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Wang C, Yan J, Ma C. Psychological distress and its associated factors among patients with chronic obstructive pulmonary disease in Hunan, China: a cross-sectional study. Sci Rep 2023; 13:5199. [PMID: 36997614 PMCID: PMC10063563 DOI: 10.1038/s41598-023-32408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) experience a high risk for psychological distress. Understanding what factors contributing to this risk is vital for developing effective interventions to address COPD-related psychological distress. To examine psychological distress and its associated factors in COPD patients in China. This is a cross-sectional study. Using cluster random sampling, 351 COPD patients participated in and completed a questionnaire survey from June 2021 to January 2022. Instruments used in this research included a self-designed social-demographic questionnaire, the Kessler Psychological Distress Scale (K10), the COPD Knowledge Question, the Type D Personality Scale (DS-14), the COPD Assessment Test (CAT), and modified Medical Research Council Dyspnea Score (mMRC). Multivariate linear regressions were used in the final analysis. Among 351 COPD patients, 307 (or 87.5%) had psychological distress. Our univariate analysis indicated that psychological distress scores were significantly associated with monthly household income (F = 2.861, P < 0.05), exercise frequency (F = 4.039, P < 0.01), type D personality (t = 5.843, P < 0.01), years with COPD (rs = 0.156, P < 0.01), frequency of acute exacerbation (rs = 0.114, P < 0.05), mMRC score (rs = 0.301, P < 0.01), and CAT score (rs = 0.415, P < 0.01). Our final multivariate linear regression showed that exercise frequency (coefficient = -1.012, P < 0.01) was an independent protective factor of psychological distress in COPD patients, while type D personality (coefficient = 3.463, P < 0.001), mMRC score (coefficient = 1.034, P < 0.001) and CAT score were independent risk factors (coefficient = .288, P < 0.001). No relationship was observed between psychological distress and knowledge of COPD. Psychological distress is commonly presented among COPD patients in China. Findings from this study suggest promoting and increasing frequency of exercise will be beneficial in reducing psychological distress among COPD patients. This study also highlights the importance of assessing personality type, dyspnea, and impact of COPD on daily living for preventing and managing psychological distress due to COPD. In addition, Given the high rate of psychological distress among COPD patients, policymakers should consider making mental health resources easily available and accessible to this vulnerable population.
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Affiliation(s)
- Chunyu Wang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Jin Yan
- Xiangya Nursing School, Central South University, Changsha, Hunan, China.
- Department of Nursing, The Third Xiangya Hospital of Central South University, No. 138 Tong Zipo Road, Changsha, 410000, Hunan, China.
| | - Chenjuan Ma
- New York University Rory Meyers College of Nursing, New York, NY, USA
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Developing a complex intervention whilst considering implementation: the TANDEM (Tailored intervention for ANxiety and DEpression Management) intervention for patients with chronic obstructive pulmonary disease (COPD). Trials 2021; 22:252. [PMID: 33823935 PMCID: PMC8025339 DOI: 10.1186/s13063-021-05203-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/17/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Guidelines now call for a thorough and comprehensive description of the development of healthcare interventions to aid evaluation and understanding of the processes of change. This was the primary aim of this study but we also recognised that effective interventions are commonly not implemented in clinical practice. It is suggested that insufficient attention is given to the implementation process at the development phase of interventions. This study outlines the 5 step iterative process we adopted for considering both implementation and effectiveness issues from the outset of intervention development. We use the development of a complex intervention Tailored intervention for ANxiety and DEpression Management (TANDEM) in patients with chronic obstructive pulmonary disease to illustrate this process. METHODS Intervention development built upon the Medical Research Council framework for developing complex interventions and the person-based approach for development of behavioural interventions. Building an expert team, specifying theory, qualitative data collection and pre-piloting were all critical steps in our intervention development and are described here. RESULTS Contact with experts in the field, and explicitly building on previous work, ensured efficiency of design. Qualitative work suggested guiding principles for the intervention such as introducing mood in relation to breathlessness, and providing flexible tailoring to patients' needs, whilst implementation principles focused on training selected respiratory professionals and requiring supervision to ensure standards of care. Subsequent steps of intervention development, pre-piloting and intervention refinement led to an intervention that was deemed acceptable and if successful will be ready for implementation. CONCLUSIONS The TANDEM study was developed efficiently by building on previous work and considering implementation issues from the outset, with the aim that if shown to be effective it will have more rapid translation in to the health care system with accelerated patient benefits. TRIAL REGISTRATION ISRCTN ISRCTN59537391 . Registered on 20 March 2017. Protocol version 6.0, 22 April 2018.
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Long J, Ouyang Y, Duan H, Xiang Z, Ma H, Ju M, Sun D. Multiple Factor Analysis of Depression and/or Anxiety in Patients with Acute Exacerbation Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:1449-1464. [PMID: 32606653 PMCID: PMC7310996 DOI: 10.2147/copd.s245842] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/30/2020] [Indexed: 01/05/2023] Open
Abstract
Objective To reveal the risk factors, the symptom distribution characteristics, the clinical values of white blood cell counts (WBC counts), red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with depression and/or anxiety. Methods The study included prospective cross-sectional and case-control studies, and was executed in the Affiliated Hospital of Zunyi Medical University, Guizhou, China. Previously diagnosed chronic obstructive pulmonary disease (COPD) patients who admitted to the hospital with AECOPD, patients with depression and/or anxiety, and healthy people were enrolled in the study. The Hamilton Rating Scales were used to assess all subjects, and the complete blood counts (CBC) were collected. Baseline data and clinical measurement data [spirometry, arterial blood gas analysis, and COPD evaluation test (the CAT scale)] from patients with AECOPD were collected. Results Of the 307 patients with AECOPD included, 63.5% (N=195) had depressive and/or anxiety symptoms, and 36.5% (N=112) had no symptoms. Sex, respiratory failure, number of comorbidities, number of acute exacerbations in the previous year and the CAT score were closely related to AECOPD combined with depression and/or anxiety (p<0.05). The CAT scale score were the independent risk factor (OR=6.576, 95% CI 3.812-11.342) and significant predictor of AECOPD with depression and/or anxiety (AUC=0.790,95% CI 0.740-0.834); the patients with depression and/or anxiety were more severe and characteristic than the patients with AECOPD combined with depression and/or anxiety; RDW was associated with AECOPD with depression and/or anxiety (p=0.020, OR1.212,95% CI1.03-1.426), and had certain clinical diagnostic value (AUC=0.570,95% CI 0.531-0.626). Conclusion Depression and anxiety should not be ignored in patients with AECOPD. The severity and quality of life of COPD were closely related to the occurrence of depression and/or anxiety symptoms. In most cases, perhaps depression and anxiety in AECOPD are only symptoms and not to the extents of the diseases. RDW had clinical diagnostic value in AECOPD combined with depression and/or anxiety. NLR, PLR, MLR, and RDW may become the novel indicators for evaluating the degree of inflammation of AECOPD and deserve further research.
