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Abstract
BACKGROUND The majority of people with anxiety tend to seek help in primary care. Patients' illness perception regarding their own anxiety can influence the assessment, treatment processes, and outcomes. This cross-sectional study explored possible relationships between patients' illness perception of their anxiety and the severity of their anxiety. MATERIALS AND METHODS Ninety-five patients with anxiety were recruited at two primary care clinics in Singapore. Their responses to the generalized anxiety disorder-7 (GAD-7) and illness perception questionnaire mental health (IPQ-MH) were examined with Spearman's rho correlation coefficients and multiple regression analyses. RESULTS Four illness perception subscales, i.e., consequences (rs = 0.23), personal control (rs = -0.27), coherence (rs = -0.22), and biological (rs = 0.34) significantly correlated to anxiety (P < 0.05). A multiple regression analysis identified that attribution to biological factors (β = 0.348, P =0.001) and attribution to personal control (β = -0.262, P =0.008) were significantly associated with anxiety. CONCLUSIONS Interventions for anxiety reduction in primary care can be enhanced with methods that promote (1) patients' awareness of the reasons for their anxiety beyond mostly bodily ones to include psychosocial ones and (2) patients' confidence in their own capacity to influence their recovery.
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Affiliation(s)
| | - Mei Yin Wong
- National Healthcare Group Polyclinics, Singapore
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2
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Werchan CA, Steele AM, Janssens T, Millard MW, Ritz T. Towards an assessment of perceived COPD exacerbation triggers: Initial development and validation of a questionnaire. Respirology 2018; 24:48-54. [PMID: 30003637 DOI: 10.1111/resp.13368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 04/18/2018] [Accepted: 06/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Prevention of exacerbations in chronic obstructive pulmonary disease (COPD) is important to decrease overall declines in functioning and improve quality of life. The present study sought to develop a psychometrically valid measure of perceived triggers of exacerbations in COPD patients, the COPD Exacerbation Trigger Inventory (CETI). METHODS Participants (n = 192) were recruited through local clinics and online to complete surveys of the CETI, demographic information, disease-specific information and the COPD Assessment Test (CAT). The CETI included a free response section on patients' individual top triggers, combined with ratings of their controllability. RESULTS Exploratory principal component analyses identified a stable 5-factor structure (33 items), from which trigger subscales for weather/climate, air pollution/irritants, exercise, infection/illness and psychological factors were formed (internal consistency Cronbach's α = 0.90-0.94). Trigger factors were associated with COPD functional status, exacerbation frequency and healthcare utilization. Participants found personal triggers related to dust, air pollution, smoking and physical activity to be the most easily controlled, whereas those related to psychological factors, climate, infection, respiratory symptoms and sleep to be more difficult to control. Greater perceived controllability of triggers was associated with lower CAT scores, indicating better health status and less impact of the disease on functioning. CONCLUSION The CETI is a psychometrically valid measure of perceived exacerbation triggers in patients with COPD. Perceived triggers are associated with clinical outcomes. Assessment of trigger classes and their controllability may prove useful in both research and clinical settings with COPD patients and to further our knowledge in prevention and disease management.
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Affiliation(s)
- Chelsey A Werchan
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Ashton M Steele
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | | | - Mark W Millard
- Department of Pulmonology, Baylor University Medical Center, Dallas, TX, USA
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
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3
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Özkan Tuncay F, Fertelli T, Mollaoğlu M. Effects of loneliness on illness perception in persons with a chronic disease. J Clin Nurs 2018; 27:e1494-e1500. [DOI: 10.1111/jocn.14273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Fatma Özkan Tuncay
- Department of Medical Nursing; Health Sciences Faculty; Cumhuriyet University; Sivas Turkey
| | - Tülay Fertelli
- Department of Medical Nursing; Health Sciences Faculty; Cumhuriyet University; Sivas Turkey
| | - Mukadder Mollaoğlu
- Department of Medical Nursing; Health Sciences Faculty; Cumhuriyet University; Sivas Turkey
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4
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Arat S, De Cock D, Moons P, Vandenberghe J, Westhovens R. Modifiable correlates of illness perceptions in adults with chronic somatic conditions: A systematic review. Res Nurs Health 2018; 41:173-184. [PMID: 29315678 DOI: 10.1002/nur.21852] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 12/01/2017] [Indexed: 11/11/2022]
Abstract
When individuals become ill, they want to understand and give meaning to their illness. The interpretation of this illness experience, or illness perception, is influenced by a range of individual, contextual, and cultural factors. Some of these factors may be modifiable by nursing interventions. The purpose of this systematic review was to investigate which modifiable factors were correlated with illness perceptions across studies of adults with different chronic somatic diseases. Using search terms tailored to each of four electronic databases, studies retrieved were reviewed by two independent evaluators, and each relevant article was assessed for methodological quality. Results were standardized by calculating correlation coefficients. Fifteen papers on illness perceptions in a variety of chronic diseases met the inclusion criteria. All used standardized measures of illness perceptions. We identified five groups of modifiable correlates of illness perceptions: illness-related factors, psychosocial factors, medication beliefs, information provision and satisfaction with information received, and quality of care. Our findings add to the knowledge of modifiable factors correlated with illness perceptions, including the importance of illness-related factors and psychosocial factors such as anxiety and depression. Knowledge of these correlates can facilitate understanding of patients' illness perceptions and might be useful in tailoring patient education programs.
