternative to face-to-face treatment of depression or anxiety for this population.
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Affiliation(s)
- Colleen Doyle
- Australian Catholic University, Melbourne, VIC, Australia
| | - David Dunt
- Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
| | - David Ames
- National Ageing Research Institute, Melbourne, VIC, Australia
| | - Marcia Fearn
- National Ageing Research Institute, Melbourne, VIC, Australia
| | | | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
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Tselebis A, Pachi A, Ilias I, Kosmas E, Bratis D, Moussas G, Tzanakis N. Strategies to improve anxiety and depression in patients with COPD: a mental health perspective. Neuropsychiatr Dis Treat 2016; 12:297-328. [PMID: 26929625 PMCID: PMC4755471 DOI: 10.2147/ndt.s79354] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by progressive and only partially reversible symptoms. Worldwide, the incidence of COPD presents a disturbing continuous increase. Anxiety and depression are remarkably common in COPD patients, but the evidence about optimal approaches for managing psychological comorbidities in COPD remains unclear and largely speculative. Pharmacological treatment based on selective serotonin reuptake inhibitors has almost replaced tricyclic antidepressants. The main psychological intervention is cognitive behavioral therapy. Of particular interest are pulmonary rehabilitation programs, which can reduce anxiety and depressive symptoms in these patients. Although the literature on treating anxiety and depression in patients with COPD is limited, we believe that it points to the implementation of personalized strategies to address their psychopathological comorbidities.
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Affiliation(s)
- Athanasios Tselebis
- Psychiatric Department, “Sotiria” General Hospital of Chest Disease, Athens, Greece
| | - Argyro Pachi
- Psychiatric Department, “Sotiria” General Hospital of Chest Disease, Athens, Greece
| | - Ioannis Ilias
- Endocrinology Department, “Elena Venizelou” Hospital, Athens, Greece
| | | | - Dionisios Bratis
- Psychiatric Department, “Sotiria” General Hospital of Chest Disease, Athens, Greece
| | - Georgios Moussas
- Psychiatric Department, “Sotiria” General Hospital of Chest Disease, Athens, Greece
| | - Nikolaos Tzanakis
- Department of Thoracic Medicine, University of Crete Medical School, Heraklion, Greece
- Social Medicine, Laboratory of Epidemiology, University of Crete Medical School, Heraklion, Greece
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Orlandi LDCL, Pinho JF, Murad MGR, Rocha FL, Rodrigues-Machado MG. Depression diagnosed by the mini international neuropsychiatric interview plus (MINI) in patients with chronic obstructive pulmonary disease: relationship with functional capacity and quality of life. BMC Res Notes 2016; 9:65. [PMID: 26847708 PMCID: PMC4743134 DOI: 10.1186/s13104-016-1883-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of depression in patients with chronic obstructive pulmonary disease (COPD) is associated with a worsening of prognosis. Most studies classify COPD patients as depressive or non-depressive based on symptoms, rather than on a diagnosis using specific tools. Thus, the aim of this study was to determine the impact of depression, as diagnosed by the Mini International Neuropsychiatric Interview Plus (MINI), on functional capacity estimated by the 6-minute walk test (6MWT) and unsupported upper-limb exercise test, and quality of life estimated by Saint George's Respiratory Questionnaire (SGRQ), among patients with COPD. RESULTS Using the MINI as a diagnostic tool, 22.2 % of all patients (6.6 % of all men and 41.6 % of all women) were diagnosed with depression. No significant differences were found between depressive and non-depressive patients with regard to anthropometric measurements, lung function, functional capacity, or quality of life variables. The best models for the dependent variables representing functional capacity and quality of life revealed that the covariates SGRQTOTAL and gender (R(2) = 16.7 %) were significant in explaining the response variable for functional capacity of the upper limbs. Results also showed that age, monthly income, insomnia, and the results of a 6MWT were significant in explaining overall quality of life (R(2) = 46 %), and that the percentage of the predicted forced expiratory volume in the first second post-bronchodilator and gender were significant in explaining walking distance (R(2) = 22 %). Depression, as diagnosed by the MINI, was not significant in explaining any of the dependent variables. CONCLUSIONS Despite a high prevalence of depression in COPD patients, especially in women, depression, as diagnosed by the MINI, was not correlated with functional capacity tests or quality of life in patients with moderate to very severe COPD in the present study. This suggests that depression identified by this diagnostic test may be more accurate than depression diagnosed by tests that evaluate symptoms, as they may be influenced by the perceptions of the patient in relation to their health.
