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Vieira DSR, Del Moro CV, Pscheidt SL, Junkes-Cunha M, Judice MM, Arcencio L, Yohannes AM. Anxiety Inventory for Respiratory Disease: Cross-Cultural Adaptation and Semantic Validity of the Brazilian Version for Individuals with Chronic Obstructive Pulmonary Disease. J Multidiscip Healthc 2024; 17:3283-3293. [PMID: 39010932 PMCID: PMC11247127 DOI: 10.2147/jmdh.s464961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/17/2024] [Indexed: 07/17/2024] Open
Abstract
Background Most instruments available to screen for anxiety in people with chronic obstructive pulmonary disease (COPD) are not disease specific. Therefore, the Anxiety Inventory for Respiratory Disease (AIR) was developed to measure anxiety for this patient group; however, it requires cross-cultural adaptation for use in non-English speaking countries. Purpose To carry out cross-cultural adaptation of the AIR scale for Brazilian patients with COPD and to analyze its semantic validity. Patients and Methods This methodological study followed six stages: 1) Initial translation by two independent translators fluent in English; 2) Synthesis of translations; 3) Back translation by two English first language translators; 4) Expert committee review (eight healthcare professionals, a methodologist, the translators, and back-translators); 5) Pre-final version evaluation with 30 patients with COPD through a cognitive interview; and 6) Submission of documents. Semantic validity was analyzed by agreement rate and content validity index (CVI) for the committee equivalence assessments. Results 1) Initial translation: the two translated versions presented eight divergences; 2) Synthesis of translations: the differences were discussed to reach consensus; 3) Back-translation: there were no important inconsistencies; 4) Expert Committee: the experts proposed eight and the instrument developer proposed three changes, which were analyzed and voted on, resulting in the pre-final version; 5) Evaluation of the pre-final version: data collection allowed for other changes and the formulation of instructions by applying the adapted instrument in an interview format. Patients rated the questions as clear or very clear; 6) The expert committee and the developer approved the final documents. The agreement rate and CVI were ≥ 0.80 for all items of the scale final version. Conclusion The process of cross-cultural adaptation followed all necessary stages and the semantic validity results were adequate, providing the Brazilian version of the AIR to assess anxiety symptoms in patients with COPD.
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Affiliation(s)
| | - Cintia Vieira Del Moro
- Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Araranguá, SC, Brazil
| | - Sabrina Leal Pscheidt
- Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Araranguá, SC, Brazil
| | - Maíra Junkes-Cunha
- Department of Gymnastics and Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | | | - Livia Arcencio
- Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Araranguá, SC, Brazil
| | - Abebaw Mengistu Yohannes
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Ali SH, Meltzer G, DiClemente RJ, Islam NS, Yi SS, Yang LH, Misra S. How Shared Dietary Behaviors Within Asian American Families Are Influenced by Emotional Interaction Qualities: A Nationwide Cross-sectional Analysis. Int J Behav Med 2024:10.1007/s12529-024-10303-4. [PMID: 38867005 DOI: 10.1007/s12529-024-10303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Asian American (AA) young adults face a looming diet-related non-communicable disease crisis. Interactions with family members are pivotal in the lives of AA young adults and form the basis of family-based interventions; however, little is known on the role of these interactions in shared family food behaviors. Through an analysis of 2021 nationwide survey data of 18-35-year-old AAs, this study examines how the quality of family member interactions associates with changes in shared food purchasing, preparation, and consumption. METHOD Interaction quality was assessed through 41 emotions experienced while interacting with family, and was categorized as positive (e.g., "I look forward to it"), negative (e.g., "I feel annoyed"), and appreciation-related (e.g., "I feel respected") interactions. Participants were also asked how frequently they ate meals, ate out, grocery shopped, and cooked with their family. RESULTS Among the 535 AAs surveyed (47.6% East Asian, 21.4% South Asian, 22.6% Southeast Asian), 842 unique family interactions were analyzed; 43.5% of interactions were with mothers, followed by siblings (27.1%), and fathers (18.5%). Participants most frequently ate meals with their family (at least daily for 33.5% of participants), followed by cooking (at least daily for 11.3%). In adjusted analyses, an increase in shared food behaviors was particularly associated with positive interactions, although most strongly with cooking together and least strongly with eating meals together; significant differences between ethnic subgroups were not observed. CONCLUSION Findings revealed the importance of family interaction quality when leveraging family relationships to develop more tailored, impactful AA young adult dietary interventions.
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Affiliation(s)
- Shahmir H Ali
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA.
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Gabriella Meltzer
- Department of Environmental Health, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA
| | - Nadia S Islam
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Stella S Yi
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA
| | - Supriya Misra
- Department of Public Health, San Francisco State University, San Francisco, CA, USA
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3
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Miao X, Han Y, Wu Z, Jin X, Niu M, Zhao Q, Lu X. Reliability, Validity, Modification and Expansion of the Chinese Version of the Disease-Specific Anxiety Questionnaire for Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2024; 19:1047-1060. [PMID: 38765767 PMCID: PMC11102147 DOI: 10.2147/copd.s455171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose To translate a disease-specific anxiety questionnaire on chronic obstructive pulmonary disease (COPD) and test its reliability and validity in China. Patients and Methods The German version of the revised COPD Anxiety Questionnaire (CAF-R) was initially validated using step-by-step translation, back-translation, and cross-cultural adaptation. The reliability and validity of the Chinese version of the CAF-R (CAF-R-CN) were tested among 448 patients with COPD (mean age =71.42±9.33 years, 17.2% female) from four medical institutions in Suzhou, Jiangsu Province, using convenience sampling, from April 2022 to June 2023. Results The CAF-R-CN included six dimensions with a total of 25 items. The item-level content validity index was 0.860-1.000; the scale-level content validity index was 0.920. The structural validity χ2/df was 2.326, the root mean square error of approximation was 0.077, the comparative fit index was 0.924, and the Tucker-Lewis index was 0.912. The six-dimensional internal consistency index Cronbach's α coefficient was 0.696-0.910, and the test-retest reliability was 0.949. An optimal cut-off score of 50.5 was selected with a sensitivity of 0.786 and specificity of 0.870. Conclusion The CAF-R-CN had satisfactory reliability and validity and can be used to identify and assess anxiety in COPD patients with a Chinese cultural background.
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Affiliation(s)
- XiaoLang Miao
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Yanxia Han
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Zhenyun Wu
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Xiaoliang Jin
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Mei’e Niu
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Qian Zhao
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Xiangmin Lu
- School of Nursing, Soochow University, Suzhou, People’s Republic of China
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Yohannes AM. Anxiety and post-traumatic stress disorders in patients with chronic respiratory diseases. Curr Opin Support Palliat Care 2023; 17:290-295. [PMID: 37877447 DOI: 10.1097/spc.0000000000000670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
PURPOSE OF REVIEW This brief critical review evaluates recent research on the impact of anxiety disorders and post-traumatic stress disorders (PTSD) on patients with chronic obstructive pulmonary disease (COPD) and asthma. In these patients, untreated anxiety and PTSD exacerbate acute symptoms, increase disability and impair quality of life. Therefore, effective interventions are also reviewed. RECENT FINDINGS Anxiety disorders and PTSD are prevalent in COPD and asthma, worsen symptoms in acute exacerbations, and increase morbidity and healthcare utilization. Pulmonary rehabilitation (PR), cognitive behavioural therapy and pharmacological therapy are each effective in COPD patients with anxiety or PTSD. However, very little work examined therapy for combined anxiety and PTSD in patients with either COPD or asthma. SUMMARY Despite the high prevalence of anxiety disorder or PTSD in patients with chronic respiratory diseases, a paucity of literature remains demonstrating the efficacy of pharmacological therapies for these conditions. This review highlights the promising benefits of PR on anxiety, but prospective trials are needed to demonstrate the efficacy of interventions with PTSD alone, or with concomitant anxiety.