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Affiliation(s)
- Seher Arat
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Diederik De Cock
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium.,Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Joris Vandenberghe
- Department of Psychiatry, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium.,Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
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5
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Karataş T, Özen Ş, Kutlutürkan S. Factor Structure and Psychometric Properties of the Brief Illness Perception Questionnaire in Turkish Cancer Patients. Asia Pac J Oncol Nurs 2017; 4:77-83. [PMID: 28217734 PMCID: PMC5297237 DOI: 10.4103/2347-5625.199080] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The main aim of this study was to investigate the factor structure and psychometric properties of the Brief Illness Perception Questionnaire (BIPQ) in Turkish cancer patients. METHODS This methodological study involved 135 cancer patients. Statistical methods included confirmatory or exploratory factor analysis and Cronbach alpha coefficients for internal consistency. RESULTS The values of fit indices are within the acceptable range. The alpha coefficients for emotional illness representations, cognitive illness representations, and total scale are 0.83, 0.80, and 0.85, respectively. CONCLUSIONS The results confirm the two-factor structure of the Turkish BIPQ and demonstrate its reliability and validity.
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Affiliation(s)
- Tuğba Karataş
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Şükrü Özen
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Sevinç Kutlutürkan
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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6
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Rzadkiewicz M, Bråtas O, Espnes GA. What else should we know about experiencing COPD? A narrative review in search of patients' psychological burden alleviation. Int J Chron Obstruct Pulmon Dis 2016; 11:2295-2304. [PMID: 27695316 PMCID: PMC5033607 DOI: 10.2147/copd.s109700] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The present paper is a narrative review focusing on the psychological impact, identification of protective factors, and interventions minimizing the psychological burdens of chronic obstructive pulmonary disease (COPD). The research reviews studies on neurocognitive functions, personality, emotional problems, and health-related quality of life. This is done with regard to resources as well as activities enabling or enhancing a patient's adaptation. PubMed and PsychArticles databases were searched for relevant medical (eg, CODP, emphysema), psychopathology (eg, depression), and psychological (eg, personality) keywords, followed by hand search. After application of the inclusion and exclusion criteria, the search resulted in 82 articles and book chapters. The choice was based on evidence accepted by evidence-based medicine, although at different levels of strength. Psychological experiencing of COPD appears to be very unequally represented with scientific research on emotional problems and functioning decrease significantly outnumbering those addressing resources or effective interventions. As our initial literature search called for an urgent need for further exploration, we have carefully pointed out numerous areas where the knowledge on how to protect or restore psychological well-being among COPD patients should be broadened.