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Affiliation(s)
- Jian Long
- Department of Respiratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou, People’s Republic of China
- Zunyi Fifth People’s Hospital (Zunyi Mental Health Center), Zunyi City, Guizhou, People’s Republic of China
| | - Yao Ouyang
- Department of Respiratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou, People’s Republic of China
| | - Haizhen Duan
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou, People’s Republic of China
| | - Zhongyong Xiang
- Zunyi Fifth People’s Hospital (Zunyi Mental Health Center), Zunyi City, Guizhou, People’s Republic of China
| | - Hongchang Ma
- Zunyi Fifth People’s Hospital (Zunyi Mental Health Center), Zunyi City, Guizhou, People’s Republic of China
| | - Mingliang Ju
- Shanghai Mental Health Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai City, People’s Republic of China
| | - Desheng Sun
- Department of Respiratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou, People’s Republic of China
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de Mol M, Visser S, Aerts J, Lodder P, van Walree N, Belderbos H, den Oudsten B. The association of depressive symptoms, personality traits, and sociodemographic factors with health-related quality of life and quality of life in patients with advanced-stage lung cancer: an observational multi-center cohort study. BMC Cancer 2020; 20:431. [PMID: 32423432 PMCID: PMC7236491 DOI: 10.1186/s12885-020-06823-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 04/02/2020] [Indexed: 01/11/2023] Open
Abstract
Background Identification of patient-related factors associated with Health-Related Quality of Life (HRQoL) and Quality of Life (QoL) at the start of treatment may identify patients who are prone to a decrease in HRQoL and/or QoL resulting from chemotherapy. Identification of these factors may offer opportunities to enhance patient care during treatment by adapting communication strategies and directing medical and psychological interventions. The aim was to examine the association of sociodemographic factors, personality traits, and depressive symptoms with HRQoL and QoL in patients with advanced-stage lung cancer at the start of chemotherapy. Methods Patients (n = 151) completed the State-Trait Anxiety Inventory (trait anxiety subscale), the Neuroticism-Extraversion-Openness-Five Factor Inventory (NEO-FFI), the Center for Epidemiologic Studies Depression (CES-D), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Simple linear regression analyses were performed to select HRQoL and QoL associated factors (a P ≤ 0.10 was used to prevent non-identification of important factors) followed by multiple linear regression analyses (P ≤ 0.05). Results In the multiple regression analyses, CES-D score (β = − 0.63 to − 0.53; P-values < 0.001) was most often associated with the WHOQOL-BREF domains and general facet, whereas CES-D score (β = − 0.67 to − 0.40; P-values < 0.001) and Eastern Cooperative Oncology Group (ECOG) performance status (β = − 0.30 to − 0.30; P-values < 0.001) were most often associated with the scales of the EORTC QLQ-C30. Personality traits were not related with HRQoL or QoL except for trait anxiety (Role functioning: β = 0.30; P = 0.02, Environment: β = − 0.39; P = 0.007) and conscientiousness (Physical health: β = 0.20; P-value < 0.04). Conclusions Higher scores on depressive symptoms and ECOG performance status were related to lower HRQoL and QoL in patients with advanced-stage non-small cell lung cancer. Supportive care interventions aimed at improvement of depressive symptoms and performance score may facilitate an increase of HRQoL and/or QoL during treatment.
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Affiliation(s)
- Mark de Mol
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Sabine Visser
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Joachim Aerts
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Paul Lodder
- Department of Methodology and Statistics, Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands
| | - Nico van Walree
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands
| | - Huub Belderbos
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands
| | - Brenda den Oudsten
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands.
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Sohanpal R, Pinnock H, Steed L, Heslop Marshall K, Chan C, Kelly M, Priebe S, Roberts CM, Singh S, Smuk M, Saqi-Waseem S, Healey A, Underwood M, White P, Warburton C, Taylor SJC. Tailored, psychological intervention for anxiety or depression in people with chronic obstructive pulmonary disease (COPD), TANDEM (Tailored intervention for ANxiety and DEpression Management in COPD): protocol for a randomised controlled trial. Trials 2020; 21:18. [PMID: 31907074 PMCID: PMC6945421 DOI: 10.1186/s13063-019-3800-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/11/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND People with chronic obstructive pulmonary disease (COPD) are at increased risk of depression and anxiety, which greatly reduces their quality of life and is associated with worse outcomes; but these psychological co-morbidities are under-recognised and undertreated in COPD patients. Pulmonary rehabilitation (PR) improves mood for up to 6 months but health practitioners under-refer, and patients commonly fail to attend/complete PR. Research suggests that complex non-pharmacological interventions, including both psychological and exercise components, may reduce anxiety and depression in COPD. We have developed a tailored, cognitive behavioural approach (CBA) intervention for patients with COPD and co-morbid anxiety and/or depression ('TANDEM'), which precedes and optimises the benefits of currently offered PR. We hypothesise that such a psychological intervention, delivered by supervised, trained respiratory healthcare professionals, will improve mood in patients with mild to moderate anxiety and/or depression and encourage uptake and completion of PR. METHODS We will conduct a multi-centre, pragmatic, randomised controlled trial of the TANDEM intervention compared to usual care across the Midlands, London, the South East and Bristol, UK. We will train healthcare professionals familiar with COPD to deliver the manualised, tailored, face-to-face, one-to-one intervention weekly for 6-8 weeks. We will recruit 430 participants from primary, community and secondary care with confirmed COPD and moderate to very severe airflow limitation, who are eligible for assessment for PR, and who screen positive for symptoms of mild/moderate depression and/or anxiety using the Hospital Anxiety and Depression scale (HADS). Participants will be randomised 1.25:1 (intervention: usual care). The co-primary outcomes are the HADS anxiety and depression subscale scores at 6 months; participants will be followed up to 12 months. Secondary outcomes include uptake and completion of PR and healthcare resource use. There will be a parallel process evaluation and a health economic evaluation. DISCUSSION The TANDEM intervention has the potential to optimise the unrealised synergy between a psychological intervention and PR. The CBA sessions will precede PR and target individuals' cognitions, behaviours and symptoms associated with anxiety and depression to decrease psychological morbidity and increase effective self-management amongst patients with COPD. TRIAL REGISTRATION ISRCTN, ID: ISRCTN59537391. Registered on 20 March 2017. Protocol version 6.0, 22 April 2018.