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Christiansen CF, Løkke A, Bregnballe V, Prior TS, Farver-Vestergaard I. COPD-Related Anxiety: A Systematic Review of Patient Perspectives. Int J Chron Obstruct Pulmon Dis 2023; 18:1031-1046. [PMID: 37304765 PMCID: PMC10257401 DOI: 10.2147/copd.s404701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
Background Anxiety in patients with chronic obstructive pulmonary disease (COPD) is prevalent but often unidentified and therefore not adequately managed. Clinicians find it difficult to detect anxiety symptoms and to differentiate subclinical anxiety from anxiety disorders, because of the considerable overlap between symptoms of COPD and anxiety. Purpose We synthesized existing qualitative research on patients' experiences of COPD-related anxiety with the purpose of gaining a richer understanding and proposing a model of the construct. Methods Searches for qualitative studies of patients' experiences of COPD-related anxiety were conducted independently by two authors in the databases of PubMed (MEDLINE), CINAHL (EBSCO), and PsycInfo (APA). English-language studies including patients diagnosed with COPD were reviewed, and data were analyzed using thematic analysis. Results A total of 41 studies were included in the review. Four themes related to COPD-related anxiety were identified: initial events; internal maintaining factors; external maintaining factors; and behavioral maintaining factors. Based on the identified four themes, a conceptual model of COPD-related anxiety from the patient perspective was developed. Conclusion A conceptual model of COPD-related anxiety from the patient perspective is now available, with the potential to inform future attempts at improving identification and management of COPD-related anxiety. Future research should focus on the development of a COPD-specific anxiety questionnaire containing domains that are relevant from the patient perspective.
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Affiliation(s)
- Camilla F Christiansen
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Thomas Skovhus Prior
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Ingeborg Farver-Vestergaard
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Uikey MS, Dayal P. Association Between Comorbid Psychiatric Disorders and Persistent Smoking After a Diagnosis of Chronic Obstructive Pulmonary Disease Among Patients Seeking Treatment at a Tertiary Care Hospital in India. Cureus 2023; 15:e37688. [PMID: 37206529 PMCID: PMC10191065 DOI: 10.7759/cureus.37688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction Smoking cessation is the most effective approach to slowing down the progression of chronic obstructive pulmonary disease (COPD). Despite this, almost half of COPD patients continue to smoke after diagnosis. COPD patients with current smoking status are more likely to have concurrent psychiatric comorbidities, for instance, depression and anxiety. These psychiatric disorders can contribute to the persistence of smoking in individuals with COPD. This study aimed to investigate predictors of smoking persistence in COPD patients. Materials and methods A cross-sectional study was conducted in the Outpatient Department (OPD) of the Department of Pulmonary Medicine in a tertiary care hospital from August 2018 to July 2019. Patients with COPD were screened for their smoking status. All subjects were then personally assessed for any psychiatric comorbidity using the Mini International Neuropsychiatric Interview (MINI), the Patient Health Questionnaire-9 (PHQ-9), and the Anxiety Inventory for Respiratory (AIR) Disease. Logistic regression was performed to compute the odds ratio (OR). Results The study included a total of 87 COPD patients. Of the 87 COPD patients, 50 were current smokers, and 37 were past smokers. COPD patients with psychiatric disorders were four times more likely to continue smoking than those without psychiatric comorbidities (OR: 4.62, 95% CI: 1.46-14.54). The results showed that increasing PHQ-9 scores by one unit in COPD patients increased the likelihood of continuing to smoke by 27 percent. Conclusion In our multivariate analysis, current depression was found as a significant predictor of continued smoking in COPD patients. The present results are consistent with reports from previous research that depressive symptoms are associated with continued smoking in patients with COPD. COPD patients who are currently smoking should be examined for psychiatric disorders and treated concurrently to achieve effective smoking cessation.
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Affiliation(s)
- Mahendra S Uikey
- Psychiatry, All India Institute of Medical Sciences, New Delhi, IND
| | - Prabhoo Dayal
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, IND
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Volpato E, Farver-Vestergaard I, Brighton LJ, Peters J, Verkleij M, Hutchinson A, Heijmans M, von Leupoldt A. Nonpharmacological management of psychological distress in people with COPD. Eur Respir Rev 2023; 32:32/167/220170. [PMID: 36948501 PMCID: PMC10032611 DOI: 10.1183/16000617.0170-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/31/2022] [Indexed: 03/24/2023] Open
Abstract
Psychological distress is prevalent in people with COPD and relates to a worse course of disease. It often remains unrecognised and untreated, intensifying the burden on patients, carers and healthcare systems. Nonpharmacological management strategies have been suggested as important elements to manage psychological distress in COPD. Therefore, this review presents instruments for detecting psychological distress in COPD and provides an overview of available nonpharmacological management strategies together with available scientific evidence for their presumed benefits in COPD. Several instruments are available for detecting psychological distress in COPD, including simple questions, questionnaires and clinical diagnostic interviews, but their implementation in clinical practice is limited and heterogeneous. Moreover, various nonpharmacological management options are available for COPD, ranging from specific cognitive behavioural therapy (CBT) to multi-component pulmonary rehabilitation (PR) programmes. These interventions vary substantially in their specific content, intensity and duration across studies. Similarly, available evidence regarding their efficacy varies significantly, with the strongest evidence currently for CBT or PR. Further randomised controlled trials are needed with larger, culturally diverse samples and long-term follow-ups. Moreover, effective nonpharmacological interventions should be implemented more in the clinical routine. Respective barriers for patients, caregivers, clinicians, healthcare systems and research need to be overcome.
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Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Shared first authorship
| | | | - Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeannette Peters
- Department of Pulmonary Diseases, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marieke Verkleij
- Department of Paediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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8
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Dayal P, Uikey MS. Psychometric Validity of the Anxiety Inventory for Respiratory Disease (AIR) Scale in an Indian Sample of Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study. Cureus 2023; 15:e36241. [PMID: 37065399 PMCID: PMC10104423 DOI: 10.7759/cureus.36241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction Researchers have found that chronic obstructive pulmonary disease (COPD) patients suffer from anxiety more than the general population. The Anxiety Inventory for Respiratory Disease (AIR) scale has been primarily used to assess non-somatic anxiety in COPD patients. The validity of AIR among COPD patients has not been evaluated in Indian settings. Therefore, this study was undertaken to determine the validity of AIR in these patients. The study aimed to evaluate concurrent criterion and discriminative validity of the AIR screening scale among patients with COPD using Mini International Neuropsychiatric Interview (MINI) 7.0.2 as the gold standard measure for diagnosing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) anxiety disorders. Materials and methods A cross-sectional study was conducted in the Outpatients Department (OPD) of the Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, from August 2018 to July 2019. A total of 100 patients diagnosed with COPD and aged 30 or above were recruited. All participants were further assessed in person by a psychiatry resident doctor using semi-structured proforma, MINI 7.0.2, and AIR Disease (Hindi). Mann-Whitney U and receiver operating characteristic (ROC) curves were conducted. The two-sided p-value of less than 0.05 was considered to be statistically significant. Results To assess the concurrent criterion validity of the AIR scale for screening clinical anxiety disorders, the ROC curve was constructed using MINI diagnoses of anxiety disorder as the gold standard measure. A cut-off score of 5.5 was found to maximize both the specificity and sensitivity of the AIR scale for screening anxiety disorders among COPD patients with COPD. The AIR scale showed a high sensitivity (95%) and specificity (89%) at this cut-point. Conclusion The findings of this study recommend a cut-off score of 5.5 on the AIR scale instead of 8 in previous studies, as maintaining the previously recommended cut-offs in Indian settings may lead to an increase in false negatives. This could have negative consequences for patients seeking treatment. Further studies may be planned to explore the psychometric properties of the current tool in a larger population.
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Rahi MS, Thilagar B, Balaji S, Prabhakaran SY, Mudgal M, Rajoo S, Yella PR, Satija P, Zagorulko A, Gunasekaran K. The Impact of Anxiety and Depression in Chronic Obstructive Pulmonary Disease. Adv Respir Med 2023; 91:123-134. [PMID: 36960961 PMCID: PMC10037643 DOI: 10.3390/arm91020011] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
Patients with COPD (chronic obstructive pulmonary disease) are at a higher risk of comorbid conditions such as anxiety and/or depression, which in turn increase their symptom burden and rehospitalizations compared to the general population. It is important to investigate the pathophysiology and clinical implications of mental health on patients with COPD. This review article finds that COPD patients with anxiety and/or depression have a higher rehospitalization incidence. It reviews the current screening and diagnosis methods available. There are pharmacological and non-pharmacologic interventions available for treatment of COPD patients with depression based on severity. COPD patients with mild depression benefit from pulmonary rehabilitation and cognitive behavioral therapy, whereas patients with severe or persistent depression can be treated with pharmacologic interventions.