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Affiliation(s)
- Marta Rzadkiewicz
- Second Faculty of Medicine with The English Division and The Physiotherapy Division, Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Ola Bråtas
- Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir Arild Espnes
- Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
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7
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Israelsson-Skogsberg Å, Lindahl B. Personal care assistants' experiences of caring for people on home mechanical ventilation. Scand J Caring Sci 2016; 31:27-36. [PMID: 27126367 DOI: 10.1111/scs.12326] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/06/2015] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to describe personal care assistants' (PCA) experiences of working with a ventilator-assisted person at home. METHODS Data were collected from fifteen audiotaped semistructured interviews with PCAs supporting a child or adult using home mechanical ventilation (HMV). Thirteen women and two men participated; their working experience with HMV users ranged from one to 17 years (median 6 years). Data were subjected to qualitative content analysis in an inductive and interpretive manner. FINDINGS Five categories emerged from the data: Being part of a complex work situation; Taking on a multidimensional responsibility; Caring carried out in someone's home; Creating boundaries in an environment with indistinct limits; and Being close to another's body and soul. CONCLUSIONS The participants felt very close to the person they worked with, both physically and emotionally. They had a great responsibility and therefore a commensurate need for support, guidance and a well-functioning organisation around the HMV user. There is international consensus that advanced home care will continue to expand and personal care assistance is key in this development. We suggest that one way to move forward for PCAs working with HMV users is to create multiprofessional teams led by a key-person who coordinates the individual needs. More research is needed within this area from a broad perspective including the HMV-assisted persons, relatives, personal care assistants and management organisations.
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Affiliation(s)
| | - Berit Lindahl
- Borås University College, Faculty of Caring Sciences, Work Life & Social Welfare, Borås, Sweden
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8
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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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9
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van Leeuwen BM, Herruer JM, Putter H, van der Mey AGL, Kaptein AA. The art of perception: Patients drawing their vestibular schwannoma. Laryngoscope 2015; 125:2660-7. [DOI: 10.1002/lary.25386] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Bibian M. van Leeuwen
- Department of Otorhinolaryngology-Head and Neck Surgery; Leiden University Medical Center; Leiden the Netherlands
| | - Jasmijn M. Herruer
- Department of Otorhinolaryngology-Head and Neck Surgery; Leiden University Medical Center; Leiden the Netherlands
| | - Hein Putter
- Department of Medical Statistics; Leiden University Medical Center; Leiden the Netherlands
| | - Andel G. L. van der Mey
- Department of Otorhinolaryngology-Head and Neck Surgery; Leiden University Medical Center; Leiden the Netherlands
| | - Adrian A. Kaptein
- Department of Medical Psychology; Leiden University Medical Center; Leiden the Netherlands
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10
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Riley GA, Hough A, Meader LM, Brennan AJ. The course and impact of family optimism in the post-acute period after acquired brain injury. Brain Inj 2015; 29:804-12. [DOI: 10.3109/02699052.2015.1004754] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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11
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Brügger A, Aubert JD, Piot-Ziegler C. Emotions while awaiting lung transplantation: A comprehensive qualitative analysis. Health Psychol Open 2014; 1:2055102914561272. [PMID: 28070345 PMCID: PMC5193305 DOI: 10.1177/2055102914561272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Patients awaiting lung transplantation are at risk of negative emotional and physical experiences. How do they talk about emotions? Semi-structured interviews were performed (15 patients). Categorical analysis focusing on emotion-related descriptions was organized into positive–negative–neutral descriptions: for primary and secondary emotions, evaluation processes, coping strategies, personal characteristics, emotion descriptions associated with physical states, (and) contexts were listed. Patients develop different strategies to maintain positive identity and attitude, while preserving significant others from extra emotional load. Results are discussed within various theoretical and research backgrounds, in emphasizing their importance in the definition of emotional support starting from the patient’s perspective.
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12
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Howard C, Dupont S. 'The COPD breathlessness manual': a randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease. NPJ Prim Care Respir Med 2014; 24:14076. [PMID: 25322078 PMCID: PMC4373470 DOI: 10.1038/npjpcrm.2014.76] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/18/2014] [Accepted: 08/12/2014] [Indexed: 11/09/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a costly long-term condition associated with frequent Accident and Emergency (A&E) and hospital admissions. Psychological difficulties and inadequate self-management can amplify this picture. Aims: To compare a cognitive-behavioural manual versus information booklets (IB) on health service use, mood and health status. Methods: Two hundred and twenty-two COPD patients were randomly allocated to receive either the COPD breathlessness manual (CM) or IB. They were instructed to work through their programme at home, over 5 weeks. Guidance from a facilitator was provided at an initial home visit plus two telephone call follow-ups. Results: After 12 months, total A&E visits had reduced by 42% in the CM group, compared with a 16% rise in the IB group. The odds of people in the IB group attending A&E 12 months post-intervention was 1.9 times higher than for the CM group (CI 1.05–3.53). Reduction in hospital admissions and bed days were greatest in the CM group. At 6 months, there were significantly greater improvements in anxiety (F (2,198)=5.612, P=0.004), depression (F (1.8,176.1)=10.697, P⩽0.001) and dyspnoea (F (2,198)=18.170, P⩽0.001) in the CM group. Estimated savings at 12 months were greatest in the CM group, amounting to £30k or £270 per participant. Conclusion: The COPD manual, which addresses physical and mental health, is a straightforward cost-effective intervention that is worth offering to COPD patients within primary or secondary care.
