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Cognitive and Perceptual Factors, Not Disease Severity, Are Linked with Anxiety in COPD: Results from a Cross-Sectional Study

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Abstract

Purpose

Guided by the Transactional Model of Stress and Coping, the purpose of this cross-sectional study was to examine clinical factors—demographics, chronic obstructive pulmonary disease (COPD) severity, cognitive/perceptual variables (appraisal and coping)—and their relationship to clinically elevated symptoms of anxiety in a sample of veterans with COPD.

Method

Participants included a sample of veterans with COPD, with or without comorbid congestive heart failure, and clinically significant symptoms of anxiety (n = 172, mean age = 65.3, SD = 8.1), who previously presented to an outpatient VA setting. Participants completed questionnaires examining COPD severity (respiratory impairment and dyspnea- and fatigue-related quality of life); perceptions of a stressor (COPD illness intrusiveness); perceptions of control (locus of health control, mastery over COPD, self-efficacy); coping strategies (adaptive and maladaptive); and anxiety and depressive symptoms.

Results

Multivariable linear regressions revealed that anxiety was positively associated with more maladaptive coping and locus of control (attributed to other people), above and beyond disease severity, demographics, and depressive symptoms.

Conclusion

These findings suggest that cognitive and perceptual factors are concurrent with anxiety; however, longitudinal investigations are needed to fully understand this relationship. Future research should also focus on identifying optimal assessment and treatment procedures when evaluating and treating patients with COPD and symptoms of anxiety.

Trial Registration

NCT01149772

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References

  1. Buist AS, MA MB, Vollmer WM, Gillespie S, Burney P, Mannino DM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007;370(9589):741–50.

    Article  PubMed  Google Scholar 

  2. Jemal A, Ward E, Hao Y, Thun M. Trends in the leading causes of death in the United States, 1970-2002. JAMA. 2005;294(10):1255–9.

    Article  CAS  PubMed  Google Scholar 

  3. Yohannes AM, Alexopoulos GS. Depression and anxiety in patients with COPD. Eur Respir Rev. 2014;23(133):345–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Pauwels RA, Rabe KF. Burden and clinical features of chronic obstructive pulmonary disease (COPD). Lancet. 2004;364(9434):613–20.

    Article  PubMed  Google Scholar 

  5. Brenes GA. Anxiety and chronic obstructive pulmonary disease: prevalence, impact, and reatment. Psychosom Med. 2003;65(6):963–70.

    Article  PubMed  Google Scholar 

  6. Kunik ME, Roundy K, Veazey C, Souchek J, Richardson P, Wray NP, et al. Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest. 2005;127(4):1205–11.

    PubMed  Google Scholar 

  7. Yohannes AM, Willgoss TG, Baldwin RC, Connolly MJ. Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles. Int J Geriatr Psychiatry. 2010;25(12):1209–21.

    Article  CAS  PubMed  Google Scholar 

  8. Aydin IO, Uluşahin A. Depression, anxiety comorbidity, and disability in tuberculosis and chronic obstructive pulmonary disease patients: applicability of GHQ-12. Gen Hosp Psychiatry. 2001;23(2):77–83.

    Article  CAS  PubMed  Google Scholar 

  9. Maurer J, Rebbapragada V, Borson S, Goldstein R, Kunik ME, Yohannes AM, et al. Anxiety and depression in COPD. Current understanding, unanswered questions, and research needs. Chest. 2008;134(4 Suppl):43S–56S.

    Article  PubMed Central  Google Scholar 

  10. Gudmundsson G, Gislason T, Janson C, Lindberg E, Hallin R, Ulrik CS, et al. Risk factors for rehospitalisation in COPD: role of health status, anxiety and depression. Eur Respir J. 2005;26(3):414–9.

    Article  CAS  PubMed  Google Scholar 

  11. Yellowlees PM, Alpers JH, Bowden JJ, Bryant GD, Ruffin RE. Psychiatric morbidity in patients with chronic airflow obstruction. Med JAust. 1987;46(6):305–7.

    Google Scholar 

  12. Mikkelsen RL, Middelboe T, Pisinger C, Stage KB. Anxiety and depression in chronic obstructive pulmonary disease (COPD). A review Nord J Psychiatry. 2004;58(1):65–70.