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Affiliation(s)
- Mandeep Singh Rahi
- Department of Pulmonary and Critical Care Medicine, Yale New Haven Health, Lawrence + Memorial Hospital, New London, CT 06320, USA
| | - Bright Thilagar
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Swetha Balaji
- Division of Endocrinology and Metabolism, Department of Medicine, University of Illinois, Chicago, IL 60607, USA
| | | | - Mayuri Mudgal
- Department of Medicine, Camden Clark Medical Center, School of Medicine, West Virginia University, Parkersburg, WV 26101, USA
| | - Suganiya Rajoo
- Department of Hematology and Oncology, WakeMed, Raleigh Campus, Raleigh, NC 27610, USA
| | - Prashanth Reddy Yella
- Department of Internal Medicine, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA
| | - Palak Satija
- Department of Internal Medicine, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA
| | - Alsu Zagorulko
- Department of Psychiatry, Illinois Center for Neurological and Behavioral Medicine, Des Plaines, IL 60016, USA
| | - Kulothungan Gunasekaran
- Department of Pulmonary Diseases and Critical Care, Yuma Regional Medical Center, Yuma, AZ 85364, USA
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Aldhahi MI, Baattaiah BA, Nazer RI, Albarrati A. Impact of Psychological Factors on Functional Performance among Patients with Chronic Obstructive Pulmonary Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1285. [PMID: 36674041 PMCID: PMC9859091 DOI: 10.3390/ijerph20021285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
The role of anxiety and depression in functional performance during walking in patients with chronic obstructive pulmonary disease (COPD) is controversial. In this cross-sectional study, we aimed to assess the effects of anxiety, depression, and health-related quality of life (HRQOL) on the functional performance of this patient population. Seventy COPD patients aged 63 ± 11 years participated in the study. To measure their functional performance, the six-minute walk test (6MWT) was used. Anxiety and depression were assessed using two questionnaires: the Anxiety Inventory for Respiratory Disease (AIR) scale and the Hospital Anxiety and Depression Scale (HADS). The St. George’s Respiratory Questionnaire (SGRQ) was used to assess HRQOL. Based on their anxiety levels, the patients were divided into a no anxiety group and a high anxiety group. There were no significant differences between the two groups in terms of pulmonary function profile or smoking status. The mean AIR and HADS (depression) scores were high (12.78 ± 4.07 and 9.90 ± 3.41, respectively). More than one-third of the patients (46%) reported high anxiety levels (above the standard cutoff score of 8). The mean score of the aggregated HADS scale was significantly higher in the high anxiety group (20.87 ± 6.13) than in the no anxiety group (9.26 ± 4.72; p = 0.01). Patients with high anxiety had poorer functional performance (6MWT: 308.75 ± 120.16 m) and HRQOL (SGRQ: 56.54 ± 22.36) than patients with no anxiety (6MWT: 373.76 ± 106.56 m; SGRQ: 42.90 ± 24.76; p < 0.01). The final multivariate model explained 33% of the variance in functional performance after controlling for COPD severity (F = 8.97). The results suggest that anxiety, depression, and poor health status are significantly associated with poor functional performance. This study highlights the need to screen patients with COPD at all stages for anxiety and depression.
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Affiliation(s)
- Monira I. Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Baian A. Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Rakan I. Nazer
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ali Albarrati
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
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11
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Albarrati A, Alzahrani M, Alnahdi AH, Taher M, Alqahtani MM, Nazer RI. Psychometric properties of the Arabic version of the anxiety inventory for respiratory disease in patients with COPD. Disabil Rehabil 2022; 44:7297-7303. [PMID: 34686081 DOI: 10.1080/09638288.2021.1983039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The Anxiety Inventory for Respiratory Disease (AIR) is a reliable and valid scale for examining the anxiety in patients with COPD. This study aimed to cross-culturally adapt and translate the original AIR scale into the Arabic language and to examine its reliability and validity in Arab patients with COPD. MATERIAL AND METHODS This was a validation study conducted on 70 Arabic patients with COPD. The AIR-A and the Hospital Anxiety and Depression Scale (HADS) were completed on the first assessment. After two weeks, 55 patients completed the AIR-A scale again. The reliability was assessed by Cronbach's α and intraclass correlation coefficients (ICC2,1). Exploratory factor analysis (EFA), and the confirmatory factor analysis (CFA) were used to measure the structural validity. The construct validity was also explored. RESULTS The AIR-A questionnaire had a Cronbach's α of 0.91 and ICC2,1 of 0.86. The EFA revealed that the AIR-A was unidimensional. The CFA showed the single-factor model required minor modifications to reach the best fit. The AIR-A was correlated with the HADS- anxiety (r = 0.89, p < 0.001). CONCLUSION The Arabic version of AIR scale is reliable, and valid for assessing the anxiety disorder in Arabic speaking patients with COPD worldwide.Implications for PracticeThe Arabic version of AIR will be useful for examining anxiety in Arabic speaking patients with COPD worldwide.The Arabic version of AIR will help clinicians to monitor the effect of interventions in Arabic speaking patients with COPD who suffer from anxiety.The Arabic version of AIR assess only the anxiety.
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Affiliation(s)
- Ali Albarrati
- Department of Rehabilitation Science, College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alzahrani
- Department of Physical Therapy, King Fahad General Hospital, Albaha, Ministry of Health, Kingdom of Saudi Arabia
| | - Ali H Alnahdi
- Department of Rehabilitation Science, College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Taher
- Department of Rehabilitation Science, College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Physical Therapy Department, Cairo University, Cairo, Egypt
| | | | - Rakan I Nazer
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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12
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Farver-Vestergaard I, Rubio-Rask S, Timm S, Christiansen CF, Hilberg O, Løkke A. Disease-Specific Anxiety in Chronic Obstructive Pulmonary Disease: Translation and Initial Validation of a Questionnaire. Front Psychol 2022; 13:907939. [PMID: 35865679 PMCID: PMC9294537 DOI: 10.3389/fpsyg.2022.907939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Commonly applied measures of symptoms of anxiety are not sensitive to disease-specific anxiety in patients with chronic obstructive pulmonary disease (COPD). There is a need for validated instruments measuring COPD-specific anxiety. Therefore, we translated the COPD-Anxiety Questionnaire (CAF) into Danish (CAF-R-DK) and performed an initial validation of the psychometric properties in a sample of patients with COPD. Materials and Methods Translation procedures followed the World Health Organization guidelines. Participants with COPD completed questionnaires measuring COPD-specific anxiety (CAF-R-DK), general psychological distress (Hospital Anxiety and Depression Scale) as well as variables related to COPD (COPD Assessment Test; modified Medical Research Council dyspnea scale), quality of life (the 12-item Short Form survey, SF12), and socio-demography. Results A total of 260 patients with COPD (mean age: 65.0, 69% female) completed questionnaires. The Danish version of CAF-R-DK demonstrated acceptable Cronbach’s α values that were comparable with those of the original CAF. As expected, the CAF-R-DK showed positive correlations with convergent constructs (CAT; HADS) and negative correlations with discriminant constructs (SF-12). However, the results for specific subdomains of the CAF-R-DK indicated inconsistency in the underlying concept of disease-specific anxiety, which was also suggested based on the subsequent confirmatory and exploratory factor analyzes. Conclusion The CAF could serve as an important supplement to generic psychological distress screening of patients with COPD in somatic health care settings, and the questionnaire is now available in Danish. Translation into other languages is needed with the purpose of obtaining data for further testing the psychometric properties of the questionnaire.
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Affiliation(s)
| | | | - Signe Timm
- Research Unit, Lillebaelt Hospital, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Ole Hilberg
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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13
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Yohannes AM, Jin JW, Kunik ME. Benefit-Risk Assessment of Psychotropic Drugs in Older Patients with Chronic Obstructive Pulmonary Disease. Drugs Aging 2022; 39:323-332. [PMID: 35437683 DOI: 10.1007/s40266-022-00935-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 01/04/2023]
Abstract
Depression, anxiety, and other mental health disorders, including bipolar disorder and schizophrenia, occur commonly in older adults with chronic obstructive pulmonary disease (COPD), and they are often inadequately treated. We review the available evidence for benefits and risks of pharmacologic treatments (e.g. selective serotonin reuptake inhibitors [SSRIs], serotonin-noradrenaline reuptake inhibitors [SNRIs], tricyclic antidepressants [TCAs], antipsychotic drugs, and benzodiazepines) for common mental illnesses in older persons with COPD. Evidence to use both SSRIs/SNRIs and TCAs from randomized controlled trials is uncertain for treating major depression in patients with COPD. However, population-based findings indicate that they are widely used, and this valuable intervention (preferably SSRIs/SNRIs) should not be denied for selected patients after evaluating potential risks and benefits, especially patients presenting with major depression and suicidal ideation, when a collaborative-care approach is being used. Although there is some evidence for the short-term use of benzodiazepines for treating insomnia, breathlessness, and anxiety in patients with COPD, their long-term use should be closely monitored or avoided to reduce the increased rate of major adverse events. Currently, there are only limited data on the use of antipsychotic drugs for managing schizophrenia or bipolar disorder in older patients with COPD. Hence, clinicians should use extra caution when prescribing antipsychotic agents and be vigilant for symptoms of acute respiratory failure and other adverse effects. Psychotropic medications are clearly beneficial for younger, healthy persons with depression and anxiety; however, the risk-benefit calculation is not so clear for treating psychological problems, schizophrenia, and bipolar disorder in older adults with COPD, given older-adult sensitivity to medications and the mixed findings of relatively few controlled trials.
