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Identification of Anxiety Symptom Clusters in Patients with COPD: Implications for Assessment and Treatment

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International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background

Treatment of chronic obstructive pulmonary disease (COPD) is palliative, and quality of life is important. Increased understanding of correlates of quality of life and its domains could help clinicians and researchers better tailor COPD treatments and better support patients engaging in those treatments or other important self-management behaviors.

Purpose

Anxiety is common in those with COPD; however, overlap of physical and emotional symptoms complicates its assessment. The current study aimed to identify anxiety symptom clusters and to assess the association of these symptom clusters with COPD-related quality of life.

Methods

Participants (N = 162) with COPD completed the Beck Anxiety Inventory (BAI), Chronic Respiratory Disease Questionnaire, Patient Health Questionnaire-9, and Medical Research Council dyspnea scale. Anxiety clusters were identified, using principal component analysis (PCA) on the BAI’s 21 items. Anxiety clusters, along with factors previously associated with quality of life, were entered into a multiple regression designed to predict COPD-related quality of life.

Results

PCA identified four symptom clusters related to (1) general somatic distress, (2) fear, (3) nervousness, and (4) respiration-related distress. Multiple regression analyses indicated that greater fear was associated with less perceived mastery over COPD (β = −0.19, t(149) = −2.69, p < 0.01).

Conclusion

Anxiety symptoms associated with fear appear to be an important indicator of anxiety in patients with COPD. In particular, fear was associated with perceptions of mastery, an important psychological construct linked to disease self-management. Assessing the BAI symptom cluster associated with fear (five items) may be a valuable rapid assessment tool to improve COPD treatment and physical health outcomes.

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Acknowledgments

This material is based upon grant support from the Department of Veterans Affairs Health Services Research and Development program (Grant IIR 09-088; Cully PI). It was also partly supported by the Veterans Health Administration, Office of Research and Development, the Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413), and the VA South Central Mental Illness, Research, Education, and Clinical Center. In addition, it was supported by the VA Office of Academic Affiliations and VA Health Services Research and Development Service in conjunction with a VA HSR&D Advanced Fellowship Program. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the US government, or Baylor College of Medicine. None of these bodies played a role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The authors would like to thank Ms. Sonora Hudson for her thoughtful review and editing of this manuscript.

Conflict of Interest

The authors report no conflicts of interest.

Author information

Authors and Affiliations

  1. Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA

    Jessica Y. Breland

  2. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94304, USA

    Jessica Y. Breland

  3. Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA

    Natalie E. Hundt, Terri L. Barrera, Joseph Mignogna, Nancy J. Petersen, Melinda A. Stanley & Jeffery A. Cully

  4. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA

    Natalie E. Hundt, Terri L. Barrera, Joseph Mignogna, Melinda A. Stanley & Jeffery A. Cully

  5. Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA

    Natalie E. Hundt, Terri L. Barrera, Joseph Mignogna, Nancy J. Petersen, Melinda A. Stanley & Jeffery A. Cully

  6. Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA

    Nancy J. Petersen

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  1. Jessica Y. Breland
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  2. Natalie E. Hundt
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  3. Terri L. Barrera
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  5. Nancy J. Petersen
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  7. Jeffery A. Cully
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Corresponding author

Correspondence to Jeffery A. Cully.

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Breland, J.Y., Hundt, N.E., Barrera, T.L. et al. Identification of Anxiety Symptom Clusters in Patients with COPD: Implications for Assessment and Treatment. Int.J. Behav. Med. 22, 590–596 (2015). https://doi.org/10.1007/s12529-014-9450-2

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  • DOI: https://doi.org/10.1007/s12529-014-9450-2

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