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Affiliation(s)
- Ratna Sohanpal
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Liz Steed
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - Karen Heslop Marshall
- Newcastle upon Tyne NHS Hospitals Foundation Trust, Chest Clinic, New Victoria Wing RVI Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
| | - Claire Chan
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - Moira Kelly
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - Stefan Priebe
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - C. Michael Roberts
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - Sally Singh
- Department of Respiratory Sciences, College of Life Sciences, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, University of Leicester, Groby Road, Leicester, LE3 9QP UK
| | - Melanie Smuk
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - Sarah Saqi-Waseem
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - Andy Healey
- King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Martin Underwood
- Warwick CTU, Warwick Medical School, Gibbet Hill Road, Coventry, CV4 7AL and University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX UK
| | - Patrick White
- School of Population Health and Environmental Sciences, King’s College London, Great Maze Pond, London, SE1 1UL UK
| | | | - Stephanie J. C. Taylor
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
| | - On behalf of the TANDEM Investigators
- Institute for Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB UK
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- Newcastle upon Tyne NHS Hospitals Foundation Trust, Chest Clinic, New Victoria Wing RVI Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
- Department of Respiratory Sciences, College of Life Sciences, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, University of Leicester, Groby Road, Leicester, LE3 9QP UK
- King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- Warwick CTU, Warwick Medical School, Gibbet Hill Road, Coventry, CV4 7AL and University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX UK
- School of Population Health and Environmental Sciences, King’s College London, Great Maze Pond, London, SE1 1UL UK
- London, UK
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Allen SF, Wetherell MA, Smith MA. A one-year prospective investigation of Type D personality and self-reported physical health. Psychol Health 2019; 34:773-795. [DOI: 10.1080/08870446.2019.1568431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Sarah F. Allen
- Department of Health Sciences, Faculty of Science, University of York, York, UK
| | - Mark A. Wetherell
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Michael A. Smith
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
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7
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Garvey C, Criner GJ. Impact of Comorbidities on the Treatment of Chronic Obstructive Pulmonary Disease. Am J Med 2018; 131:23-29. [PMID: 29777661 DOI: 10.1016/j.amjmed.2018.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/04/2018] [Indexed: 01/03/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) frequently exists alongside other chronic diseases. Comorbidities can have a significant influence on the course of COPD, affecting disease-related symptoms and increasing morbidity and mortality in patients. Studies indicate that management of comorbid COPD can be improved by engaging in a multidisciplinary team-based approach. A collaborative effort from different disease specialists and health care professionals, together with disease self-management and management programs, could improve the outcomes of patients with comorbid COPD.
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Affiliation(s)
- Chris Garvey
- Sleep Disorders and Pulmonary Rehabilitation, University of California, San Francisco.
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
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8
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Li X, Gao M, Zhang S, Xu H, Zhou H, Wang X, Qu Z, Guo J, Zhang W, Tian D. Medication Adherence Mediates the Association between Type D Personality and High HbA1c Level in Chinese Patients with Type 2 Diabetes Mellitus: A Six-Month Follow-Up Study. J Diabetes Res 2017; 2017:7589184. [PMID: 28280745 PMCID: PMC5322451 DOI: 10.1155/2017/7589184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/23/2016] [Accepted: 12/07/2016] [Indexed: 11/17/2022] Open
Abstract
Aims. To examine the association between Type D personality and HbA1c level and to explore the mediating role of medication adherence between them in patients with type 2 diabetes mellitus (T2DM). Methods. 330 patients went on to complete a self-report measure of medication adherence and the HbA1c tests. Chi-square test, T test, Ordinary Least Square Regression (OLS), and Recentered Influence Function Regression (RIF) were employed. Results. Patients with Type D personality had significantly higher HbA1c value (P < 0.01). When Type D personality was operationalized as a categorical variable, SI was associated with HbA1c (P < 0.01). When NA, SI, and their interaction term were entered into regression, all of them were no longer associated with HbA1c level (P > 0.1). On the other hand, when Type D personality was operationalized as a continuous variable, only SI trait was associated with HbA1c level (P < 0.01). When NA, SI, and NA × SI term together were entered into regression, only SI was not related to HbA1c level. Furthermore, medication adherence had a significant mediation effect between Type D personality and HbA1c, accounting for 54.43% of the total effect. Conclusion. Type D personality was associated with HbA1c in direct and indirect ways, and medication adherence acted as a mediator role.
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Affiliation(s)
- Xuemei Li
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing 100875, China
- Clinics of Cadre, Department of Outpatient, General Hospital of the People's Liberation Army (301 Hospital), Beijing 100853, China
| | - Min Gao
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing 100875, China
| | - Shengfa Zhang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing 100875, China
| | - Huiwen Xu
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY 14642, USA
| | - Huixuan Zhou
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing 100875, China
| | - Xiaohua Wang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing 100875, China
| | - Zhiyong Qu
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing 100875, China
| | - Jing Guo
- Department of Sociology, Huazhong University of Science and Technology, Wuhan, Hubei 430074, China
| | - Weijun Zhang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing 100875, China
| | - Donghua Tian
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing 100875, China
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9
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Condén E, Rosenblad A, Wagner P, Leppert J, Ekselius L, Åslund C. Is type D personality an independent risk factor for recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients? Eur J Prev Cardiol 2017; 24:522-533. [PMID: 28071958 DOI: 10.1177/2047487316687427] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Type D personality refers to a combination of simultaneously high levels of negative affectivity and social inhibition. The present study aimed to examine whether type D personality was independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality. Design This was a prospective cohort study. Methods Utilising data from the Västmanland Myocardial Infarction Study, 946 post-acute myocardial infarction patients having data on the DS14 instrument used to measure type D personality were followed-up for recurrent myocardial infarction and all-cause mortality until 9 December 2015. Data were analysed using Cox regression, adjusted for established risk factors. Results In total, 133 (14.1%) patients suffered from type D personality. During a mean follow-up time for recurrent myocardial infarction of 5.7 (3.2) years, 166 (17.5%) patients were affected by recurrent myocardial infarction, of which 26 (15.7%) had type D personality, while during a mean follow-up time for all-cause mortality of 6.3 (2.9) years, 321 (33.9%) patients died, of which 42 (13.1%) had type D personality. After adjusting for established risk factors, type D personality was not significantly associated with recurrent myocardial infarction or all-cause mortality using any of the previously proposed methods for measuring type D personality. A weak association was found between the social inhibition part of type D personality and a decreased risk of all-cause mortality, but this association was not significant after taking missing data into account in a multiple imputation analysis. Conclusions No support was found for type D personality being independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality.