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Affiliation(s)
- Abebaw Mengistu Yohannes
- Department of Physical Therapy, Azusa Pacific University, 701 East Foothill Boulevard, Azusa, CA, 91702, USA.
| | - Jeff W Jin
- McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Mark E Kunik
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- South Central Mental Illness Research, Education, and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, TX, USA
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14
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Yohannes AM, Casaburi R, Dryden S S, Hanania NA. Predictors of premature discontinuation and prevalence of dropouts from a pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease. Respir Med 2022; 193:106742. [DOI: 10.1016/j.rmed.2022.106742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 12/30/2022]
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15
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Larsen CH, Bendstrup E, Neergaard MA. Screening Tools for Depression and Anxiety in Patients with Chronic Obstructive Pulmonary Disease - A Systematic Review. COPD 2021; 18:683-689. [PMID: 34486457 DOI: 10.1080/15412555.2021.1972091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The diagnosis of depression or anxiety is often difficult to establish in patients with Chronic Obstructive Pulmonary Disease (COPD) as many physical symptoms are shared. There is no consensus on a screening tool for depression and anxiety in patients with COPD. The aim of this systematic review is to review screening tools for depression and anxiety suitable for application among patients with COPD in the clinical setting. A systematic review was made using predefined search terms and eligibility criteria. Of 274 initially screened articles, seven studies were found eligible. Three depression screening tools (BASDEC, BDI-II and HADS-D) had a sensitivity of 100% and a specificity >85%. The best performing anxiety screening tool (GAI) had a sensitivity of 86% and a specificity of 78%. Three screening tools had acceptable psychometric properties according to sensitivity and specificity to detect depression among patients with COPD, but the screening tools for anxiety were of less quality. Further research in and validation of the screening tools is needed to recommend one specific tool.
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Affiliation(s)
- C H Larsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - E Bendstrup
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - M A Neergaard
- Palliative Care Unit, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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16
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Chakeri A, Rostami Qadi M, Haghani S. Comparison of Anxiety Levels in Patients with Coronavirus Disease (COVID-19) and their Families. BIONATURA 2021. [DOI: 10.21931/rb/2021.06.03.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Very little research has been done on the anxiety of the families of patients with covid-19. Considering the vital role of the family in the continuation of supportive-psychological therapies and the direct impact on the patient's anxiety level, in this study, we examined the anxiety level of the family of patients with Covid-19 and compared their with their patient's anxiety level. In this comparative study, the samples were 60 people who were given a definitive diagnosis of covid-19 in selected hospitals (Masih Daneshvari Hospital and Besat Hospital). From the family members, the person who, according to the patient, is most affected and has an emotional relationship with him (spouse-father-mother-child) was selected. The standard Spielberger Anxiety Questionnaire has been used to measure apparent (state) and hidden (trait) anxiety. The questionnaire was completed by both groups (patient-family) and compared with each other. The mean of evident anxiety in patients and caregivers was 70.82 and 74.2, respectively, which this difference was statistically significant (P = 0.023). It is also observed that the mean of hidden anxiety in patients and caregivers was 68.83 and 74.71, respectively, which the mean of hidden anxiety in patients was significantly less than caregivers (P = 0.006). After identifying anxiety, nurses can better and more effectively deal with these unwanted conditions in the patient and her family by providing appropriate and correct education.
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Affiliation(s)
- Azin Chakeri
- Correspond author, Department of Nursing, Garmsar branch, Islamic Azad University, Garmsar, Iran
| | - Maryam Rostami Qadi
- Department of nursing sari bu-Ali sina Therapeutic and Education center Mazandaran University of medical science, Sari, Iran
| | - Shima Haghani
- Master of Biostatistics, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
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17
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Volpato E, Toniolo S, Pagnini F, Banfi P. The Relationship Between Anxiety, Depression and Treatment Adherence in Chronic Obstructive Pulmonary Disease: A Systematic Review. Int J Chron Obstruct Pulmon Dis 2021; 16:2001-2021. [PMID: 34262270 PMCID: PMC8275112 DOI: 10.2147/copd.s313841] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/01/2021] [Indexed: 01/04/2023] Open
Abstract
Background Almost half of the people with chronic obstructive pulmonary disease (COPD) do not adhere to the prescribed treatments and report anxiety and depression as comorbidities, resulting in higher rates of exacerbations, hospitalizations, and worse clinical outcomes. Objective This systematic review provided a synthesis of studies about the relationships between anxiety, depression, and adherence in people affected by COPD. Methods English language publications were searched in the PUBMED, SCOPUS, PsycInfo, Web of Science, PsycArticles, and Cochrane Library databases from December 2020 to March 2021, following PRISMA guidelines. The reference lists of eligible studies and other relevant systematic reviews were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently. The reference lists of eligible studies and other relevant systematic reviews were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently. Results A total of 34 studies (23 quantitative and 2 qualitative studies, 9 reviews) were included. The relationship between depression and treatment adherence was significant and negative. Adherence to both rehabilitation, psychological, and antidepressant pharmacological treatments in depressed patients was linked to a decreased risk of hospitalization. Moreover, depressed patients compliant with an antidepressant were more likely to adherent to COPD maintenance inhalers. On the other hand, the associations between anxiety and adherence were poorly investigated and high heterogeneity characterized the studies, leading to a weak and variable relationship as well as too few interventions. Conclusion The systematic review highlights the variability in estimates of the relationship between depression, anxiety, and treatment adherence in COPD. It could be explained by methodological differences across the included studies. This suggests that standardization is critical to improving the precision of the estimates. Recommendations for future research include attention to causal inferences, an exploration of mechanisms to explain the relationships between both anxiety and depression and adherence in COPD, and a comprehensive, systematic approach.
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Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Heart-Respiratory Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Stefania Toniolo
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Paolo Banfi
- Heart-Respiratory Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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18
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Wang YY, Yan JC, Li CY, Zhong L, Sun Y, Fu LL. Development and preliminary validation of a self-rating anxiety inventory for maintenance haemodialysis patients. PSYCHOL HEALTH MED 2021; 27:1482-1494. [PMID: 33602028 DOI: 10.1080/13548506.2021.1890159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to develop a self-rating anxiety inventory for maintenance haemodialysis patients (AI-MHD) and perform preliminary validation to provide a simple, effective, and highly specific practical tool for effective anxiety disorder screening in haemodialysis patients. Based on existing general anxiety disorder screening scales and common symptoms of MHD patients as a reference and after expert discussions and preliminary validation at a single dialysis centre, a self-rating AI-MHD containing 12 items was developed. Subsequently, the AI-MHD was applied in 4 dialysis centres and compared with GAD-7 and HADS-A. Further multicentre validation showed that Cronbach's alpha for the scale was 0.918; the AI-MHD score not only significantly differed between the anxiety disorders group and the non-anxiety disorders group (p<0.001) but also correlated with GAD-7 and HADS-A scores (p<0.001). In addition, the Kaiser-Meyer-Olkin (KMO) score was 0.847, and Bartlett's test of sphericity was significant (x2=849.45, p<0.001). The anxiety disorder detection rate was 93%, and the specificity was 90%, which were significantly better than the screening results using the GAD-7 and HADS-A scales in the same groups. Although there were limitations, such as the sample size and regionality, the AI-MHD showed good efficacy and reliability in rating anxiety in MHD patients.
