Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
University of Alabama Birmingham, Birmingham, Alabama, United States of America.
PLoS One. 2021 Mar 17;16(3):e0245478. doi: 10.1371/journal.pone.0245478. eCollection 2021.
The purpose of this study was to explore the association between perceived social support and COPD outcomes and to determine whether the associations are mediated by depressive symptoms.
Subjects with COPD who were enrolled as part of SPIROMICS were included in this analysis. Questionnaires relating to quality of life, symptom burden, and functional status were administered at annual clinic visits for over a 3 year period. In both cross-sectional and longitudinal analyses, we examined the association of social support as measured by the FACIT-F with COPD outcomes. Cross sectional analyses used multivariable linear or logistic regression, adjusting for covariates. For longitudinal analyses, generalized linear mixed models with random intercepts were used. Models were adjusted with and without depressive symptoms and mediation analyses performed.
Of the 1831 subjects with COPD, 1779 completed the FACIT- F questionnaire. In adjusted cross-sectional analysis without depressive symptoms, higher perceived social support was associated with better quality of life, well-being, 6 minute walk distance, and less dyspnea. When also adjusting for depressive symptoms, all associations between social support and COPD outcomes were attenuated and no longer statistically significant. Mediation analysis suggested that depressive symptoms explained the majority (> = 85%) of the association between social support and measured COPD outcomes. Results of the longitudinal analysis were consistent with the cross-sectional analyses. There was no association between social support and odds of exacerbations.
Higher social support was associated with better COPD outcomes across several measures of morbidity including quality of life, respiratory symptoms, and functional status. In addition, these associations were largely attenuated when accounting for depressive symptoms suggesting that the beneficial association of social support with COPD outcomes may be largely mediated by the association between social support and depression.
SPIROMICS was approved by Institutional Review Boards at each center and all participants provided written informed consent (clinicaltrials.gov: NCT01969344).
本研究旨在探讨感知社会支持与 COPD 结局的关系，并确定这些关系是否通过抑郁症状介导。
本分析纳入了作为 SPIROMICS 一部分入组的 COPD 患者。在为期 3 年的年度临床就诊期间，通过问卷调查评估生活质量、症状负担和功能状态。在横断面和纵向分析中，我们检查了 FACIT-F 测量的社会支持与 COPD 结局的关系。横断面分析采用多变量线性或逻辑回归，调整协变量。对于纵向分析，采用具有随机截距的广义线性混合模型。模型调整了有无抑郁症状，并进行了中介分析。
在 1831 例 COPD 患者中，有 1779 例完成了 FACIT-F 问卷。在无抑郁症状的调整后横断面分析中，较高的感知社会支持与更好的生活质量、幸福感、6 分钟步行距离和更少的呼吸困难相关。当同时调整抑郁症状时，社会支持与 COPD 结局之间的所有关联均减弱且不再具有统计学意义。中介分析表明，抑郁症状解释了社会支持与测量的 COPD 结局之间的大部分关联（> = 85%）。纵向分析的结果与横断面分析一致。社会支持与加重的几率之间没有关联。
在包括生活质量、呼吸症状和功能状态在内的几种发病率指标中，较高的社会支持与 COPD 结局相关。此外，当考虑到抑郁症状时，这些关联大部分减弱，表明社会支持与 COPD 结局的有益关联在很大程度上是通过社会支持与抑郁之间的关联介导的。
SPIROMICS 得到了每个中心的机构审查委员会的批准，所有参与者均提供了书面知情同意书（clinicaltrials.gov：NCT01969344）。
