Tselebis A, Bratis D, Pachi A, Moussas G, Karkanias A, Harikiopoulou M, Theodorakopoulou E, Kosmas E, Ilias I, Siafakas N, Vgontzas A, Tzanakis N
Psychiatric Department, "Sotiria" General Hospital, Athens.
Psychiatriki. 2013 Apr-Jun;24(2):109-16.
Chronic Obstructive Pulmonary Disease (COPD) is mainly related to smoking habit and is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Worldwide and in Greece, COPD constitutes a major epidemiological issue. Incidence of depression and anxiety is high in the COPD population. Most studies on depression and anxiety in COPD deal with factors that are positively correlated with both of these comorbidities. The aim of our study was to assess whether two variables, sense of coherence (SOC) and perception of family support (FS), are negatively correlated with depressive and anxiety symptoms in outpatients with COPD. According to Aaron Antonovsky, sense of coherence refers to the ability of individuals to make sense of and manage events. Studies in other diseases suggest that sense of family support has a significant impact on the course and outcome of the disease, yet a limited number of reports across literature addresses the role of family support in COPD patients. In our present study one hundred twenty two (98 men and 24 women) outpatients with pure COPD were included. Age and years of education were recorded. Severity of COPD was assessed with spirometry before and after bronchodilation. All patients replied to self- administered questionnaires on depression (Beck Depression Inventory, BDI), anxiety (Spielberger State-Trait Anxiety Scale, STAI), family support (Family Support Scale, FSS-13) and sense of coherence (Sense of Coherence Scale, SOC). According to our results the mean BDI depression score was 11.65 (SD 7.35), mean trait anxiety score was 40.69 (SD 11.19), mean SOC score was 54.62 (SD 7.40) and mean FS score was 64.58 (SD 11.63). Women patients had higher anxiety scores and lower sense of family support compared to men. Significant negative correlations were evidenced between depression and sense of coherence as well as between anxiety and family support. Step-wise multiple linear regression analysis verified the results and quantified the aforementioned correlations. Notably, raising scores in sense of family support by one point reduces anxiety scores by 0.14 points, and increasing sense of coherence scores by one point reduces depression scores by 0.21 points. In sum, our study confirms the presence of high levels of anxiety and depressive symptoms in COPD patients, with females being in a more disadvantaged position as they tend to have higher levels of both. Sense of coherence and family support are both protective psychological factors against the risk of developing anxiety and depressive symptoms in these patients.
慢性阻塞性肺疾病（COPD）主要与吸烟习惯有关，其特征是气流受限且不完全可逆。气流受限通常呈进行性，并且与肺部对有害颗粒或气体的异常炎症反应相关。在全球范围内以及在希腊，COPD都是一个重大的流行病学问题。COPD患者中抑郁和焦虑的发生率很高。大多数关于COPD患者抑郁和焦虑的研究都涉及与这两种合并症呈正相关的因素。我们研究的目的是评估两个变量，即连贯感（SOC）和家庭支持感（FS），是否与COPD门诊患者的抑郁和焦虑症状呈负相关。根据亚伦·安东诺夫斯基的观点，连贯感是指个体理解和应对事件的能力。其他疾病的研究表明，家庭支持感对疾病的进程和结果有重大影响，但文献中涉及家庭支持在COPD患者中作用的报告数量有限。在我们目前的研究中，纳入了122名（98名男性和24名女性）单纯COPD门诊患者。记录了年龄和受教育年限。通过支气管扩张前后的肺功能测定评估COPD的严重程度。所有患者都回答了关于抑郁（贝克抑郁量表，BDI）、焦虑（斯皮尔伯格状态-特质焦虑量表，STAI）、家庭支持（家庭支持量表，FSS - 13）和连贯感（连贯感量表，SOC）的自填问卷。根据我们的结果，BDI抑郁平均得分是11.65（标准差7.35），特质焦虑平均得分是40.69（标准差11.19），SOC平均得分是54.62（标准差7.40），FS平均得分是64.58（标准差11.63）。女性患者的焦虑得分高于男性，家庭支持感低于男性。抑郁与连贯感之间以及焦虑与家庭支持之间存在显著的负相关。逐步多元线性回归分析验证了结果并量化了上述相关性。值得注意的是，家庭支持感得分每提高1分，焦虑得分降低0.14分，连贯感得分每提高1分，抑郁得分降低0.21分。总之，我们的研究证实了COPD患者中存在高水平的焦虑和抑郁症状，女性处于更不利的地位，因为她们往往在这两方面的水平都更高。连贯感和家庭支持都是这些患者预防焦虑和抑郁症状发生风险的保护性心理因素。