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Affiliation(s)
- Yun Yan Wang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Chuan Yan
- Neurology Center, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chun Yin Li
- Department of Nephrology, The Third People's Hospital of Chongqing, Chongqing, China
| | - Ling Zhong
- Department of Nephrology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yan Sun
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Li Fu
- Department of Nephrology, Daping Hospital, Third Military Medical University, Chongqing, China
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19
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Yohannes AM, N Eakin M, Holbrook JT, Sugar EA, Henderson R, Baker AM, Casper AS, Kaminsky DA, Rea AL, Mathews AM, Que LG, Ramsdell JW, Gerald LB, Wise RA, Hanania NA. Association of mild cognitive impairment and characteristic of COPD and overall health status in a cohort study. Expert Rev Respir Med 2020; 15:153-159. [PMID: 33054443 DOI: 10.1080/17476348.2021.1838278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: We evaluated risk factors and demographic characteristics of associated with mild cognitive impairment (MCI) in patients with COPD. Methods: 220 individuals with COPD enrolled in a cohort study designed to evaluate anxiety conducted at 16 clinical centers. Cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA), a cutoff score of <26 defined as MCI. Data were collected including spirometry, 6-minute walk test, symptom burden by COPD Assessment Test and dyspnea by Modified Medical Research Council, anxiety measured by Anxiety Inventory of Respiratory Disease, Generalized Anxiety Disorder-7 and Hospital Anxiety Depression Scale, depression by Patient Health Questionnaire-9 and health status by Patient Reported Outcomes Measurement Information System and sleep quality by the Pittsburg Sleep Quality Index. Results: The median age was 65 years and 54% of participants were male. 119(54%) of participants had MCI as classified by MoCA. In multivariable logistic regression, higher odds ratios (OR) (95% confidence interval) for MCI (MoCA) <26 were associated with increased years of age, 1.06 (1.02 -1-09, p<0.003); African-American race, 3.68(1.67-8.11, p<0.001); persistent phlegm, 2 (1.12-3.57, p<0.01) and sleep disturbance, 1.04(1.01-1.08, p<0.01). Conclusions: COPD patients commonly screen positive for MCI. Characteristics associated with MCI included age, African-American race, sleep disturbance and persistent phlegm.
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Affiliation(s)
- Abebaw M Yohannes
- Department of Physical Therapy, School of Behavioral and Applied Sciences, Azusa Pacific University , Azusa, United States
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine , Baltimore, USA
| | - Janet T Holbrook
- Johns Hopkins Bloomberg School of Public Health , Baltimore, USA
| | | | - Robert Henderson
- Johns Hopkins Bloomberg School of Public Health , Baltimore, USA
| | - Anna M Baker
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine , Baltimore, USA
| | - Anne S Casper
- Johns Hopkins Bloomberg School of Public Health , Baltimore, USA
| | - David A Kaminsky
- Section of Pulmonary Medicine, University of Vermont Larner College of Medicine , Burlington, United States
| | - Alexis L Rea
- Johns Hopkins Bloomberg School of Public Health , Baltimore, USA
| | - Anne M Mathews
- Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine Pulmonary Division , Durham, USA
| | - Loretta G Que
- Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine Pulmonary Division , Durham, USA
| | - Joe W Ramsdell
- Division of Internal Medicine, The University of California San Diego , San Diego, USA
| | - Lynn B Gerald
- Department of Asthma and Airway Disease Research Center, Mel & Enid Zuckerman College of Public Health and the Asthma and Airway Disease Research Center, the University of Arizona , Tucson, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine , Baltimore, USA
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine , Houston, United States
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20
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Yohannes AM, Dryden S, Casaburi R, Hanania NA. Long-Term Benefits of Pulmonary Rehabilitation in Patients With COPD: A 2-Year Follow-Up Study. Chest 2020; 159:967-974. [PMID: 33098829 DOI: 10.1016/j.chest.2020.10.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 09/27/2020] [Accepted: 10/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) improves exercise capacity in patients with COPD in the short term. RESEARCH QUESTION In patients with COPD, does 8 weeks of PR confer long-term benefits on symptoms of dyspnea, anxiety, and depression, and on quality of life, 2 years after completion? STUDY DESIGN AND METHODS One hundred and sixty-five patients with COPD completed an 8-week, community-based, comprehensive PR program, comprising 2-h sessions twice weekly. Sessions included aerobic exercise and an educational program. Patients were encouraged to perform daily walking exercise up to 30 min at home. We evaluated a number of outcome measures at baseline, 8 weeks, and 2 years, including the following: dyspnea measured with the modified Medical Research Council (mMRC) questionnaire, quality of life assessed with the St. George's Respiratory Questionnaire (SGRQ), and anxiety measured with the Anxiety Inventory for Respiratory Disease (AIR) and the Depression Anxiety Stress Scale (DASS). In addition, we measured exercise capacity, using the Incremental Shuttle Walk Test (ISWT), at baseline and 8 weeks. RESULTS Mean age (SD) was 72 (8.6) years; 55% were men. At 8 weeks, improvements in mMRC, SGRQ, ISWT, DASS, and AIR were all statistically significant (P < .001). During the 2-year follow-up, changes observed at 8 weeks were maintained for anxiety symptoms, and for symptoms, impact, and total SGRQ scores. In multivariate analysis, initial elevated levels of dyspnea, depression, anxiety, and decreased exercise capacity predicted greater quality of life improvement at 2 years (all P < .001). INTERPRETATION Over a 2-year period, an effective 8-week PR program provides sustained improvement in anxiety and quality of life. Short-term improvements in dyspnea, depression, and stress symptoms at 8 weeks were not maintained at 2 years.
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Affiliation(s)
- Abebaw M Yohannes
- Department of Physical Therapy, Azusa Pacific University, Azusa, CA.
| | - Sheila Dryden
- St. Annes Primary Care Center, Lytham, Lancashire, United Kingdom
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX
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21
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Alipour A, Ghadami A, Farsham A, Dorri N. A New Self-Reported Assessment Measure for COVID-19 Anxiety Scale (CDAS) in Iran: A Web-Based Study. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1316-1323. [PMID: 33083298 PMCID: PMC7548505 DOI: 10.18502/ijph.v49i7.3585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Given the epidemic of Corona disease and its associated anxiety, it is necessary to develop a tool to measure anxiety. This study was conducted to instruct Corona Disease Anxiety Scale (CDAS) to measure the level of anxiety, during the prevalence of the COVID-19 in Iran. Methods: The present study was considered as applied research in terms of purpose and descriptive-correlational research in terms of methodological. 318 individuals (aged from 18 to 60 years old) completed the Corona Disease Anxiety Scale (CDAS) and the General Health Questionnaire (GHQ) online Results: Corona Disease Anxiety Scale had a good internal consistency (α=0.91) and good convergent validity, correlating with the GHQ-28 (r=0.49, P>0.01). Exploratory analysis revealed psychological and physical factors. These 2 factor account for 51% of the total variance and 9 items were loaded on every factor. Conclusion: This scale is reliable and valid scale for measuring Corona anxiety in non-clinical Iranian population.
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Affiliation(s)
- Ahmad Alipour
- Department of Psychology, Payame Noor University, Tehran, Iran
| | - Abolfazl Ghadami
- Department of Assessment and Measurement, Allameh Tabatabai University, Tehran, Iran
| | - Aida Farsham
- Department of Psychology, School of Health Psychology, University of Tehran, Tehran, Iran
| | - Negin Dorri
- Department of Psychology, School of Health Psychology, University of Tehran, Tehran, Iran
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22
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Chakeri A, Jalali E, Ghadi MR, Mohamadi M. Evaluating the effect of nurse-led telephone follow-ups (tele-nursing) on the anxiety levels in people with coronavirus. J Family Med Prim Care 2020; 9:5351-5354. [PMID: 33409214 PMCID: PMC7773123 DOI: 10.4103/jfmpc.jfmpc_847_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/14/2020] [Accepted: 07/27/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Nowadays, the prevalence of coronary heart disease has challenged the lives of families around the world. Anxiety is one of the most important consequences of coronavirus. The nurse-led telephone follow-ups (tele-nursing) are a way to train nurses to further improve nursing services and increase the patients' well-being. The aim of this study was to determine the effect of nurse-led telephone follow-ups (tele-nursing) on the level of anxiety of people with coronavirus who spend their quarantine and treatment at home. METHODS In this semi-experimental study, the number of sample was 100 newly diagnosed patients with Corona, who were tested positive using the CT scan of the lungs and were selected by continuous sampling. In this study, Spielberger's state-trait anxiety inventory was used to collect data before and after the intervention. Samples were randomly divided into control and intervention groups (50 subjects in each group) after receiving initial training in the form of lectures on the corona disease, and the tele-nursing program was implemented on the intervention group every other day for 21 consecutive days. Finally, after the end of the 21st day and the completion of the tele-nursing intervention, the questionnaire was again completed by the control and intervention groups and the results of both groups were compared. RESULTS The results indicated that the level of anxiety in the two groups after the training program and tele-nursing were significantly different (p < 0.001) and the mean score of the anxiety level after the training program and tele-nursing was significantly reduced (p < 0.001). CONCLUSION This study showed that tele-nursing has had a significant effect on reducing the anxiety level of people with Cavid-19 virus. As the telephone technology is available in most clients' homes and its use is easy and accessible, it is recommend including this technology in the field of nursing care and training especially in relation to people with coronavirus.