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Affiliation(s)
- Claire Howard
- Department of Clinical Health Psychology, Central and North West London NHS Foundation Trust, The Hillingdon Hospital, Pield Heath Road, Uxbridge, UK
| | - Simon Dupont
- Department of Clinical Health Psychology, Central and North West London NHS Foundation Trust, The Hillingdon Hospital, Pield Heath Road, Uxbridge, UK
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13
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Borge CR, Moum T, Puline Lein M, Austegard EL, Wahl AK. Illness perception in people with chronic obstructive pulmonary disease. Scand J Psychol 2014; 55:456-63. [DOI: 10.1111/sjop.12150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 05/21/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Christine Råheim Borge
- Department of Health Sciences; University of Oslo; Norway
- Department of Medicine; Lovisenberg Diaconale Hospital; Oslo Norway
| | - Torbjørn Moum
- Department of Behavioral Sciences in Medicine; University of Oslo; Norway
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14
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Lewis A, Bruton A, Donovan-Hall M. Uncertainty prior to pulmonary rehabilitation in primary care: A phenomenological qualitative study in patients with chronic obstructive pulmonary disease. Chron Respir Dis 2014; 11:173-180. [PMID: 24980128 DOI: 10.1177/1479972314539981] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pulmonary rehabilitation (PR) is recommended for patients functionally restricted by chronic obstructive pulmonary disease (COPD). However, attendance and adherence to PR remains suboptimal. No previous research has explored COPD patient experiences during the key period from referral to initiation of PR in the United Kingdom. This research aimed to explore the lived experience of COPD patients referred to PR programmes prior to participation. COPD participants were recruited from referrals to two community PR programmes. Semi-structured interviews with COPD participants occurred following PR referral, but prior to programme initiation. Data were analyzed using applied interpretive phenomenology. Twenty-five COPD participants aged 42-90 were interviewed. 'Uncertainty' affected participants throughout their lived experience of COPD that negatively impacted illness perceptions, PR perceptions and increased participant's panic and anger. Participants who perceived COPD less as a chronic condition and more as a cyclical process experienced fewer feelings of panic or anger. The experience of uncertainty was disabling for these COPD participants. Recognition of the role that uncertainty plays in patients with COPD is the first step towards developing interventions focused on reducing this uncertainty, thereby reducing the burden of the disease for the individual patient and facilitating PR attendance.
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Affiliation(s)
- Adam Lewis
- Faculty of Health Sciences, University of Southampton, UK Solent NHS Trust, UK Respiratory Care Team, Virgin Care, Peach Portacabins, Bournewood House, St Peters Hospital, Chertsey, UK
| | - Anne Bruton
- Faculty of Health Sciences, University of Southampton, UK
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15
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Zoeckler N, Kenn K, Kuehl K, Stenzel N, Rief W. Illness perceptions predict exercise capacity and psychological well-being after pulmonary rehabilitation in COPD patients. J Psychosom Res 2014; 76:146-51. [PMID: 24439691 DOI: 10.1016/j.jpsychores.2013.11.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 11/26/2013] [Accepted: 11/29/2013] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Patients' beliefs about their disease have been associated with emotional adjustment and outcomes in several severe illnesses. The aim of the present study was to investigate whether illness perceptions before pulmonary rehabilitation influence exercise capacity and quality of life after rehabilitation in patients suffering from chronic obstructive pulmonary disease (COPD). METHODS Ninety-six patients with COPD (GOLD III/IV) were approached on admission to rehabilitation and reassessed before discharge. Assessment included medical measures of FEV% predicted, and exercise capacity (6 min walk test). Additionally, depressive symptoms (Hospital Anxiety and Depression scale), anxiety (COPD specific anxiety questionnaire) and quality of life (Short Form 36 health survey (SF-36)) were assessed. Illness beliefs were measured by the Revised Illness Perception Questionnaire (IPQ-R). RESULTS Exercise capacity and psychological well-being (SF-36) of patients improved after rehabilitation programme, while physical functioning (SF-36) did not change. Additionally, patients showed significantly lower levels of depressive symptoms, COPD specific anxiety and negative perceptions of their illness after pulmonary rehabilitation compared to baseline. In the hierarchical multiple regression analyses, after controlling for socio-demographic data, psychological variables, illness severity and baseline scores of the corresponding variables, it was shown that illness perceptions before rehabilitation predicted exercise capacity and psychological well-being, both assessed at the end of treatment. CONCLUSION COPD patients' perceptions about their illness before rehabilitation influence exercise capacity and quality of life (psychological well-being) after treatment. Therefore it might be relevant to identify and change maladaptive illness perceptions in order to improve medical and psychological outcome in COPD.