    Article  PubMed  Google Scholar 

  13. Cully JA, Graham DP, Stanley MA, Ferguson CJ, Sharafkhaneh A, Souchek J, et al. Quality of life in patients with chronic obstructive pulmonary disease and comorbid anxiety or depression. Psychosomatics. 2006;47(4):312–9.

    Article  PubMed  Google Scholar 

  14. Meek PM, Lareau SC. Critical outcomes in pulmonary rehabilitation: assessment and evaluation of dyspnea and fatigue. J Rehabil Res Dev. 2003;40(5 Suppl 2):13–24.

    Article  PubMed  Google Scholar 

  15. Harver A, Mahler DA. Dyspnea: sensation, symptom, and illness. Lung Biol Health Dis. 1998;111:1–33.

    Google Scholar 

  16. Felker B, Bush KR, Harel O, Shofer JB, Shores MM, Au DH. Added burden of mental disorders on health status among patients with chronic obstructive pulmonary disease. Prim Care Companion J Clin Psychiatry. 2010;12(4).

  17. Coultas DB, Edwards DW, Barnett B, Wludyka P. Predictors of depressive symptoms in patients with COPD and health impact. COPD. 2007;4(1):23–8.

    Article  PubMed  Google Scholar 

  18. Paukert AL, Lemaire A, Cully JA. Predictors of depressive symptoms in older veterans with heart failure. Aging Ment Health. 2009;13(4):601–10.

    Article  PubMed  Google Scholar 

  19. Devins GM, Bezjak A, Mah K, Loblaw DA, Gotowiec AP. Context moderates illness-induced lifestyle disruptions across life domains: a test of the illness intrusiveness theoretical framework in six common cancers. Psyco-Oncology. 2006;15(3):221–33.

    Article  Google Scholar 

  20. Shuster J, McCormack J, Riddell RP, Toplak ME. Understanding the psychosocial profile of women with fibromyalgia syndrome. Pain Res Manag. 2009;14(3):239–45.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wallston KA, Wallston BS, Smith S, Dobbins CJ. Perceived control and health. Curr Psychol: Res Rev. 1987;6:5–25.

    Article  Google Scholar 

  22. Edwards R, Telfair J, Cecil H, Lenoci J. Self-efficacy as a predictor of adult adjustment to sickle cell disease: one-year outcomes. Psychosom Med. 2001;63(5):850–8.

    Article  CAS  PubMed  Google Scholar 

  23. Lee H, Young Yoon J, Kim I, Young-Hee J. The effects of personal resources and coping strategies on depression and anxiety in patients with chronic obstructive pulmonary disease. Heart Lung. 2013;42(6):473–9.

    Article  PubMed  Google Scholar 

  24. Simpson E, Jones MC. An exploration of self-efficacy and self-management in COPD patients. Br J Nurs. 2013;22(19):1105–9.

    Article  PubMed  Google Scholar 

  25. Breland JY, Hundt NE, Barrera TL, Mignogna J, Petersen NJ, Stanley MA, et al. Identification of anxiety symptom clusters in patients with COPD: implications for assessment and treatment. Int J Behav Med. 2015;22(5):1–7.

    Article  Google Scholar 

  26. Scharloo M, Kaptein AA, Weinman JA, Willems LNA, Rooijmans HGM. Physical and psychological correlates of functioning in patients with chronic obstructive pulmonary disease. J Asthma. 2000;37(1):17–29.

    Article  CAS  PubMed  Google Scholar 

  27. Stoilkova A, Janssen DJ, Franssen FM, Spruit MA, Wouters EF. Coping styles in patients with COPD before and after pulmonary rehabilitation. Respir Med. 2013;107(6):825–33.

    Article  PubMed  Google Scholar 

  28. McCathie HCF, Spence SH, Tate RL. Adjustment to chronic obstructive pulmonary disease: the importance of psychological factors. Eur Respir J. 2002;19(1):47–53.

    Article  CAS  PubMed  Google Scholar 

  29. Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.

    Google Scholar 

  30. Englbrecht M, Gossec L, DeLongis A, Scholte-Voshaar M, Sokka T, Kvien TK, et al. The impact of coping strategies on mental and physical well-being in patients with rheumatoid arthritis. Semin Arthritis Rheum. 2012;41(14):545–55.