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Affiliation(s)
| | - José Felippe Pinho
- Faculdade Ciências Médicas-Minas Gerais, Pós-Graduação, Alameda Ezequiel Dias, 275, 30130-110, Belo Horizonte, Minas Gerais, Brazil.
| | | | - Fábio Lopes Rocha
- Instituto de Previdência dos Servidores do Estado de Minas Gerais, Clínica de Psiquiatria, Belo Horizonte, Minas Gerais, Brazil.
| | - Maria Glória Rodrigues-Machado
- Faculdade Ciências Médicas-Minas Gerais, Pós-Graduação, Alameda Ezequiel Dias, 275, 30130-110, Belo Horizonte, Minas Gerais, Brazil.
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Bertolotti G, Moroni L, Burro R, Spanevello A, Pedretti RF, Giorgetti G. Shortened questionnaires to assess anxiety and depression during in-hospital rehabilitation: clinical validation and cutoff scores. Neuropsychiatr Dis Treat 2016; 12:2627-2633. [PMID: 27789951 PMCID: PMC5068471 DOI: 10.2147/ndt.s111797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A postacute phase needs reliable routine screening instruments in order to identify the patients to be referred for a clinical interview with a psychologist. The aim of this study was to estimate the clinical cutoff scores of the anxiety and depression questionnaires and their clinical validity using a gold standard. METHODS The study involved 177 patients with pulmonary, cardiac, or neurological disease undergoing in-hospital rehabilitation. Receiver operating characteristic curves were used to determine the best concordance between questionnaire's scores and the gold standards. RESULTS There was a significant difference (P<0.001) between clinically anxious and depressed patients and nonclinical subjects. The receiver operating characteristic curve for anxiety indicated that the best area under the curve for State Anxiety Inventory is obtained with a cutoff point of 21 for males and 25 for females; for depression scores, the highest area under the curve for Depression Questionnaire-Reduced Form is obtained with a cutoff point of six for males and eight for females. CONCLUSION Using appropriate cutoff values, the State Anxiety Inventory and Depression Questionnaire-Reduced Form allow psychologists to optimize early clinical intervention strategies selecting patients with significant needs.
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Affiliation(s)
- Giorgio Bertolotti
- Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Scientific Institute, Tradate
| | - Loretta Moroni
- Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Scientific Institute, Tradate
| | - Roberto Burro
- Department of Human Sciences - University of Verona, Verona
| | | | | | - Giandomenico Giorgetti
- Department of Neuromotor Rehabilitation, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Tradate, Italy
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Boland MRS, Kruis AL, Tsiachristas A, Assendelft WJJ, Gussekloo J, Blom CMG, Chavannes NH, Rutten-van Mölken MPMH. Cost-effectiveness of integrated COPD care: the RECODE cluster randomised trial. BMJ Open 2015; 5:e007284. [PMID: 26525419 PMCID: PMC4636669 DOI: 10.1136/bmjopen-2014-007284] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 07/06/2015] [Accepted: 08/21/2015] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To investigate the cost-effectiveness of a chronic obstructive pulmonary disease (COPD) disease management (COPD-DM) programme in primary care, called RECODE, compared to usual care. DESIGN A 2-year cluster-randomised controlled trial. SETTING 40 general practices in the western part of the Netherlands. PARTICIPANTS 1086 patients with COPD according to GOLD (Global Initiative for COPD) criteria. Exclusion criteria were terminal illness, cognitive impairment, alcohol or drug misuse and inability to fill in Dutch questionnaires. Practices were included if they were willing to create a multidisciplinary COPD team. INTERVENTIONS A multidisciplinary team of caregivers was trained in motivational interviewing, setting up individual care plans, exacerbation management, implementing clinical guidelines and redesigning the care process. In addition, clinical decision-making was supported by feedback reports provided by an ICT programme. MAIN OUTCOME MEASURES We investigated the impact on health outcomes (quality-adjusted life years (QALYs), Clinical COPD Questionnaire, St. George's Respiratory Questionnaire and exacerbations) and costs (healthcare and societal perspective). RESULTS The intervention costs were €324 per patient. Excluding these costs, the intervention group had €584 (95% CI €86 to €1046) higher healthcare costs than did the usual care group and €645 (95% CI €28 to €1190) higher costs from the societal perspective. Health outcomes were similar in both groups, except for 0.04 (95% CI -0.07 to -0.01) less QALYs in the intervention group. CONCLUSIONS This integrated care programme for patients with COPD that mainly included professionally directed interventions was not cost-effective in primary care. TRIAL REGISTRATION NUMBER Netherlands Trial Register NTR2268.
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Affiliation(s)
- Melinde R S Boland
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Annemarije L Kruis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Apostolos Tsiachristas
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Coert M G Blom
- Stichting Zorgdraad foundation, Oosterbeek, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Maureen P M H Rutten-van Mölken
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
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