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 Table of Contents  
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 29-34

Health-related quality of life and psychological well-being in chronic obstructive pulmonary diseases

Department of Clinical Psychology, Amity University, Kolkata, West Bengal, India

Date of Submission24-Apr-2021
Date of Decision10-May-2021
Date of Acceptance13-May-2021
Date of Web Publication18-Jul-2021

Correspondence Address:
Dr. Susmita Halder
Department of Clinical Psychology, Amity University, Kolkata, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjp.tjp_18_21

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Background: Chronic obstructive pulmonary disease (COPD) is a persistent inflammatory lung disease which is characterized by progressive and partially reversible symptoms. The incidence rate of COPD is accelerating and becoming remarkable among worldwide population. Increasing recognition of psychological comorbidities among patients with COPD is more likely to be seen than non-COPD patients. Impairment in physiological functioning and restricted lifestyle leads to higher rate of mental health deterioration. Understanding the spectrum of negative consequences related to the psychological and social functioning of the patients with COPD has been underrecognized, and deficits are mostly untreated. Due to deleterious effects of COPD on physical functioning, decline in quality of life (QOL) has been acknowledged.
Aim: The aim of the study is to compare the health-related QOL (HRQL) and psychological well-being between COPD patients and normal controls.
Methods: In the present study, sixty individuals, thirty individuals diagnosed with COPD and 30 normal controls were taken of both genders, with the age range of 50–70 years. Measures were taken on the basis of psychological well-being and HRQOL.
Results: Results suggest that individuals with COPD differed significantly in subjective psychological well-being and HRQOL in comparison with normal controls.
Conclusion: In conclusion, COPD affects patients overall psychological well-being and QOL adversely, and requirement of comprehensive psychosocial management is recommended.

Keywords: Chronic obstructive pulmonary diseases, health-related quality of life, mental health, psychological well-being

How to cite this article:
Samajdar S, Halder S. Health-related quality of life and psychological well-being in chronic obstructive pulmonary diseases. Telangana J Psychiatry 2021;7:29-34

How to cite this URL:
Samajdar S, Halder S. Health-related quality of life and psychological well-being in chronic obstructive pulmonary diseases. Telangana J Psychiatry [serial online] 2021 [cited 2021 Dec 2];7:29-34. Available from: http://www.:tjpipstsb.org/text.asp?2021/7/1/29/321766

  Introduction Top

Chronic obstructive pulmonary disease (COPD) is a respiratory disease with chronic longevity which correlates with physiological and functional restrictedness.[1] Patients with COPD, usually have low energy, could not able to perform well in coordinated way and prolonged and exhausted treatment procedure might have unfavorable impact on domains of lifestyle.[2] COPD is highly correlated with health problem and can disturb various aspects of life of the patient. The functional ability of the patient as well as quality of life (QOL) is being complicated by psychological complaints or even a concurrent mental disorder. The physical illness itself probably contributed to the occurrence and severity of the psychological complaints. Continuous and incurable course of COPD declining the physiological and psychological aspects of the patients which is also impacting on the maintenance of QOL and inducing disability for the prolonged period of time. Patients with COPD exhibit low physical and mental health-related QOL (HRQOL), and COPD affects the person's moods and the pattern through impacting on accomplishment of daily activities (DAs). It is also suggestible to disability of social and occupational functioning of the patients. Substantial burden of symptoms of COPD is impacting upon the physical and psychological functioning and reducing the HRQL.[3]

In COPD patients, comorbid psychological symptoms are highly prevalent, affective disorders. Prevalence is ranging from 8% to 80% for depressive symptoms and from 6% to 74% for anxiety symptoms.[4],[5] Preexisting symptoms of affective disorders were linked with the further onset of dyspnea, whereas preexisting dyspnea was only weakly linked with later symptoms of anxiety and depression.[6] However, patients with asthma as well as individuals without respiratory symptoms, are also having these symptoms, thus preventing specific conclusions for patients with COPD. The role of disease severity and repeated experiences with frightening episodes of dyspnea as potential risk factors for the further relapse of psychological comorbidities, especially for patients who tend to catastrophize bodily sensations.[7] It might further be speculated that a relevant factor is underlying both COPD and psychopathology, for example, genetic influences or systemic inflammatory processes.[8] Once comorbid psychopathology and COPD are present, both direct physical and indirect behavioral pathways might associate these comorbidities with a worse course of disease condition. Whereas studies for the direct physical pathway are scarce in patients with COPD, hence, psychopathology in COPD is related to worse exercise performance.[9] Indication of a behavioral pathway such that anxious avoidance or depression-related motivational disturbances result in avoidance of many daily functional activities that could lead to dyspnea and a further decrease in patients' health status. Another behavioral pathway of comorbid psychological symptoms is their negative impact on adherence to prescribed treatments, in particular smoking cessation or medication adherence, which is generally regarded as poor in COPD patients.[10] Overall, psychopathology, and worse course of COPD could be seen and reported.