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Affiliation(s)
- Natalie Zoeckler
- Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany.
| | - Klaus Kenn
- Pulmonary Rehabilitation Centre (Schoen Klinik Berchtesgadener Land), Schoenau, Germany.
| | - Kerstin Kuehl
- Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany.
| | - Nikola Stenzel
- Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany.
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany.
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16
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Harrison S, Robertson N, Graham C, Williams J, Steiner M, Morgan M, Singh S. Can we identify patients with different illness schema following an acute exacerbation of COPD: A cluster analysis. Respir Med 2014; 108:319-28. [DOI: 10.1016/j.rmed.2013.10.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 10/18/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
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17
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Schou L, Østergaard B, Rydahl-Hansen S, Rasmussen LS, Emme C, Jakobsen AS, Phanareth K. A randomised trial of telemedicine-based treatment versus conventional hospitalisation in patients with severe COPD and exacerbation - effect on self-reported outcome. J Telemed Telecare 2013; 19:160-165. [PMID: 23612519 DOI: 10.1177/1357633x13483255] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2013] [Indexed: 11/15/2022]
Abstract
We investigated self-reported outcome in patients with COPD and exacerbation. Consecutive patients were randomised to an intervention group with home telemedicine and a control group who had conventional hospital admission. We assessed Health-Related Quality of Life (HRQoL) using the St George's Respiratory Questionnaire, daily activity using Instrumental Activity of Daily Living, anxiety and depression using the Hospital Anxiety and Depression Scale, and self-assessed cognitive decline using Subjective Cognitive Functioning. Data were collected at 3 days, 6 weeks and 3 months after discharge. There were 22 patients in each group. Their baseline characteristics were similar: a mean age of 70 years, FEV1 42% predicted and oxygen saturation 95%. After 6 weeks, FEV1 had improved in both groups, to 1.2 L in the intervention group and 1.0 L in the control group. Oxygen saturation had improved in the intervention group from 94% to 96%. Regarding HRQoL, there was a non-significant (P = 0.05) improvement in the symptom score in favour of the control group, but the improvement was not maintained after three months. However, there were no significant differences in self-reported outcomes in COPD patients with exacerbation treated at home via telemedicine versus conventionally in hospital.