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Affiliation(s)
- Emelie Condén
- 1 Centre for Clinical Research, Uppsala University, Sweden.,2 School of Health, Care and Social Welfare, Malardalen University, Sweden
| | | | | | - Jerzy Leppert
- 1 Centre for Clinical Research, Uppsala University, Sweden
| | - Lisa Ekselius
- 3 Department of Neuroscience, Uppsala University, Sweden
| | - Cecilia Åslund
- 1 Centre for Clinical Research, Uppsala University, Sweden
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10
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Bock K, Bendstrup E, Hilberg O, Løkke A. Screening tools for evaluation of depression in Chronic Obstructive Pulmonary Disease (COPD). A systematic review. Eur Clin Respir J 2017; 4:1332931. [PMID: 28649311 PMCID: PMC5475296 DOI: 10.1080/20018525.2017.1332931] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/08/2017] [Indexed: 01/13/2023] Open
Abstract
Background: Anxiety and depression are common comorbid disorders in patients with chronic obstructive pulmonary disease (COPD), though estimates of their prevalence vary considerably. Depressive symptoms/depression are important comorbidities in COPD and an increasing interest is shown to these disorders. Depression may lead to reduced quality of life and increased morbidity and mortality. These statements underline the importance of implementing the use of screening instruments for depressive symptoms in a clinical setting. This systematic review evaluates four commonly used screening tools for depression in COPD. Furthermore we assess the prevalence of depression in COPD in the evaluated studies. Design: A literature search identified studies dealing with screening for depression in patients with COPD. We focused on the instruments: Beck Depression Inventory, Geriatric depression scale, Centre for Epidemiological Studies scale on Depression and Hospital and Anxiety Depression Scale. Results: Overall prevalence of depression was 30%. Demographic variations and severity of COPD influenced prevalence. The inter-prevalence of the four screening tools was consistent. We found a low variation between studies using the same tool. Few studies used control groups or compared the screening tool to a psychiatrist evaluation. Conclusions: This article calls for further investigation of the association between COPD and depressive symptoms. The subject is highly relevant for everyday life of patients with COPD and attention needs to be drawn to this issue in both an out- and in-patients.
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Affiliation(s)
- K. Bock
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus C, Denmark
| | - E. Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus C, Denmark
| | - O. Hilberg
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus C, Denmark
| | - A. Løkke
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus C, Denmark
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Hoogendoorn M, Feenstra TL, Asukai Y, Briggs AH, Borg S, Dal Negro RW, Hansen RN, Jansson SA, Leidl R, Risebrough N, Samyshkin Y, Wacker ME, Rutten-van Mölken MPMH. Patient Heterogeneity in Health Economic Decision Models for Chronic Obstructive Pulmonary Disease: Are Current Models Suitable to Evaluate Personalized Medicine? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:800-810. [PMID: 27712708 DOI: 10.1016/j.jval.2016.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 02/18/2016] [Accepted: 04/03/2016] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To assess how suitable current chronic obstructive pulmonary disease (COPD) cost-effectiveness models are to evaluate personalized treatment options for COPD by exploring the type of heterogeneity included in current models and by validating outcomes for subgroups of patients. METHODS A consortium of COPD modeling groups completed three tasks. First, they reported all patient characteristics included in the model and provided the level of detail in which the input parameters were specified. Second, groups simulated disease progression, mortality, quality-adjusted life-years (QALYs), and costs for hypothetical subgroups of patients that differed in terms of sex, age, smoking status, and lung function (forced expiratory volume in 1 second [FEV1] % predicted). Finally, model outcomes for exacerbations and mortality for subgroups of patients were validated against published subgroup results of two large COPD trials. RESULTS Nine COPD modeling groups participated. Most models included sex (seven), age (nine), smoking status (six), and FEV1% predicted (nine), mainly to specify disease progression and mortality. Trial results showed higher exacerbation rates for women (found in one model), higher mortality rates for men (two models), lower mortality for younger patients (four models), and higher exacerbation and mortality rates in patients with severe COPD (four models). CONCLUSIONS Most currently available COPD cost-effectiveness models are able to evaluate the cost-effectiveness of personalized treatment on the basis of sex, age, smoking, and FEV1% predicted. Treatment in COPD is, however, more likely to be personalized on the basis of clinical parameters. Two models include several clinical patient characteristics and are therefore most suitable to evaluate personalized treatment, although some important clinical parameters are still missing.
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Affiliation(s)
- Martine Hoogendoorn
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Talitha L Feenstra
- Department for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Yumi Asukai
- IMS Health, Health Economics and Outcomes Research and Real-World Evidence Solutions, London, UK
| | - Andrew H Briggs
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Sixten Borg
- The Swedish Institute for Health Economics, Lund, Sweden; Health Economics Unit, Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden; Evidera, London, UK
| | - Roberto W Dal Negro
- National Center for Respiratory Pharmacoeconomics and Pharmacoepidemiology (CESFAR), Verona, Italy
| | - Ryan N Hansen
- Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Sven-Arne Jansson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Reiner Leidl
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich, Neuherberg, Germany
| | | | - Yevgeniy Samyshkin
- IMS Health, Health Economics and Outcomes Research and Real-World Evidence Solutions, London, UK
| | - Margarethe E Wacker
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich, Neuherberg, Germany
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12
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Li X, Zhang S, Xu H, Tang X, Zhou H, Yuan J, Wang X, Qu Z, Wang F, Zhu H, Guo S, Tian D, Zhang W. Type D Personality Predicts Poor Medication Adherence in Chinese Patients with Type 2 Diabetes Mellitus: A Six-Month Follow-Up Study. PLoS One 2016; 11:e0146892. [PMID: 26894925 PMCID: PMC4760773 DOI: 10.1371/journal.pone.0146892] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/24/2015] [Indexed: 01/19/2023] Open
Abstract
Background Type D personality and medication nonadherence have been shown to be associated with poor health outcomes. Type D personality is associated with poor medication adherence in patients with coronary artery disease, myocardial infarction, and heart failure. However, the relationship between type D personality and medication adherence in patients with Type 2 Diabetes Mellitus (T2DM) remains unknown. This study aims to examine whether type D personality was associated with medication adherence in patients with T2DM. Design and Settings A follow-up study was conducted in general hospital of the People's Liberation Army in Beijing. Methods 412 T2DM patients (205 females), who were recruited by circular systematic random sampling, provided demographic and baseline data about medical information and completed measures of Type D personality. Then, 330 patients went on to complete a self-report measure of medication adherence at the sixth month after baseline data collection. Chi-square test, t tests, and hierarchical multiple regression analyses were conducted, as needed. Results Patients with type D personality were significantly more likely to have poor medication adherence (p<0.001). Type D personality predicts poor medication adherence before and after controlling for covariates when it was analyzed as a categorical variable. However, the dimensional construct of type D personality was not associated with medication adherence when analyzed as a continuous variable. Conclusion Although, as a dimensional construct, type D personality may not reflect the components of the personality associated with poor medication adherence in patients with T2DM, screening for type D personality may help to identify those who are at higher risk of poor medication adherence. Interventions, aiming to improve medication adherence, should be launched for these high-risk patients.