    Article  PubMed  Google Scholar 

  31. Cully JA, Armento ME, Mott J, Nadorff MR, Naik AD, Stanley MA, et al. Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness implementation design. Implement Sci. 2012;7:64.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54(7):581–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Spitzer RL, Williams JB, Kroenke K, Linzer M, de Gruy FV 3rd, Hahn SR, et al. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. JAMA. 1994;272(22):1749–56.

    Article  CAS  PubMed  Google Scholar 

  34. Guyatt GH, Berman LB, Townsend M, Pugsley SO, Chambers LW. A measure of quality of life for clinical trials in chronic lung disease. Thorax. 1987;42(10):773–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Devins GM, Binik YM, Hutchinson TA, Hollomby DJ, Barre PE, Guttmann RD. The emotional impact of end-stage renal disease: importance of patients’ perceptions of intrusiveness and control. Int J Psychiatry Med. 1983;13(4):327–43.

    Article  PubMed  Google Scholar 

  36. Wallston KA, Stein MJ, Smith CA. Form C of the MHLC scales: a condition-specific measure of locus of control. J Pers Assess. 1994;63(3):534–53.

    Article  CAS  PubMed  Google Scholar 

  37. Lorig K, Stewart A, Ritter P, Gonzalez V, Laurent D, Lynch J. Outcome measures for health education and other health care interventions. Thousand Oaks: Sage Publications; 1996.

    Google Scholar 

  38. Carver CS. You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med. 1997;4(1):92–100.

    Article  CAS  PubMed  Google Scholar 

  39. Beck A, Steer R. Beck anxiety inventory manual. San Antonio: Harcourt Brace and Company; 1990.

    Google Scholar 

  40. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Ries AL. Impact of chronic obstructive pulmonary disease on quality of life: the role of dyspnea. Am J Med. 2006;119(10 Suppl 1):12–20.

    Article  PubMed  Google Scholar 

  42. Reardon JZ, Lareau SC, ZuWallack R. Functional status and quality of life in chronic obstructive pulmonary disease. Am J Med. 2006;119(10 Suppl 1):32–7.

    Article  PubMed  Google Scholar 

  43. Bendel RB, Afifi A. Comparison of stopping rules in forward regression. J Am Stat Assoc. 1977;72:46–53.

    Google Scholar 

  44. Hundt NE, Amspoker AB, Kraus-Schuman C, Cully JA, Rhoades H, Kunik ME, et al. Predictors of CBt outcome in older adults with GAD. J Anxiety Disord. 2014;28(8):845–50.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Barrera TL, Cully JA, Amspoker AB, Wilson NL, Kraus-Schuman C, Wagener PD, et al. Cognitive-behavioral therapy for late-life anxiety: similarities and differences between veteran and community participants. J Anxiety Disord. 2015;33:72–80.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Asadi-Pooyab AA, Schilling CA, Glosser D, Tracy JI, Sperling MR. Health locus of control in patients with epilepsy and its relationship to anxiety, depression, and seizure control. Epilepsy Behav. 2007;11(3):347–50.

    Article  Google Scholar 

  47. Carver CS, Connor-Smith J. Personality and coping. Annu Rev Psychol. 2010;61:679–704.

    Article  PubMed  Google Scholar 

  48. Van Ede L, Yzermans CJ, Brouwer HJ. Prevalence of depression in patients with chronic obstructive pulmonary disease: a systematic review. Thorax. 1999;54(8):688–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. McAndrew LM, Musumeci-Szabó TJ, Mora PA, Vileikyte L, Burns E, Halm EA, et al. Using the common sense model to design interventions for the prevention and management of chronic illness threats: from description to process. B J Health Psychol. 2008;13(2):195–204.

    Article  Google Scholar 

  50. Scharloo M, Kaptein AA, Weinman J, Hazes JM, Willems LN, Bergman W, et al. Illness perceptions, coping and functioning in patients with rheumatoid arthritis, chronic obstructive pulmonary disease and psoriasis. J Psychosom Res. 1998;44(5):573–l85.

    Article  CAS  PubMed  Google Scholar 

  51. Scharloo M, Kaptein AA, Schlösser M, Pouwels H, Bel CH, Rabe KF, et al. Illness perceptions and quality of life in patients with chronic obstructive pulmonary disease. J Asthma. 2007;44(7):575–81.

