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      Assessment of illness acceptance by patients with COPD and the prevalence of depression and anxiety in COPD

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          Abstract

          Background

          COPD is a civilization disease. It affects up to 8%–10% of population >30 years of age. Coexistence of depression occurs in 20%–40% of patients with COPD. Depression and anxiety reduce compliance and worsen prognosis.

          Objective

          The aims of this study were to determine the degree of illness acceptance among patients with COPD, to examine the relation between disease acceptance and perceived anxiety and depression, and to verify which of the sociodemographic and clinical factors are associated with illness acceptance, anxiety, and depression.

          Materials and methods

          The study included 102 patients with COPD (mean age 65.8 years), hospitalized due to exacerbations. Acceptance of Illness Scale and Hospital Anxiety and Depression Scale were used. For statistical analysis, Student’s t-test and Pearson’s r correlation coefficient were carried out.

          Results

          The overall illness acceptance level was moderate with a tendency toward lack of acceptance (mean 20.6, standard deviation [SD] 7.62). The overall scores were 10.2 (SD 3.32) for anxiety and 10.8 (SD 4.14) for depression, which indicate borderline or high intensity of these symptoms. Acceptance of illness was negatively correlated with the intensity of depression symptoms ( r=−0.46, P<0.05). Intensity of depression was significantly associated with intensity of smoking, duration of the disease, severity of dyspnea, and living in a rural area.

          Conclusion

          Early identification and assessment of depression and anxiety symptoms allow health care providers to offer patients at risk of depression a special medical supervision. Rapid start of antidepressant therapy may increase illness acceptance and improve prognosis among patients with COPD.

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          Most cited references 35

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          Anxiety and depression in COPD: current understanding, unanswered questions, and research needs.

          Approximately 60 million people in the United States live with one of four chronic conditions: heart disease, diabetes, chronic respiratory disease, and major depression. Anxiety and depression are very common comorbidities in COPD and have significant impact on patients, their families, society, and the course of the disease. We report the proceedings of a multidisciplinary workshop on anxiety and depression in COPD that aimed to shed light on the current understanding of these comorbidities, and outline unanswered questions and areas of future research needs. Estimates of prevalence of anxiety and depression in COPD vary widely but are generally higher than those reported in some other advanced chronic diseases. Untreated and undetected anxiety and depressive symptoms may increase physical disability, morbidity, and health-care utilization. Several patient, physician, and system barriers contribute to the underdiagnosis of these disorders in patients with COPD. While few published studies demonstrate that these disorders associated with COPD respond well to appropriate pharmacologic and nonpharmacologic therapy, only a small proportion of COPD patients with these disorders receive effective treatment. Future research is needed to address the impact, early detection, and management of anxiety and depression in COPD.
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            Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life.

            Depressive symptoms are common among patients with chronic obstructive pulmonary disease (COPD), but depression's impact on COPD outcomes has not been fully investigated. We evaluated the impact of comorbid depression on mortality, hospital readmission, smoking behavior, respiratory symptom burden, and physical and social functioning in patients with COPD. In this prospective cohort study, 376 consecutive patients with COPD hospitalized for acute exacerbation were followed up for 1 year. The independent associations of baseline comorbid depression (designated as a Hospital Anxiety and Depression Scale score of > or =8) with mortality, hospital readmission, length of stay, persistent smoking, and quality of life (determined by responses to the St George Respiratory Questionnaire) were evaluated after adjusting for potential confounders. The prevalence of depression at admission was 44.4%. The median follow-up duration was 369 days, during which 57 patients (15.2%) died, and 202 (53.7%) were readmitted at least once. Multivariate analyses showed that depression was significantly associated with mortality (hazard ratio, 1.93; 95% confidence interval, 1.04-3.58), longer index stay (mean, 1.1 more days; P = .02) and total stay (mean, 3.0 more days; P = .047), persistent smoking at 6 months (odds ratio, 2.30; 95% confidence interval, 1.17-4.52), and 12% to 37% worse symptoms, activities, and impact subscale scores and total score on the St George Respiratory Questionnaire at the index hospitalization and 1 year later, even after controlling for chronicity and severity of COPD, comorbidities, and behavioral, psychosocial, and socioeconomic variables. Comorbid depressive symptoms in patients with COPD are associated with poorer survival, longer hospitalization stay, persistent smoking, increased symptom burden, and poorer physical and social functioning. Interventions that reduce depressive symptoms may potentially affect COPD outcomes.
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              Stress and coping in the explanation of psychological adjustment among chronically ill adults.

              This study evaluates the utility of a stress and coping paradigm for explaining individual differences in psychological adjustment to chronic illness. Using data from the first wave of a longitudinal study of 170 middle-aged and elderly adults faced with one of four chronic illnesses (hypertension, diabetes mellitus, cancer and rheumatoid arthritis), this paper examines the relationship between the stresses of chronic illness and coping, and the ability of coping to explain psychological adjustment. Results show coping strategy use tends to be minimally explained by medical diagnosis. Cognitive strategies, including information seeking, are related to positive affect while emotional strategies, particularly those involving avoidance, blame and emotional ventilation, are related to negative affect, lowered self-esteem and poorer adjustment to illness. While the findings suggest that a stress and coping model may be valuable in understanding adjustment among the chronically ill, the general modesty of coping effects and the failure of the stress buffering hypothesis to explain adjustment indicates a need for new research approaches and some modification of current theories of coping.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2016
                09 May 2016
                : 11
                : 963-970
                Affiliations
                [1 ]Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
                [2 ]Department of Thoracic Surgery, Wroclaw Medical University, Wroclaw, Poland
                [3 ]Division of Nursing in Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
                Author notes
                Correspondence: Mariusz Chabowski, Division of Nursing in Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618 Wroclaw, Poland, Tel/fax +48 71784 1805, Email mariusz.chabowski@ 123456gmail.com
                Article
                copd-11-963
                10.2147/COPD.S102754
                4869633
                27274217
                © 2016 Uchmanowicz et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed

                Categories
                Original Research

                Respiratory medicine

                acceptance of illness, copd, depression, anxiety

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