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Affiliation(s)
- Xuemei Li
- Clinics of Cadre, Department of Outpatient, General Hospital of the People's Liberation Army (301 Hospital), Beijing, China
| | - Shengfa Zhang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Huiwen Xu
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America
| | - Xinfeng Tang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Huixuan Zhou
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Jiaqi Yuan
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Xiaohua Wang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Zhiyong Qu
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Fugang Wang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - He Zhu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, United States of America
| | - Shuai Guo
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
| | - Donghua Tian
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
- * E-mail: (DT); (WZ)
| | - Weijun Zhang
- School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China
- * E-mail: (DT); (WZ)
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13
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Wu JR, Moser DK. Type D personality predicts poor medication adherence in patients with heart failure in the USA. Int J Behav Med 2015; 21:833-42. [PMID: 24198039 DOI: 10.1007/s12529-013-9366-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Type D (distressed) personality and medication nonadherence have been associated with poor health outcomes. Type D personality is associated with poor medication adherence in patients with coronary artery disease. However, the relationship between type D personality and medication adherence in patients with heart failure (HF) remains unknown. PURPOSE Therefore, the goal of this study was to examine the association between type D personality and medication adherence in patients with HF. METHOD This was a sub-analysis of baseline data from a randomized controlled trial with 84 patients with HF in the USA. Demographic, clinical, and psychological data were collected at baseline by interview, questionnaires, and medical record review. Type D personality was assessed using the Type D Personality Scale (DS14). Medication adherence was measured using both objective (Medication Event Monitoring System, MEMS) and self-reported (Morisky Medication Adherence Scale, MMAS-4) measures. Patients started medication adherence monitoring with the MEMS bottle at baseline and is used continuously for a month. Multiple regressions were used to explore the relationships between type D personality and medication adherence while adjusting for demographic, clinical, and psychological factors. RESULTS Patients with type D personality were more likely to have poor medication adherence. Type D personality was associated with medication adherence before and after adjusting for covariates when it was analyzed as a categorical variable. However, type D personality was not associated with medication adherence when analyzed as a dimensional construct. Negative affectivity, a component of type D personality, was associated with medication adherence. CONCLUSION As a dimensional construct, type D personality may not reflect the components of the personality associated with poor outcomes. Negative affectivity was associated with medication adherence in patients with HF. Interventions aiming to improving/enhancing medication adherence need to take into account patients with the negative affectivity component of type D personality who are at higher risk for poor medication adherence, which may lead to adverse health outcomes.
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Affiliation(s)
- Jia-Rong Wu
- School of Nursing, University of North Carolina at Chapel Hill, 435 Carrington Hall, CB# 7460, Chapel Hill, NC, 27599-7460, USA,
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14
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Wu JR, Song EK, Moser DK. Type D personality, self-efficacy, and medication adherence in patients with heart failure-A mediation analysis. Heart Lung 2015; 44:276-81. [PMID: 25979573 DOI: 10.1016/j.hrtlng.2015.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 03/19/2015] [Accepted: 03/22/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Type D personality is associated with medication non-adherence. Both Type D personality and non-adherence are predictors of poor outcomes. Self-efficacy, which is modifiable, is also associated with medication adherence. OBJECTIVES To determine the relationships among Type D personality, self-efficacy, and medication adherence in 84 heart failure patients. METHODS Self-efficacy, Type D personality, medication adherence, demographic and clinical data were collected. Hierarchical linear regression was used. RESULTS Type D patients were more likely to have lower self-efficacy (p = .023) and medication non-adherence (p = .027) than non-Type D patients. Low self-efficacy was associated with medication non-adherence (p < .001). Type D personality didn't predict medication adherence after entering self-efficacy in the model (p = .422), demonstrating mediation. CONCLUSIONS Self-efficacy mediates the relationship between Type D personality and medication adherence. Developing and applying interventions to enhance self-efficacy may help to sever the link between Type D personality and poor outcomes.
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Affiliation(s)
- Jia-Rong Wu
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC 27599, USA.
| | - Eun Kyeung Song
- University of Ulsan, College of Medicine, Department of Nursing, Ulsan, South Korea
| | - Debra K Moser
- University of Kentucky, College of Nursing, Lexington, KY 40536, USA
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15
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Lou P, Zhu Y, Chen P, Zhang P, Yu J, Wang Y, Chen N, Zhang L, Wu H, Zhao J. Interaction of depressive and anxiety symptoms on the mortality of patients with COPD: a preliminary study. COPD 2015; 11:444-50. [PMID: 25010754 DOI: 10.3109/15412555.2013.822856] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Depressive and anxiety symptoms increase the risk of death in patients with Chronic Obstructive Pulmonary Disease (COPD), but the combined effects of the two factors are unknown. PURPOSE To assess the possible interactive effects of depressive and anxiety symptoms on the death of patients with COPD. METHODS Prospective data for 7787 Chinese patients with COPD was analyzed and the deaths were recorded. Depressive and anxiety symptoms were evaluated using the Hospital Anxiety and Depression Scale. A product of depressive and anxiety symptoms was added to the logistic regression model to evaluate the multiplicative interaction, and relative excess risk of interaction (RERI), attributable proportion (AP) of interaction, and synergy index (S) were applied to evaluate the additive interaction of the two factors. Bootstrap was used to calculate 95% confidence intervals (CIs) of RERI, AP and S. RERI > 0, AP > 0, or S > 1 indicated biological interaction. RESULTS After 4 years' follow-up, the cumulative mortality was 20.0%, and the percentages of deaths in patients with depressive and anxiety symptoms were 28.5% and 30.9%, respectively. When adjusting for variables such as age, sex, disease duration, marital status, income, education level, co-morbidity, smoke status, biomass smoke, 6MWD, MRC, BMI and FEV1. the RERI, AP, and S (with 95% CIs) resulted in depression and anxiety scores of 6.54 (1.23-13.79), 0.54 (0.18-0.83), and 2.64 (1.33-4.75) respectively. CONCLUSION Interaction effects were found between depressive and anxiety symptoms on the death of patients with COPD. Patients with both depressive and anxiety symptoms have an increased risk of death from COPD.