The aim of the study is to compare the HRQL and psychological well-being between COPD patients and normal controls.

  Methods Top


In the present study, a total of 60 individuals, 30 diagnosed with COPD and 30 normal controls, were selected following purposive sampling technique. The severity of illness was determined in accordance to Global Initiative of Chronic Obstructive Lung Diseases standard. Patients with mild (>/80% forced expiratory volume 1 [FEV1]) to moderate (50% ≤ FEV1 < 80%) level of COPD were selected in the study. Sociodemographic criteria for both groups were considered as age range between 50 and 70 years, both genders, and minimum education of class 8th grade. In disease variable, in terms of severity of illness were remained constant for the participants with COPD and minimum 5 years of duration of illness and in terms of severity only mild to moderate groups were considered. Individuals with a history of other medical, neurological, or psychiatric conditions were excluded from the study for both the groups.

Data collection was conducted from different outpatient departments of multispecialty hospitals, clinics, and community areas of Kolkata, India. Informed consent was obtained from each participant before including them in the study.

Tools used

Semi-structured sociodemographic and clinical data sheet were used to collect demographic details regarding age, sex, education level, occupation, psychological/physical comorbidities, and duration of illness. To assess HRQOL and psychological well-being, following standardized tools were used.

Health-related quality of life questionnaire

The HRQOL[11] is to assess the perception of health in accordance to QOL of the patient. Internal consistency reliability was found to be 0.83–0.93 for the eight scales, respectively.

Psychological well-being index

The psychological general well-being index[12] is a measure of the level of subjective psychological well-being. It assesses affective and emotional states comprehending through subjective well-being or distress. The test–retest coefficient ranged around the median value of 0.80.

Statistical analysis

In the present study, all the scales were scored, and quantitative analysis was done through descriptive statistics. Student t-test was used to differentiate between the groups (COPD and normal controls). Statistical treatment was conducted through SPSS for Windows Version 25, Chicago.

  Results Top

The present study has conducted to compare HRQOL and psychological well-being between COPD patients and normal controls. It has been seen that the detrimental impact of COPD on patient's psychological functioning and QOL. Results were exploring and understanding the variables, subjective psychological well-being, and HRQOL of the patients with COPD.

  Discussion Top

The present study is aimed to compare the HRQL and psychological well-being of patients with COPD and normal controls. In the present study the mean age range of the sample was found to be 60.60 ( ±6.74) years for individuals with COPD and 58 (±6.71) for normal controls [Table 1]. In clinical management of patients with COPD, it is important to include psychological issues related to well-being, as COPD is an irreversible condition. It has been studied that COPD patients' significant level of anxiety and depression is interlinked with higher level of dyspnea, and to maximize the QOL, psychological factors are needed to be assessed and intervened.[13],[14] Furthermore, in the present study, the results suggested that, there are significant differences between the groups in the domain of HRQL and psychological well-being [Table 2] and [Table 3] and [Figure 1] and [Figure 2].
Table 1: Sociodemographic details of the sample

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Table 2: Comparison of health-related quality of life between patients with chronic obstructive pulmonary diseases and normal controls

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Table 3: Comparison of psychological well-being index between patients with chronic obstructive pulmonary diseases and normal controls

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Figure 1: Health-related quality of life of chronic obstructive pulmonary diseases patients and normal controls

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Figure 2: The psychological well-being index of chronic obstructive pulmonary diseases patients and normal controls

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COPD patients usually experience a decline in their HRQL and COPD symptoms such as dyspnea, cough, and production of sputum, also acute exacerbations of the disease, and comorbidities which are predominant in COPD patients contribute to the overall severity of the disease. In the present study, overall impairment has been found in the domains of HRQOL. COPD restraints physical functioning of the patients, and it also leads to other emotional and behavioral distress in the patients. COPD is linked with impaired DAs and reduced HRQoL.[15] Dyspnea was associated with impairment in physical functioning, role functioning due to physical problems, psychological health, and vitality. Patients with the diagnosis of COPD have higher social consequences[16] and the impact of COPD on functionality and how they manifested in the frequency of daily support, personal network size, and satisfaction with received help. The combination of the abnormalities in pulmonary functioning and these adverse effects on COPD determine the integrated health condition.[17]

QOL related to health is impaired in COPD patients, and it is impaired with increasing severity level of the disease condition. Decreased lung function with increasing age and duration of illness, symptoms severity, worsening dyspnea, and lower socioeconomic state led to impaired QOL in patients with COPD. COPD is a progressive illness and incurable, but the amount of improvement in lung function is limited to increase treatable aspects of QOL, which may lead to a much more effective care of patients with COPD. Functional limitations can be observed whether as generic functional status which includes, difficulties in the performing specific actions such as walking one block, or as difficulties performing specific activities of daily living, i.e. difficulty in caring for one's self or one's home. McSweeny, et al.[18] reported impairment in a broad range of areas, particularly daily living functioning, sleep and rest, recreation employment, and in a group of COPD patients.