    Article  PubMed  Google Scholar 

  52. Vaske I, Kenn K, Keil DC, Rief W, Stenzel NM. Illness perceptions and coping with disease in chronic obstructive pulmonary disease: effects on health-related quality of life. J Health Psychol. 2016.

  53. Zoeckler N, Kenn K, Kuehl K, Stenzel N, Rief W. Illness perceptions predict exercise capacity and psychological well-being after pulmonary rehabilitation in COPD patients. J Psychosom Res. 2014;76(2):146–51.

    Article  PubMed  Google Scholar 

  54. De Peuter S, Janssens T, Van Diest I, Stans L, Troosters T, Decramer M, et al. Dyspnea-related anxiety: the Dutch version of the breathlessness beliefs questionnaire. Chron Respir Dis. 2011;8(1):11–9.

    Article  PubMed  Google Scholar 

  55. Keil DC, Stenzel NM, Kühl K, Vaske I, Mewes R, Rief W, et al. The impact of chronic obstructive pulmonary disease-related fears on disease-specific disability. Chron Respir Dis. 2014;11(1):31–40.

    Article  PubMed  Google Scholar 

  56. Janssens T, De Peuter S, Stans L, Verleden G, Troosters T, Decramer M, et al. Dyspnea perception in COPD: association between anxiety, dyspnea-related fear, and dyspnea in a pulmonary rehabilitation program. Chest. 2011;140(3):618–25.

    Article  PubMed  Google Scholar 

  57. Heslop-Marshall K, De Soyza A. Are we missing anxiety in people with chronic obstructive pulmonary disease (COPD)? Ann Depress Anxiety. 2014;1:1023.

    Google Scholar 

  58. Usmani ZA, Carson KV, Cheng JN, Esterman AJ, Smith BJ. Pharmacological interventions for the treatment of anxiety disorders in chronic obstructive pulmonary disease. The Cochrane Library. 2011.

  59. Cully JA, Paukert A, Falco J, Stanley M. Cognitive-behavioral therapy: innovations for cardiopulmonary patients with depression and anxiety. CognBehav Pract. 2009;16:394–407.

    Google Scholar 

  60. Cully JA, Stanley MA, Deswal A, Hanania NA, Phillips LL, Kunik ME. Cognitive-behavioral therapy for chronic cardiopulmonary conditions: preliminary outcomes from an open trial. Prim Care Companion J Clin Psychiatry. 2010;12(4).

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Authors and Affiliations

  1. Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, 77030, USA

    Elyse R. Thakur, Shubhada Sansgiry, Nancy J. Petersen, Melinda Stanley, Mark E. Kunik, Aanand D. Naik & Jeffrey A. Cully

  2. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA

    Elyse R. Thakur, Melinda Stanley, Mark E. Kunik & Jeffrey A. Cully

  3. VA South Central Mental Illness, Research and Education Clinical Center, Houston, TX, USA

    Elyse R. Thakur, Shubhada Sansgiry, Melinda Stanley, Mark E. Kunik & Jeffrey A. Cully

  4. Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Shubhada Sansgiry, Nancy J. Petersen & Aanand D. Naik

Authors
  1. Elyse R. Thakur
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  2. Shubhada Sansgiry
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  3. Nancy J. Petersen
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  4. Melinda Stanley
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  5. Mark E. Kunik
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  7. Jeffrey A. Cully
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Corresponding author

Correspondence to Jeffrey A. Cully.

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Funding

This material is based upon work supported by the Department of Veterans Affairs (Health Services Research & Development Grant IIR 09-088). It was also partly supported by the Veterans Health Administration, Office of Research and Development and the Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety (CIN13-413) and the South Central Mental Illness, Research, Education, and Clinical Center. 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. The authors have full control of all primary data and agree to allow review of their data if requested.

Conflict of Interest

The authors report no conflicts of interest. However, some of the authors are employees of the Veterans Health Administration.

Research Involving Human Participants

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The parent study was approved by the institutional review boards of the Michael E. DeBakey VA Medical Center and Baylor College of Medicine.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Thakur, E.R., Sansgiry, S., Petersen, N.J. et al. Cognitive and Perceptual Factors, Not Disease Severity, Are Linked with Anxiety in COPD: Results from a Cross-Sectional Study. Int.J. Behav. Med. 25, 74–84 (2018). https://doi.org/10.1007/s12529-017-9663-2

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