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Affiliation(s)
- Peian Lou
- 1Department of Control and Prevention of Chronic Non-Communicable Diseases, Xuzhou Center for Disease Control and Prevention , Xuzhou, Jiangsu Province, Xuzhou , China
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16
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Maters GA, de Voogd JN, Sanderman R, Wempe JB. Predictors of all-cause mortality in patients with stable COPD: medical co-morbid conditions or high depressive symptoms. COPD 2014; 11:468-74. [PMID: 24831411 DOI: 10.3109/15412555.2014.898026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Co-morbid conditions are frequently found in patients with COPD. We evaluate the association of co-morbidities with mortality, in stable COPD. 224 patients, mean age 61.2 (± 10.00), 48.2% female, mean FEV1 1.1 (± 0.5) liters, median follow-up time 4.2 years, participated. Medical co-morbidities were scored according to the Charlson Co-morbidity Index (CCI). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS) and Symptom Checklist-90 (SCL-90). The Cox proportional hazard model was used for survival analyses. In our sample, 70% of all patients have a co-morbid medical condition or high depressive symptoms. During follow-up 51% of all patients died, and those with heart failure have the highest mortality rate (75%). Age, fat-free mass and exercise capacity were predictive factors, contrary to CCI-scores and high depressive symptoms. An unadjusted association between heart failure and survival was found. Although the presence of co-morbidities, using the CCI-score, is not related to survival, heart failure seems to have a detrimental effect on survival. Higher age and lower exercise capacity or fat-free mass predict mortality.
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Affiliation(s)
- Gemma A Maters
- 1Department of Health Sciences, Health Psychology Section, University of Groningen, University Medical Center, Groningen , The Netherlands
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17
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Atlantis E, Fahey P, Cochrane B, Smith S. Bidirectional associations between clinically relevant depression or anxiety and COPD: a systematic review and meta-analysis. Chest 2014; 144:766-777. [PMID: 23429910 DOI: 10.1378/chest.12-1911] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The longitudinal associations between depression or anxiety and COPD, and their comorbid effect on prognosis, have not been adequately addressed by previous reviews. We aimed to systematically assess these associations to inform guidelines and practice. METHODS We searched electronic databases for articles published before May 2012. Longitudinal studies in adult populations that reported an association between clinically relevant depression or anxiety and COPD, or that reported their comorbid effect on exacerbation and/or mortality, were eligible. Risk ratios (RRs) were pooled across studies using random-effects models and were verified using fixed-effects models. Heterogeneity was explored with subgroup and metaregression analyses. RESULTS Twenty-two citations yielded 16 studies on depression or anxiety as predictors of COPD outcomes (incident COPD/chronic lung disease or exacerbation) and/or mortality, in 28,759 participants followed for 1 to 8 years, and six studies on COPD as a predictor of depression in 7,439,159 participants followed for 1 to 35 years. Depression or anxiety consistently increased the risk of COPD outcomes (RR, 1.43; 95% CI, 1.22-1.68), particularly in higher-quality studies and in people aged ≤ 66 years. Comorbid depression increased the risk of mortality (RR, 1.83; 95% CI, 1.00-3.36), particularly in men. Anxiety (or psychologic distress) increased the risk of COPD outcomes/mortality in most studies (RR, 1.27; 95% CI, 1.02-1.58). Finally, COPD consistently increased the risk of depression (RR, 1.69; 95% CI, 1.45-1.96). CONCLUSIONS Depression and anxiety adversely affect prognosis in COPD, conferring an increased risk of exacerbation and possibly death. Conversely, COPD increases the risk of developing depression. These bidirectional associations suggest potential usefulness of screening for these disease combinations to direct timely therapeutic intervention.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, Campbelltown Campus, NSW, Australia.
| | - Paul Fahey
- School of Science and Health, University of Western Sydney, Campbelltown Campus, NSW, Australia
| | - Belinda Cochrane
- School of Nursing and Midwifery, Campbelltown Campus, NSW, Australia; School of Medicine, University of Western Sydney, Campbelltown Campus, NSW, Australia; Campbelltown Hospital, Department of Medicine, SLHD/SWSLHD, Campbelltown, NSW, Australia
| | - Sheree Smith
- School of Nursing and Midwifery, Campbelltown Campus, NSW, Australia; Centre for Pharmacology and Therapeutics, Division of Experimental Medicine, Imperial College, South Kensington, London, England
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18
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Williams L, O'Connor RC, Grubb NR, O'Carroll RE. Type D personality and three-month psychosocial outcomes among patients post-myocardial infarction. J Psychosom Res 2012; 72:422-6. [PMID: 22656437 DOI: 10.1016/j.jpsychores.2012.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 02/24/2012] [Accepted: 02/24/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Type D personality has been proposed as a risk factor for poor prognosis in cardiac patients. Recent studies which have adopted a dimensional approach to Type D (negative affectivity×social inhibition) found no effect of Type D on mortality, after controlling for its constituent elements. To-date, no study has determined if Type D is associated with psychosocial outcomes in post-myocardial infarction (MI) patients when conceptualised as a dimensional variable. METHODS Participants were 192 MI patients (138 males, 54 females, mean age 66.0years) who provided demographic and clinical information, and completed measures of Type D one-week post-MI. Three months later, 131 of these MI patients completed measures of disability and quality of life. RESULTS Using regression analyses, adjusted for demographic and clinical data, Type D emerged as a significant predictor of disability and quality of life in MI patients, when analysed using the traditional categorical approach. However, Type D did not predict disability and quality of life when it was analysed using the interaction of negative affectivity and social inhibition. Negative affect emerged as a significant predictor of both disability (β=.433, t(130)=3.53, p<.01), and quality of life (β=-.624, t(130)=-5.68, p<.001). CONCLUSIONS The results suggest that Type D is not associated with short-term psychosocial outcome in MI patients, after controlling for its constituent elements. However, negative affect was significantly associated with both disability and quality of life. Future research should conceptualise Type D as the interaction between negative affectivity and social inhibition, rather than as a typology.
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Affiliation(s)
- Lynn Williams
- School of Social Sciences, University of the West of Scotland, Paisley, UK.