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Affiliation(s)
- Lone Schou
- Telemedicine Research Unit, Frederiksberg University Hospital, Copenhagen, Denmark
| | - Birte Østergaard
- Research Unit of Nursing, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Susan Rydahl-Hansen
- Research Unit of Clinical Nursing, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Lars S Rasmussen
- Department of Anesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University Hospital of Copenhagen, Østerbro, Denmark
| | - Christina Emme
- Research Unit of Clinical Nursing, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Anna Svarre Jakobsen
- Research Unit of Clinical Nursing, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Klaus Phanareth
- Telemedicine Research Unit, Frederiksberg University Hospital, Copenhagen, Denmark
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18
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Hallas CN, Howard C, Theadom A, Wray J. Negative beliefs about breathlessness increases panic for patients with chronic respiratory disease. PSYCHOL HEALTH MED 2012; 17:467-77. [PMID: 22329594 DOI: 10.1080/13548506.2011.626434] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Breathlessness is a multidimensional symptom of respiratory disease and is associated with the experience of panic. Patients with panic disorder have increased mortality, morbidity and healthcare utilisation that is unrelated to their disease severity. Our qualitative study aimed to appraise respiratory patients' experiences of breathlessness and whether their cognitions were associated with panic aetiology. The self-regulatory theory was utilised to develop the framework for the semi-structured interview schedule. Twelve individuals with respiratory disease at a U.K. cardiothoracic centre participated and their data were analysed using interpretative phenomenological analysis. Perceived control over the disease, symptoms and panic emerged as the core theme with three related belief systems; (1) Perceived consequences of panic and disease; (2) Illness and symptom coherence; and (3) Emotional adaptation. Panic symptoms were most prevalent in participants with low perceived control over symptoms and the disease, negative beliefs about the life-limiting consequences of unpredictable breathless attacks and by those using emotional coping strategies such as denial and avoidance. The experience of panic for respiratory patients can be explained through the cognitive-behavioural model of anxiety, which highlights the contributory role of catastrophic beliefs about the control and consequences of symptoms and disease as a significant contributory factor for the prevalence and maintenance of panic. The mortality and morbidity of respiratory patients is significantly affected by a co-morbid diagnosis of panic disorder and so it is critical to patients' long-term healthcare that their psychological experiences are assessed. Healthcare services must enhance patients' understanding about their disease to improve their confidence to control symptoms. Recent evidence suggests that cognitive-behavioural interventions that increase problem-solving coping will reduce catastrophic misinterpretations about the perceived consequences of breathlessness and improve emotional adaption to respiratory disease.
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Affiliation(s)
- Claire N Hallas
- Department of Rehabilitation and Therapies, Royal Brompton & Harefield NHS Trust, Middlesex, UK.
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Spitzer C, Gläser S, Grabe HJ, Ewert R, Barnow S, Felix SB, Freyberger HJ, Völzke H, Koch B, Schäper C. Mental health problems, obstructive lung disease and lung function: findings from the general population. J Psychosom Res 2011; 71:174-9. [PMID: 21843753 DOI: 10.1016/j.jpsychores.2011.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 03/02/2011] [Accepted: 03/15/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is cumulative evidence for a strong association of obstructive lung disease, i.e. asthma and COPD, with poor mental health, particularly with anxiety disorders and major depression. However, studies relating mental health problems to objective measures of lung function as assessed by spirometry are lacking. METHODS The 12-month prevalence of specific psychopathological syndromes among 1772 adults from the general population was estimated by a structured interview. Additionally, participants underwent spirometry and were asked about obstructive lung disease in the year prior to the study. Logistic and linear regression models were used to relate obstructive lung disease and spirometrically defined airway obstruction to mental health problems. RESULTS Mental health problems were found in 35.7% of the participants. After adjusted for sociodemographic, clinical and life-style factors, asthma and chronic bronchitis were associated with almost all domains of mental health problems. In contrast, independent of its definition, spirometric airflow limitation was only related to generalized anxiety (odds ratios ranging from 2.3 to 2.7). A reduced ratio of forced expiratory volume in one second to forced vital capacity was associated with mental health problems in general and panic and general anxiety in particular. CONCLUSION Our findings suggest an association of objective measure of airflow limitation to generalized anxiety and panic. While the causal relationship between obstructive lung disease, airflow limitation and anxiety remains to be determined, clinicians should pay diagnostic attention to the significant overlap of these conditions.
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Affiliation(s)
- Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany.