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Affiliation(s)
- Azin Chakeri
- Department of Nursing, Garmsar Branch, Islamic Azad University, Garmsar, Iran
| | - Ehsan Jalali
- Department of Nursing, Garmsar Branch, Islamic Azad University, Garmsar, Iran
| | - Maryam Rostami Ghadi
- Department of Nursing Sari Bu-Ali Sina Therapeutic and Education Center Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Mohamadi
- Department of Nursing, Garmsar Branch, Islamic Azad University, Garmsar, Iran
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Belief in a just world, health-related quality of life, and mental health among Chinese patients with chronic obstructive pulmonary disease. Qual Life Res 2020; 30:157-167. [PMID: 32865697 DOI: 10.1007/s11136-020-02619-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Personal belief in a just world (PBJW) has been demonstrated to protect mental health. However, whether general belief in a just world (GBJW) serves adaptive functions for mental health across different groups and cultures remains unclear. This study explored the effects of PBJW and GBJW on mental health and moderating effects of PBJW and GBJW on the relation between health-related quality of life and mental health among patients with chronic obstructive pulmonary disease (COPD) in China. METHODS A total of 147 patients with COPD (90.5% male; mean age = 64.44 years) completed measures of health-related quality of life, depression, anxiety, PBJW, and GBJW and provided pulmonary function data. RESULTS Younger age and female sex were related to higher depression; female sex, living with others, and high financial burden were associated with higher anxiety. Worse health-related quality of life and lower PBJW were associated with higher depression and anxiety. An interaction between health-related quality of life and BJW was revealed. For patients with low PBJW, lower health-related quality of life was correlated with higher depression. For patients with stronger endorsement of GBJW, worse health-related quality of life was associated with higher depression and anxiety, but the variance of anxiety caused by interaction was insignificant. CONCLUSIONS The findings suggest that for patients with COPD experiencing health deterioration, holding strong PBJW but weak GBJW may be beneficial for mental health. Our study advances our understanding of the different functions of PBJW and GBJW in mental health across different groups and cultures.
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24
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Oleynick C. Recurrent episodes of hypercapnic respiratory failure triggered by panic attacks in a patient with chronic obstructive pulmonary disease. Respir Med Case Rep 2020; 30:101044. [PMID: 32257794 PMCID: PMC7118310 DOI: 10.1016/j.rmcr.2020.101044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 11/27/2022] Open
Abstract
A 67-year old female with moderate chronic obstructive pulmonary disease (COPD) and generalized anxiety disorder presents with three episodes of severe hypercapnic respiratory failure over the previous three months without a clear precipitant that were treated with invasive and non-invasive ventilation. These episodes were labelled as acute exacerbations of COPD, however she lacked any typical features or triggers and responded faster than expected to treatment and she underwent extensive investigations to identify an alternative etiology. While admitted and under observation, she became extremely anxious, began to hyperventilate and went into hypercapnic respiratory failure, which was successfully aborted with sublingual lorazepam causing resolution of tachypnea. It became clear that the patient was suffering from panic attacks as the precipitant for her respiratory failure and she was successfully treated with psychiatric medication and breakthrough anxiolytics. Anxiety and panic disorders are more prevalent in patients with COPD than the general population and effective management is important as patient's with anxiety and COPD have worse clinical outcomes than with COPD alone. Additionally, panic attacks should be considered as an etiology for hypercapnic respiratory failure in patients with COPD and anxiety when the clinical presentation is atypical.
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Yohannes AM, Dryden S, Hanania NA. The responsiveness of the Manchester Chronic Obstructive Pulmonary Disease Fatigue Scale to pulmonary rehabilitation. Ther Adv Chronic Dis 2019; 10:2040622319882206. [PMID: 31695862 PMCID: PMC6820178 DOI: 10.1177/2040622319882206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/04/2019] [Indexed: 01/08/2023] Open
Abstract
Background: We examined the responsiveness of the Manchester Chronic Obstructive Pulmonary Disease (COPD) Fatigue Scale (MCFS) in patients with COPD following 8 weeks of pulmonary rehabilitation (PR). Methods: Patients (n = 273) with clinically stable COPD completed 8 weeks of outpatient multidisciplinary PR, comprising 2 h (1 h exercise and 1 h education) weekly. Anxiety, exercise capacity, quality of life, dyspnea, fatigue were measured pre- and post-PR, utilizing the Anxiety Inventory for Respiratory Disease (AIR), Incremental Shuttle Walk Test (ISWT), St. George’s Respiratory Questionnaire (SGRQ), and modified Medical Research Council (mMRC) scale and MCFS, respectively. Results: The mean (SD) age of participants was 72 (8) years, and 50% were women. Total MCFS score fell after PR mean (95% confidence interval) −4.89 (–7.90 to −3.79) as did domain scores: physical −1.89 (–2.33 to −1.46), cognition −1.37 (–1.65 to −1.09), and psychosocial −1.62 (–2.00 to −1.62). Total MCFS effect size (ES) was 0.55; and for domains, physical was 0.52, cognition was 0.59, and psychosocial was 0.51. The ES for AIR was 0.30, mMRC was 0.38, SGRQ was 0.66, and ISWT was 1.19. MCFS changes correlated with changes in both SGRQ (p < 0.002) and AIR (p < 0.004), but not ISWT (p = 0.30) or mMRC (p = 0.18). The AIR, SGRQ, mMRC, and ISWT all improved after PR (all, p < 0.001). Conclusion: The MCFS scale is a valid and responsive scale to measure fatigue in patients with COPD after pulmonary rehabilitation.
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Affiliation(s)
- Abebaw Mengistu Yohannes
- Department of Physiotherapy, School of Behavioral and Applied Sciences, Azusa Pacific University, 701 East Foothill Boulevard, Azusa, CA 91702-7000, USA
| | - Sheila Dryden
- Lytham St. Annes Primary Care Center, Lancashire, UK
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Zareifopoulos N, Bellou A, Spiropoulou A, Spiropoulos K. Prevalence, Contribution to Disease Burden and Management of Comorbid Depression and Anxiety in Chronic Obstructive Pulmonary Disease: A Narrative Review. COPD 2019; 16:406-417. [DOI: 10.1080/15412555.2019.1679102] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Nicholas Zareifopoulos
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
| | - Aggeliki Bellou
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
| | - Agathi Spiropoulou
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
| | - Kostas Spiropoulos
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
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Hanania NA, O'Donnell DE. Activity-related dyspnea in chronic obstructive pulmonary disease: physical and psychological consequences, unmet needs, and future directions. Int J Chron Obstruct Pulmon Dis 2019; 14:1127-1138. [PMID: 31213793 PMCID: PMC6538882 DOI: 10.2147/copd.s188141] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/01/2019] [Indexed: 12/27/2022] Open
Abstract
Dyspnea is a distressing, debilitating, and near-ubiquitous symptom affecting patients with COPD. In addition to the functional consequences of dyspnea, which include activity limitation and reduced exercise tolerance, it is important to consider its psychological impact on patients with COPD, such as onset of depression or anxiety. Moreover, the anticipation of dyspnea itself can have a significant effect on patients' emotions and behavior, with patients frequently self-limiting physical activity to avoid what has become the hallmark symptom of COPD. Dyspnea is, therefore, a key target for COPD treatments. Pharmacologic treatments can optimize respiratory mechanics, provide symptom relief, and reduce patients' increased inspiratory neural drive to breathe. However, it is important to acknowledge the value of non-pharmacologic interventions, such as pulmonary rehabilitation and patient self-management education, which have proven to be invaluable tools for targeting the affective components of dyspnea. Furthermore, it is important to encourage maintenance of physical activity to optimize long-term patient outcomes. Here, we review the physiological and psychological consequences of activity-related dyspnea in COPD, assess the efficacy of modern management strategies in improving this common respiratory symptom, and discuss key unmet clinical and research needs that warrant further immediate attention.