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19
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Abrams TE, Vaughan-Sarrazin M, Van der Weg MW. Acute exacerbations of chronic obstructive pulmonary disease and the effect of existing psychiatric comorbidity on subsequent mortality. PSYCHOSOMATICS 2012; 52:441-9. [PMID: 21907063 DOI: 10.1016/j.psym.2011.03.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 03/16/2011] [Accepted: 03/17/2011] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Studies investigating associations between chronic obstructive pulmonary disease (COPD) outcomes and psychiatric comorbidity have yielded mixed findings. We examined a national sample of hospitalized COPD patients to evaluate the impact of three psychiatric conditions on mortality and readmission. METHODS Department of Veterans Affairs (VA) administrative and laboratory data were used to identify 26,591 consecutive patients admitted for COPD during October 2006 to September 2008. Associations between psychiatric comorbidity and both 30-day mortality and readmission were examined using generalized estimating equations and Cox proportional hazards regression, respectively, with adjustments for patient demographics, medical comorbidities, illness severity, and clustering within hospitals. RESULTS Unadjusted 30-day mortality was higher in patients with anxiety (5.3% vs. 3.8% [P < 0.001]) and depression (6.2% vs. 3.8% [<0.001]). In multivariable analyses, adjusted odds of 30-day mortality were higher for patients with depression (OR, 1.53; 95% CI, 1.28-1.82) and anxiety (OR, 1.72; 1.42 -2.10), but not for patients with PTSD (OR, 1.19; 0.92-1.55). Unadjusted 30-day readmission rates also varied by diagnosis; depression and PTSD were associated with lower rates of readmission (10.4% vs. 11.6% [<0.05] and 8.6% vs. 11.6% [<0.001], respectively), whereas anxiety was not (11.3% vs. 11.5% [NS]). However, after covariate adjustment using multivariable models, anxiety and depression (but not PTSD) were associated with increased risk for readmission (HR, 1.22; 1.03 -1.43 and HR, 1.35; 1.18 -1.54, respectively). CONCLUSION Comorbid anxiety and depression may have an adverse impact on COPD hospital prognosis or may be indicative of more severe illness.
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Affiliation(s)
- Thad E Abrams
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region, Iowa City VAMC, Iowa City, IA, USA.
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20
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Grande G, Romppel M, Barth J. Association Between Type D Personality and Prognosis in Patients with Cardiovascular Diseases: a Systematic Review and Meta-analysis. Ann Behav Med 2012; 43:299-310. [DOI: 10.1007/s12160-011-9339-0] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
OBJECTIVE Type D personality has been established as a predictor of adverse clinical events in patients with cardiovascular diseases. To date, all studies except one have been conducted by a single research group. Thus, the aim of our study was to provide an independent replication of the results regarding the prognostic validity of Type D personality in a German sample of cardiac patients. METHODS Cardiac patients (n = 1040) were recruited from cardiac rehabilitation centers (n = 484), an outpatient clinic (n = 249), and a university hospital (n = 307). Main analyses were based on the combined data from these three subsamples. Cardiac health status, medical risk factors, sociodemographic characteristics, psychological symptoms, and Type D personality were assessed at baseline. The primary end point was all-cause mortality. The Cox proportional hazards regression model was used to estimate the relative risk of death. RESULTS Vital status was known for 977 patients (22.5% women; mean [standard deviation] = 63.3 [10.7] years). Within the follow-up time (mean [standard deviation] = 71.5 [3.6] months), 172 patients died. Type D personality was found in 25.2% of survivors and in 22.2% of nonsurvivors (χ²= 0.78, p = .38). Depressive symptoms (p = .13) and anxiety (p = .27) were also not predictive of mortality. In the multivariate analyses, neither Type D (p = .95) nor negative affectivity (p = .71) and social inhibition (p = .59), as well as their interaction (p = .88), were associated with all-cause mortality. CONCLUSIONS In the present study, Type D personality and its constituents are not associated with increased mortality in patients with heart disease. The discrepancies with previous results deserve further investigation.
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Coyne JC, Jaarsma T, Luttik ML, van Sonderen E, van Veldhuisen DJ, Sanderman R. Lack of prognostic value of type D personality for mortality in a large sample of heart failure patients. Psychosom Med 2011; 73:557-62. [PMID: 21862826 DOI: 10.1097/psy.0b013e318227ac75] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Type D personality has been proposed as a prognostic indicator for mortality in cardiovascular disease. Most research examining this construct originates from one research group, and it is critical that the predictive value of Type D personality for adverse outcomes is independently cross-validated. This study examined its prognostic value in heart failure, relative to B-type natriuretic peptide (BNP) and depressive symptoms. METHODS We studied 706 patients with complete BNP, depressive symptom, and Type D personality and mortality data from 958 patients with heart failure enrolled after hospitalization for a multisite study of a disease management program. Multivariable models were adjusted for BNP and depression. RESULTS At 18 months, there were 192 deaths (27.2%). No evidence was found for a prognostic value of Type D personality in the unadjusted model (hazard ratio [HR] = 0.893, 95% confidence interval [CI] = 0.582-1.370). In contrast, BNP was significantly predictive of mortality (HR = 1.588, 95% CI = 1.391-1.812), whereas depression was not (HR = 1.011, 95% CI = 0.998-1.024). Type D was also not predictive in covariate-adjusted models (HR = 0.779, 95% CI = 0.489-1.242). Similar results were obtained when analyzing Type D as the interaction between continuous z scores of its two components, negative affectivity and social inhibition (p = .144). CONCLUSIONS In the largest study to date, Type D does not predict mortality. Future research should construe Type D as the interaction of continuous negative affectivity and social inhibition z scores, rather than as a typology, and consider analyses replacing negative affectivity with depression.
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Affiliation(s)
- James C Coyne
- Health Psychology Section, Department of Health Science, University Medical Center Groningen, University of Groningen, HPC FA12, PO Box 196, NL-9700 AD Groningen, The Netherlands.
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Chapman BP, Roberts B, Duberstein P. Personality and longevity: knowns, unknowns, and implications for public health and personalized medicine. J Aging Res 2011; 2011:759170. [PMID: 21766032 PMCID: PMC3134197 DOI: 10.4061/2011/759170] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 05/19/2011] [Indexed: 11/23/2022] Open
Abstract
We review evidence for links between personality traits and longevity. We provide an overview of personality for health scientists, using the primary organizing framework used in the study of personality and longevity. We then review data on various aspects of personality linked to longevity. In general, there is good evidence that higher level of conscientiousness and lower levels of hostility and Type D or "distressed" personality are associated with greater longevity. Limited evidence suggests that extraversion, openness, perceived control, and low levels of emotional suppression may be associated with longer lifespan. Findings regarding neuroticism are mixed, supporting the notion that many component(s) of neuroticism detract from life expectancy, but some components at some levels may be healthy or protective. Overall, evidence suggests various personality traits are significant predictors of longevity and points to several promising directions for further study. We conclude by discussing the implications of these links for epidemiologic research and personalized medicine and lay out a translational research agenda for integrating the psychology of individual differences into public health and medicine.