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20
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Attributions about cause of illness in chronic obstructive pulmonary disease. J Psychosom Res 2011; 70:465-72. [PMID: 21511077 PMCID: PMC3081443 DOI: 10.1016/j.jpsychores.2010.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 09/29/2010] [Accepted: 10/02/2010] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Patients' beliefs about the causes of their illness have been associated with emotional adjustment and behavioral outcomes in several medical conditions; however, few studies have examined illness attributions among patients with chronic obstructive pulmonary disease (COPD). In the current study, patterns of patients' causal attributions for COPD were identified and examined in relation to health behaviors and symptoms. METHOD Three-hundred and ninety-four patients with COPD and >10 pack year history of smoking completed a self-report questionnaire that included the Illness Perception Questionnaire-Revised (IPQ-R). RESULTS A factor analysis of the IPQ-R cause items using principal axis factoring yielded four individual items (i.e., smoking, heredity, pollution, and personal behavior) and one large factor that was primarily driven by psychological attributions. Ninety-three percent of patients agreed or strongly agreed that smoking was a cause of their COPD. Higher scores on the large IPQ-R factor were associated with reduced quality of life (r=.25, P<.001) and symptoms of anxiety (r=.33, P<.001) and depression (r=.31, P<.001), indicating that patients who attributed their COPD to psychological factors were more likely to have poorer emotional adjustment and quality of life. CONCLUSIONS Our finding of one large factor with several stand-alone items is in contrast with previous research that has derived a multifactor structure for the cause items of the IPQ-R in other chronic illness populations. This difference may be due to the importance of smoking, environmental exposures, and heredity in the development of COPD. Future research should expand upon these specific attributions in COPD.
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Fischer M, Scharloo M, Abbink J, 't Hul A, Ranst D, Rudolphus A, Weinman J, Rabe K, Kaptein AA. The dynamics of illness perceptions: Testing assumptions of Leventhal's common-sense model in a pulmonary rehabilitation setting. Br J Health Psychol 2010; 15:887-903. [DOI: 10.1348/135910710x492693] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Howard C, Dupont S, Haselden B, Lynch J, Wills P. The effectiveness of a group cognitive-behavioural breathlessness intervention on health status, mood and hospital admissions in elderly patients with chronic obstructive pulmonary disease. PSYCHOL HEALTH MED 2010; 15:371-85. [DOI: 10.1080/13548506.2010.482142] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Padilha JMDSC. Influência da percepção da doença pulmonar obstrutiva crónica na promoção do autocontrolo da doença. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010; 16:641-8. [DOI: 10.1016/s0873-2159(15)30058-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Livermore N, Sharpe L, McKenzie D. Panic attacks and panic disorder in chronic obstructive pulmonary disease: a cognitive behavioral perspective. Respir Med 2010; 104:1246-53. [PMID: 20457513 DOI: 10.1016/j.rmed.2010.04.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 04/02/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022]
Abstract
The prevalence of panic disorder in patients with chronic obstructive pulmonary disease (COPD) is up to 10 times greater than the overall population prevalence of 1.5-3.5%, and panic attacks are commonly experienced. When present, clinically significant anxiety decreases quality of life for COPD patients, and also increases health care costs. Therefore, understanding why COPD patients have such high rates of panic attacks and panic disorder is important for optimal management of COPD. The cognitive model of panic anxiety is the most widely accepted theory of panic attacks and panic disorder in physically healthy adults. According to this model, panic attacks occur when catastrophic misinterpretations of ambiguous physical sensations (such as shortness of breath or increased heart rate) increase arousal, creating a positive feedback loop that results in panic. As the major symptom of a terminal illness that threatens our most basic physical requirement, dyspnea in COPD is open to catastrophic misinterpretation. There is some experimental and clinical evidence for the applicability of the cognitive model of panic anxiety in COPD, and of the utility of cognitive behavior therapy (CBT), based on this model, for treating anxiety symptoms and panic attacks in COPD patients. However, there is much need for further studies. Evidence is increasing that mental health professionals, in collaboration with multi-disciplinary pulmonary teams, potentially have key roles to play in preventing and treating panic attacks and panic disorder in COPD patients. This review addresses diagnosis, epidemiology, theoretical conceptualizations, treatment, and recommendations for future research.
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Affiliation(s)
- Nicole Livermore
- Department of Liaison Psychiatry, Prince of Wales Hospital, Sydney, Australia.
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Abstract
Chronic lung diseases continue to be common and cause significant morbidity and mortality. There is a complex interplay between psychiatric issues and pulmonary diseases. This review aims to summarize the recent literature and advances involving psychiatric aspects of lung diseases, including chronic obstructive pulmonary disease, asthma, restrictive lung disease, and cystic fibrosis. The authors include the latest findings in epidemiology, impact, etiology, screening, and management of psychiatric and pulmonary comorbidity. The relationship between mental health and lung disease, as it is between mental health and other physical illnesses, is multifactorial. Further studies continue to clarify issues and treatment guidelines for this comorbidity.
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Affiliation(s)
- Abhishek Jain
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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