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Affiliation(s)
- Nicola A Hanania
- Department of Medicine, Section of Pulmonary and Critical Care, Baylor College of Medicine, Houston, TX, USA
| | - Denis E O'Donnell
- Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Houben-Wilke S, Triest FJJ, Franssen FM, Janssen DJ, Wouters EF, Vanfleteren LE. Revealing Methodological Challenges in Chronic Obstructive Pulmonary Disease Studies Assessing Comorbidities: A Narrative Review. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2019; 6:166-177. [PMID: 30974051 PMCID: PMC6596435 DOI: 10.15326/jcopdf.6.2.2018.0145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2018] [Indexed: 12/11/2022]
Abstract
Beyond respiratory impairment, patients with chronic obstructive pulmonary disease (COPD) often suffer from comorbidities which are associated with worse health status, higher health care costs and worse prognosis. Reported prevalences of comorbidities largely differ between studies which might be explained by different assessment methods (objective assessment, self-reported assessment, or assessment by medical records), heterogeneous study populations, inappropriate control groups, incomparable methodologies, etc. This narrative review demonstrates and further evaluates the variability in prevalence of several comorbidities in patients with COPD and control individuals and discusses several shortcomings and pitfalls which need to be considered when interpreting comorbidity data. Like in other chronic organ diseases, the accurate diagnosis and integrated management of comorbidities is a key for outcome in COPD. This review highlights that there is a need to move from the starting point of an established index disease towards the concept of the development of multimorbidity in the elderly including COPD as an important and highly prevalent pulmonary component.
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Affiliation(s)
- Sarah Houben-Wilke
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Filip J. J. Triest
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frits M.E. Franssen
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Centre of Expertise for Palliative Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daisy J.A. Janssen
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Centre of Expertise for Palliative Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Emiel F.M. Wouters
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lowie E.G.W. Vanfleteren
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
- COPD Center, Sahlgrenska University Hospital and Institute of Medicine, Gothenburg University, Gothenburg, Sweden
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Cohen JN, Gopal A, Roberts KJ, Anderson E, Siegel AM. Ventilator-Dependent Patients Successfully Weaned With Cognitive-Behavioral Therapy: A Case Series. PSYCHOSOMATICS 2019; 60:612-619. [PMID: 31327505 DOI: 10.1016/j.psym.2019.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Jonah N Cohen
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
| | - Arun Gopal
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Karsten J Roberts
- Department of Respiratory Care Services, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Eleanor Anderson
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Andrew M Siegel
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Turon H, Carey M, Boyes A, Hobden B, Dilworth S, Sanson-Fisher R. Agreement between a single-item measure of anxiety and depression and the Hospital Anxiety and Depression Scale: A cross-sectional study. PLoS One 2019; 14:e0210111. [PMID: 30608969 PMCID: PMC6319715 DOI: 10.1371/journal.pone.0210111] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/16/2018] [Indexed: 11/18/2022] Open
Abstract
Anxiety and depression can be heightened among individuals living with chronic diseases. Identifying these individuals is necessary for ensuring they are provided with adequate support. Traditional tools such as clinical interviews or symptom checklists are not always feasible to implement in practice. Robust single-item questions may be a useful alternative. This study aimed to measure agreement, sensitivity, specificity, positive predictive value and negative predictive value of a single-item question about anxiety and depression compared to the widely used Hospital Anxiety and Depression Scale (HADS). A cross-sectional survey of 2,811 people with cancer attending 19 treatment centres in Australia. Patients were approached in the waiting room prior to an outpatient clinic appointment and invited to complete a pen and paper survey. Participants completed the HADS as well as 2 single-items asking if they have felt anxious or depressed in the last week. The single-items for anxiety and depression each demonstrated moderate levels of sensitivity (0.78 for anxiety; 0.63 for depression) and specificity (0.75 for anxiety; 0.84 for depression) against the relevant HADS subscale. Positive predictive values were moderate (0.53 for anxiety and 0.52 for depression) while negative predictive values were high for both single-item questions (0.90 for anxiety and 0.89 for depression). The single-item measures of anxiety and depression may be useful to rule out individuals who do not require further psychological assessment or intervention for anxiety and depression. Further research is needed to explore whether these findings generalise to other chronic diseases.
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Affiliation(s)
- Heidi Turon
- Health Behaviour Research Collaborative, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Mariko Carey
- Health Behaviour Research Collaborative, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Allison Boyes
- Health Behaviour Research Collaborative, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Bree Hobden
- Health Behaviour Research Collaborative, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Sophie Dilworth
- Health Behaviour Research Collaborative, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Yohannes AM, Dryden S, Hanania NA. Validity and Responsiveness of the Depression Anxiety Stress Scales-21 (DASS-21) in COPD. Chest 2018; 155:1166-1177. [PMID: 30594559 DOI: 10.1016/j.chest.2018.12.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We examined the validity and responsiveness of the Depression Anxiety and Stress Scales-21 (DASS-21) in patients with COPD following an 8-week pulmonary rehabilitation program (PRP). METHODS Five hundred and fifty-seven patients with clinically stable COPD completed an 8-week outpatient multidisciplinary PRP, comprising 2 h (1 h of exercise and 1 h of education) per week. Anxiety, exercise capacity, quality of life, and dyspnea were measured pre- and post-PRP, utilizing the Anxiety Inventory for Respiratory Disease, Incremental Shuttle Walk Test, St. George's Respiratory Questionnaire, and modified Medical Research Council dyspnea scale, respectively. In addition, we administered the DASS-21 to assess both the validity and responsiveness of this tool compared with other, well-established metrics. RESULTS The mean (SD) age of participants was 71.6 (9.4) years, and 49% were women. The DASS-21 reflected responsiveness to pulmonary rehabilitation. Among participants with a high depression score (> 9), the depression subscale score fell from 18.62 pre-PRP to 13.12 post-PRP (P < .001). Similarly, among participants with a high anxiety score (> 7), the anxiety subscale fell from 14.60 pre-PRP to 10.99 post-PRP (P < .001). Likewise, among participants with a high stress score (> 14), the stress subscale score fell from 23.51 pre-PRP to 16.34 post-PRP (P < .001). Among these subsamples, the effect size was medium at 0.49 for depression and 0.54 for anxiety, and large at 0.81 for stress. The change in DASS-21 subset (depression, anxiety, and stress) correlated with the change in total SGRQ score, at P < .001. CONCLUSIONS The DASS-21 has acceptable validity and is a responsive scale for use in PRP in patients with COPD.
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Affiliation(s)
- Abebaw M Yohannes
- Department of Physical Therapy, Azusa Pacific University, Azusa, CA.
| | - Sheila Dryden
- Lytham St. Annes Primary Care Centre, Lancashire, UK
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX
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Wang YY, Zhang WW, Feng L, Gao D, Liu C, Zhong L, Ren JW, Wu YZ, Huang L, Fu LL, He YN. Development and Preliminary Validation of a Depression Assessment Tool for Maintenance Hemodialysis Patients. Ther Apher Dial 2018; 23:49-58. [PMID: 30239119 DOI: 10.1111/1744-9987.12749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/11/2018] [Accepted: 07/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Yun-yan Wang
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Wei-wei Zhang
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Lei Feng
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Dong Gao
- Department of Sleep and Psychology, Institute of Surgery Research, Daping Hospital; Third Military Medical University; Chongqing China
| | - Chun Liu
- Department of Nephrology; The Third People's Hospital of Chongqing; Chongqing China
| | - Ling Zhong
- Department of Nephrology, The Second Affiliated Hospital; Chongqing Medical University; Chongqing China
| | - Jiang-wen Ren
- Department of Nephrology; The First People's Hospital of Jiulongpo District; Chongqing China
| | - Ya-zhou Wu
- Department of Statistics, Preventive Medicine; Third Military Medical University; Chongqing China
| | - Long Huang
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Li-li Fu
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Ya-ni He
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
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Test Performance Characteristics of the AIR, GAD-7, and HADS-Anxiety Screening Questionnaires for Anxiety in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2018; 15:926-934. [PMID: 29986152 DOI: 10.1513/annalsats.201708-631oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Rationale: Anxiety is a common comorbidity of chronic obstructive pulmonary disease (COPD) that is associated with higher morbidity and mortality. We evaluated three anxiety screening questionnaires: the Generalized Anxiety Disorder 7-Item Scale (GAD-7), the Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A), and the Anxiety Inventory for Respiratory Disease (AIR).Objectives: To evaluate and compare the test performance characteristics of three anxiety screening questionnaires, using the Mini-International Neuropsychiatric Interview (MINI), version 7.0, as the "gold standard."Methods: Individuals with COPD were recruited at 16 centers. The MINI and questionnaires were administered by trained research coordinators at an in-person visit and readministered by telephone 2-4 weeks later. A composite score for the presence of any Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) anxiety disorder was computed, based on the MINI as the gold standard, compared with a participant screening positive on self-report measures for these analyses.Results: Two hundred and twenty eligible individuals with COPD were enrolled; 219 completed the study. Eleven percent were identified as having a DSM-V anxiety disorder, based on the MINI. Elevated anxiety symptoms based on questionnaires were 38% for the AIR, 30% for the GAD-7, and 20% for the HADS-A. Area under the receiver operating characteristic curve (AUC) was highest for the GAD-7 (0.78; 95% confidence interval [CI], 0.69-0.87), followed by the HADS-A (0.74; 95% CI, 0.64-0.84) and the AIR (0.66; 95% CI, 0.56-0.76). The AUC for the GAD-7 was significantly greater than for the AIR (P = 0.014). Sensitivity was not statistically different among the questionnaires: 77% for the GAD-7, 63% for the HADS-A, and 66% for the AIR. The HADS-A had the highest specificity, 85%, which was significantly higher than that of the GAD-7 (77%; P < 0.001) and the AIR (65%; P < 0.001); GAD-7 specificity was higher than AIR specificity (P < 0.001).Conclusions: Symptoms of anxiety among patients with COPD as identified by screening questionnaires were common and significantly higher than the prevalence of anxiety disorder meeting DSM-V criteria. The GAD-7, the HADS-A and the AIR questionnaires had fair to moderate psychometric properties as screening tools for anxiety in individuals with COPD, indicating the need for improved measures for this patient population.