Among all aspects affecting COPD, the activity score was the highest, indicating that the dyspnea is the most distressing COPD symptom affecting HRQoL.[19] Although decline in pulmonary functioning is the central physiological limitation,[20] deficiency in basic physical activities such as strength or mobility,[21] energy insufficiency,[22] and impairing sociocultural QOL.[23] Frequent exacerbations, low lung function, comorbidities, and a decreased level of physical activities have been recognized as factors that negatively influence the health status in COPD.[24] In COPD condition, chronic respiratory failure could be seen, and the patient becomes limited by specific symptomatology and complaints that negatively influence the HRQOL.[25] COPD patients experience the severe breathlessness during minimal effort or even at rest in daily life. Higher level of carbon dioxide (CO2) might have an impact on headaches or concentration difficulties. These could reduce the ability to perform the daily living activities. Social relationships and functioning become difficult and patients might have depressive or anxiety symptoms.

COPD is known to have an adverse impact on disease-specific health condition.[26] Disease-specific health condition could have more strong association with the psychological well-being than with the impaired respiratory functioning.[27] Anxiety and depressive symptoms may have long-lasting consequences for patients with COPD. Hypoxia has a secondary factor that have a role in the development of depressive symptoms in COPD patients. Low arterial oxygen saturation has been shown to be interrelated with periventricular white matter lesions, which are present also in patients with clinical depression.[28] There is an overlap of symptoms of anxiety and panic attack with COPD.[29] The exaggerated breathing in excess of metabolic need, causing lowering pCO2, and causing respiratory alkalosis is known as hyperventilation. The breathing pattern can lead to dyspnea in healthy individuals and panic attacks could be seen in those predisposed patients. Importantly, symptoms of anxiety and depression in COPD were shown to be associated with a worse course of disease, which leads to decreased QOL and increased symptoms such as burden, use of health care, and also mortality.[30] Individuals COPD usually have greater levels of limitation in functioning and disability than persons of comparable age in the general population.

Psychological well-being is attained by achieving a state of balance affected by both challenging and rewarding life events. In case of COPD patients, smoking, exacerbations, and hypoxia lead to comorbid conditions of affective symptoms. Hypoxia induces impairment in psychological functioning and accumulates symptoms of anxiety and depression.[5],[31]

Depressive symptoms in patients with COPD are associated with worse survival, prognosis, and more days of hospitalization and more unsuccessful smoking cessation. In the course of the degradation of the lung tissue and airflow limitations, the gas exchange impairment increases, and chronic respiratory failure develops which is coincident with worsening of emotional well-being with illness progression which indicates failure in energy consumption, limitation in activities, decreased stamina, and body conditioning in COPD patients are impacting on well-being, self–control,[32] and vitality. The pathophysiology of anxiety and depressive among patients with COPD is complicated and poorly understood. Patients with clinical depression and anxiety are at higher risk of development of COPD due to smoking habit. The physiological, emotional, and social influence of COPD patients is interrelated with development depression and anxiety symptoms. This interaction between COPD and mental health diseases may have a self-perpetuating cause that has a severe effect on a patient's overall well-being. Low self-confidence, self–esteem, or self-efficacy may lead to worsened cope ability with chronic disease.[31] Enhancement in recognizing anxiety and depressive symptoms may be the first step which may lead to effective intervention of the symptomatology and in physical functioning and disease-specific health status improvement could have been seen.

Implications of the study include the assessment and addressing psychological symptoms related to disease condition which can help to focus on intervention process and planning through psychotherapeutic approach. In COPD patients, as affective symptoms are prevalent, and in the present study, the nature of psychological status is indicating primary focus on the psychoeducating the client in terms of managing disease condition. Chronic and deteriorating symptoms discourage patients with COPD, and therapeutic goal could be on the emotional catharses and redirecting patients' negative emotions to more adaptive way. Further, it can be also suggested, exploration of HRQL is also an important area in COPD patients. Inadequacy in establishing the connection between COPD symptoms and QOL could be seen and understandings of difficulties of psychological well-being in patients with COPD and the interferences to daily living of the patients should be encouraged. Deficits in the areas indicated along with medical support and proper psychosocial interventions including family support are needed for betterment of overall disease condition.

  Conclusion Top

COPD is a multicomponent disease and its wide-ranging detrimental effects lead to global deficiency in psychological well-being, in terms of presence of symptoms of anxiety and depression, decreased positive well-being, self–control, and vitality. Whereas inadequate HRQOL due to decline in physical and emotional functioning, insufficient energy and inadequate social functioning can also be seen.

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Conflicts of interest

There are no conflicts of interest.

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  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3]


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