Psychopathology and illness beliefs influence COPD self-management

• Published in: Journal of psychosomatic research Vol. 55; no. 3; pp. 333 - 340
• Main Authors: Dowson, Claire A, Frampton, Christopher, Mulder, Roger T, Town, G Ian
• Format: Journal Article
• Language: English
• Published: 01.03.2004
• Subjects: Alcohol abuse; Chronic obstructive pulmonary disease; Disease concept; Psychopathology; Risk factors; Selfmanagement
• ISSN: 0022-3999

Objective: To explore the influence of psychological characteristics in Chronic Obstructive Pulmonary Disease (COPD) self-management. Methods: Patients admitted with an exacerbation of COPD were interviewed for psychiatric symptoms, illness beliefs and self-management behaviour using a new COPD Self-Management Interview (COPD-SMI). This comprised three scenarios to mimic a future evolving exacerbation. Responses were scored for knowledge and actions (adherence) for each scenario. Results: Of 47 people approached, 39 participated; 41% had panic attacks, 33% general anxiety, 35% a depression history, 31% an anxiety history and 21% an alcohol dependence history. Twenty-six (67%) had a self-management plan. When hypothetically "well" lower (poorer) COPD-SMI Knowledge Scores were associated with an alcohol dependence history (P=.025), no panic (P=.021) and males (P=.028). Those perceiving less influence over COPD had lower Action Scores during this scenario (P=.01) and the "early exacerbation" scenario (P= .05). Lower Knowledge Scores for the "early exacerbation" were associated with no panic (P=.01) and no self-management plans (P=.03). For the "severe exacerbation", lower Action Scores were associated with depression history (P=.004), panic (P=.002), higher FEVi% and no self-management plans (P= .005). Higher PaCO(sub 2) was associated with lower confidence in symptom recognition, self-management ability and medical care influencing COPD. Conclusion: Anxiety, depression, alcohol use and illness beliefs may differentially influence self-management. Depression, previous alcohol dependence and perceived less influence over COPD inhibited self-management. Those with panic demonstrated more self-management knowledge when "well" but performed poorly on actions during the "severe exacerbation". Those with self-management plans had better knowledge and actions. (Original abstract)