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Management of Dyspnea and Anxiety in Chronic Obstructive Pulmonary Disease: A Critical Review. J Am Med Dir Assoc 2017; 18:1096.e1-1096.e17. [DOI: 10.1016/j.jamda.2017.09.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 11/19/2022]
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Dong XY, Wang L, Tao YX, Suo XL, Li YC, Liu F, Zhao Y, Zhang Q. Psychometric properties of the Anxiety Inventory for Respiratory Disease in patients with COPD in China. Int J Chron Obstruct Pulmon Dis 2016; 12:49-58. [PMID: 28053516 PMCID: PMC5191851 DOI: 10.2147/copd.s117626] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anxiety is a common comorbidity in patients with COPD in China, and it can significantly decrease patients' quality of life. Almost all anxiety measurements contain somatic items that can overlap with symptoms of COPD and side effects of medicines, which can lead to bias in measuring anxiety in patients with COPD. Therefore, a brief and disease-specific non-somatic anxiety measurement scale, the Anxiety Inventory for Respiratory Disease (AIR), which has been developed and validated in its English version, is needed for patients with COPD in China. METHODS A two-center study was conducted in two tertiary hospitals in Tianjin, China. A total of 181 outpatients with COPD (mean age 67.21±8.10 years, 32.6% women), who met the inclusion and exclusion criteria, were enrolled in the study. Test-retest reliability was examined using intraclass correlation coefficients. The internal consistency was calculated by Cronbach's α. Content validity was examined using the Content Validity Index (CVI), scale-level CVI/universal agreement, and scale-level CVI/average agreement (S-CVI/Ave). Besides, convergent validity and construct validity were also examined. RESULTS The AIR-C (AIR-Chinese version) scale had high test-retest reliability (intraclass correlation coefficient =0.904) and internal consistency (Cronbach's α=0.914); the content validity of the AIR-C scale was calculated by CVI, scale-level CVI/universal agreement, and S-CVI/Ave at values of 0.89-1, 0.90, and 0.98, respectively. Meanwhile, the AIR-C scale had good convergent validity, correlating with the Hospital Anxiety and Depression Scale-Anxiety (r=0.81, P<0.01), and there were significant correlations between the AIR-C and Clinical COPD Questionnaire (CCQ; r=0.44, P<0.01) and Activities of Daily Living Scale (ADLS; r=0.36, P<0.01). A two-factor model of general anxiety and panic symptoms in the AIR-C scale had the best fit according to Confirmatory Factor Analysis (CFA). CONCLUSION The AIR-C scale had a good reliability and validity for patients with COPD and can be used as a user-friendly and valid tool for measuring anxiety symptoms among patients with COPD in China.
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Affiliation(s)
| | - Lan Wang
- School of Nursing, Tianjin Medical University
| | - Yan-Xia Tao
- School of Nursing, Tianjin Medical University
| | - Xiu-Li Suo
- Department of Respiratory Care, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Yue-Chuan Li
- Department of Respiratory Care, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Fang Liu
- School of Nursing, Tianjin Medical University
| | - Yue Zhao
- School of Nursing, Tianjin Medical University
| | - Qing Zhang
- School of Nursing, Tianjin Medical University
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von Leupoldt A, Janssens T. Could targeting disease specific fear and anxiety improve COPD outcomes? Expert Rev Respir Med 2016; 10:835-7. [DOI: 10.1080/17476348.2016.1198697] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Yohannes AM, Dryden S, Hanania NA. The Responsiveness of the Anxiety Inventory for Respiratory Disease Scale Following Pulmonary Rehabilitation. Chest 2016; 150:188-95. [PMID: 26953219 DOI: 10.1016/j.chest.2016.02.658] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/08/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND To date, there are no studies that have examined the responsiveness of the Anxiety Inventory for Respiratory disease (AIR) scale to any intervention in patients with COPD. We examined the responsiveness of the AIR scale in an 8-week pulmonary rehabilitation (PR) program. METHODS A total of 192 patients with COPD who were clinically stable and had a percent predicted FEV1 < 70% completed 8-week outpatient multidisciplinary PR. The duration of the program was 2 h per/week (1 h exercise and 1 h education). Pre- and postrehabilitation outcome measures were evaluated: exercise capacity by the incremental shuttle walk test, quality of life by the St Georges Respiratory Questionnaire (SGRQ), and severity of dyspnea by the Medical Research Council (nMRC) scale. Anxiety was measured using the self-administered AIR scale. RESULTS The mean (SD) age was 71 (8.4) years and 51% were women. The AIR scale was responsive to PR with (AIR ≥ 8, high anxiety load) a mean change pre- vs post scores (12.25 vs 6.70, t = 7.56, P < .001), in incremental shuttle walk test (183 vs 258, t = 9.49, P < .001), in total SGRQ score (62.54 vs 55.70, t = 4.77, P < .001) and in nMRC score (3.32 vs 3.04, t = 2.57, P = .03) following PR. Change in AIR was significantly correlated with change in total SGRQ (r = 0.16, P = .02) and in nMRC (r = 0.15, P = .03). The effect size for the AIR was 1.01 and minimal clinical important difference was 5.55. Anxiety is a predictor of noncompletion of PR. CONCLUSIONS The AIR scale is sensitive to change following PR in patients with COPD and can be used in future studies evaluating interventions that reduce anxiety in this disease.
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Affiliation(s)
- Abebaw M Yohannes
- Department of Health Professions, Manchester Metropolitan University, Manchester, England.
| | - Sheila Dryden
- St. Annes Primary Care Center, Lytham, Lancashire, England
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX
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Yohannes AM, Willgoss TG. The accuracy of the anxiety inventory respiratory disease scale for patients with chronic obstructive pulmonary disease. Int J Geriatr Psychiatry 2015; 30:106-8. [PMID: 25502901 DOI: 10.1002/gps.4202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 07/30/2014] [Accepted: 07/30/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Abebaw M Yohannes
- Department of Health Professions, Manchester Metropolitan University, Research Institute for Health and Social Care, Manchester, UK.
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Pumar MI, Gray CR, Walsh JR, Yang IA, Rolls TA, Ward DL. Anxiety and depression-Important psychological comorbidities of COPD. J Thorac Dis 2014; 6:1615-31. [PMID: 25478202 PMCID: PMC4255157 DOI: 10.3978/j.issn.2072-1439.2014.09.28] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/03/2014] [Indexed: 12/28/2022]
Abstract
Anxiety and depression are common and important comorbidities in patients with chronic obstructive pulmonary disease (COPD). The pathophysiology of these psychological comorbidities in COPD is complex and possibly explained by common risk factors, response to symptomatology and biochemical alterations. The presence of anxiety and/or depression in COPD patients is associated with increased mortality, exacerbation rates, length of hospital stay, and decreased quality of life and functional status. There is currently no consensus on the most appropriate approach to screening for anxiety and depression in COPD. Treatment options include psychological [relaxation, cognitive behavioural therapy (CBT), self-management] and pharmacological interventions. Although there is some evidence to support these treatments in COPD, the data are limited and mainly comprised by small studies. Pulmonary rehabilitation improves anxiety and depression, and conversely these conditions impact rehabilitation completion rates. Additional high quality studies are urgently required to optimise screening and effective treatment of anxiety and depression in patients with COPD, to enhance complex chronic disease management for these patients.
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