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Affiliation(s)
- Benjamin P. Chapman
- Laboratory of Personality and Development and Rochester Health Decision Making Group, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden, Rochester, NY 14607, USA
| | - Brent Roberts
- Personality Interest Group, Department of Psychology, University of Illinoi, Rochester, NY 14607, USA
| | - Paul Duberstein
- Laboratory of Personality and Development and Rochester Health Decision Making Group, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden, Rochester, NY 14607, USA
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Williams L, O'Connor RC, Grubb N, O'Carroll R. Type D personality predicts poor medication adherence in myocardial infarction patients. Psychol Health 2011; 26:703-12. [PMID: 21391133 DOI: 10.1080/08870446.2010.488265] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Type D personality, the combination of negative affectivity (NA) and social inhibition (SI), is an emerging risk factor in cardiovascular disease. This study aimed to examine one possible behavioural mechanism to explain the link between Type D and ill-health. It was hypothesised that Type D personality would predict medication adherence in myocardial infarction (MI) patients. In a prospective study, 192 MI patients (54 females and 138 males) completed measures of Type D personality and provided demographic and medical information 1 week post-MI, and then 131 patients went on to complete a self-report measure of medication adherence 3 months post-MI. It was found that Type D personality predicts adherence to medication, after controlling for demographic and clinical risk factors. Critically, the constituent components of Type D, NA and SI, interact to predict medication adherence, after controlling for the effects of each component separately. Poor adherence to medication may represent one mechanism to explain why Type D cardiac patients experience poor clinical outcome, in comparison to non-Type D patients. Interventions, which target the self-management of medication, may be useful in these high-risk patients.
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Affiliation(s)
- Lynn Williams
- School of Social Sciences, University of the West of Scotland, Paisley, UK.
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Couillard A, Veale D, Muir JF. [Comorbidities in COPD: a new challenge in clinical practice]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:143-153. [PMID: 21665077 DOI: 10.1016/j.pneumo.2010.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 04/14/2010] [Accepted: 05/25/2010] [Indexed: 05/30/2023]
Abstract
Today it is a recognised fact that chronic obstructive pulmonary disease (COPD) is a real systemic disease that is respiratory-based. Recently, the focus has been on the importance of the comorbidities that are associated with COPD, such as all the cardiovascular diseases, lung cancer, diabetes, metabolic syndrome, peripheral muscular dysfunction, depression, anxiety, osteoporosis and anaemia, etc. These comorbidities constitute a new medical and therapeutic challenge with regard to COPD; their high frequency and considerable impact on the quality of life and the prognosis for survival of the patients make them a key element. The aims of this focus are to present the spectrum and prevalence of comorbidities in COPD, to obtain an objective view as to why and how these comorbidities should be systematically assessed and treated in patients, and subsequently to discuss the impact of this new data in clinical practice and in research. This recent data is another positive step in understanding the disease, optimising the diagnosis, and assessing and caring for COPD patients.
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Affiliation(s)
- A Couillard
- Fédération Antadir, boulevard Saint- Michel, Paris, France.
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Postintensive care unit psychological burden in patients with chronic obstructive pulmonary disease and informal caregivers: A multicenter study. Crit Care Med 2011; 39:112-8. [PMID: 21037472 DOI: 10.1097/ccm.0b013e3181feb824] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the prevalence and risk factors of symptoms of anxiety, depression, and posttraumatic stress disorder-related symptoms in patients with chronic obstructive pulmonary disease and their relatives after an intensive care unit stay. DESIGN Prospective multicenter study. SETTING Nineteen French intensive care units. SUBJECTS One hundred twenty-six patients with chronic obstructive pulmonary disease who survived an intensive care unit stay and 102 relatives. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Patients and relatives were interviewed at intensive care unit discharge and 90 days later to assess symptoms of anxiety and depression using Hospital Anxiety and Depression Scale (HADS) and posttraumatic stress disorder-related symptoms using the Impact of Event Scale (IES). At intensive care unit discharge, 90% of patients recollected traumatic psychological events in the intensive care unit. At day 90, we were able to conduct telephone interviews with 53 patients and 47 relatives. Hospital Anxiety and Depression Scale scores indicated symptoms of anxiety and depression in 52% and 45.5% of patients at intensive care unit discharge and in 28.3% and 18.9% on day 90, respectively. Corresponding prevalence in relatives were 72.2% and 25.7% at intensive care unit discharge and 40.4% and 14.9% on day 90, respectively. The Impact of Event Scale indicated posttraumatic stress disorder-related symptoms in 20.7% of patients and 29.8% of relatives on day 90. Peritraumatic dissociation assessed using the Peritraumatic Dissociative Experiences Questionnaire was independently associated with posttraumatic stress disorder-related symptoms in the patients and relatives. Previous intensive care unit experience and recollection of bothersome noise in the intensive care unit predicted posttraumatic stress disorder-related symptoms in the patients. CONCLUSIONS Psychiatric symptoms were found to be common in a group of 126 patients with chronic obstructive pulmonary disease who survived an intensive care unit stay and their relatives at intensive care unit discharge and 90 days later. Peritraumatic dissociation at intensive care unit discharge was found to independently predict posttraumatic stress disorder-related symptoms in this sample of patients and relatives.
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Couillard A. Les facteurs pronostiques dans la BPCO : la tête, les jambes et le souffle ! Rev Mal Respir 2011; 28:174-86. [DOI: 10.1016/j.rmr.2010.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 09/25/2010] [Indexed: 11/15/2022]
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Denollet J, Schiffer AA, Spek V. A General Propensity to Psychological Distress Affects Cardiovascular Outcomes. Circ Cardiovasc Qual Outcomes 2010; 3:546-57. [DOI: 10.1161/circoutcomes.109.934406] [Citation(s) in RCA: 251] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Johan Denollet
- From the CoRPS–Center of Research on Psychology in Somatic diseases (J.D., A.A.S., V.S.), Tilburg University, Tilburg, The Netherlands; and the Department of Medical Psychology and Neuropsychology (A.A.S.), TweeSteden Hospital, Tilburg, The Netherlands
| | - Angélique A. Schiffer
- From the CoRPS–Center of Research on Psychology in Somatic diseases (J.D., A.A.S., V.S.), Tilburg University, Tilburg, The Netherlands; and the Department of Medical Psychology and Neuropsychology (A.A.S.), TweeSteden Hospital, Tilburg, The Netherlands
| | - Viola Spek
- From the CoRPS–Center of Research on Psychology in Somatic diseases (J.D., A.A.S., V.S.), Tilburg University, Tilburg, The Netherlands; and the Department of Medical Psychology and Neuropsychology (A.A.S.), TweeSteden Hospital, Tilburg, The Netherlands
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