Improving Quality of Life in Depressed COPD Patients: Effectiveness of a Minimal Psychological Intervention

Figures & data

Table 1.  Phases of the Minimal Psychological Intervention (MPI)

Phase	Description
1	The nurse explores the patient's feelings, cognitions and behaviours
2	The patient keeps a diary, where he or she records symptoms, complaints, thoughts, worries, related feelings and behaviour
3	The patient is challenged to link his or her mood to the consequent behaviour, using information from the diary
4	The self-management approach is introduced. The patient explores possibilities to alter his or her behaviour and draws up an action plan
5	Evaluation of progress in achieving the goals of the action plan

Figure 1.  Patient flow and follow up in the study.

Table 2.  Comparability of MPI intervention and control groups regarding socio-demographic variables and baseline values of outcomes

	Usual care	MPI	P-value
Variable	n = 91	n = 96
Age, yrs (SD)	71.5 (7.1)	70.5 (6.3)	0.32
Sex, No. (%)
Male	53 (58.2)	59 (61.5)
Female	38 (41.8)	37 (38.5)	0.65
Education level^†, No. (%)
Low	31 (34.1)	36 (37.5)
Medium	24 (26.4)	31 (32.3)
High	36 (39.6)	29 (30.2)	0.39
BDI, mean (SD)	18.3 (7.2)	17.1 (6.5)	0.23
SCL, mean (SD)	20.4 (7.3)	20.6 (6.2)	0.83
SGRQ total score, mean (SD)	56.8 (19.5)	54.9 (17.5)	0.55
SGRQ activity, mean (SD)	70.9 (21.0)	70.6 (20.9)	0.79
SGRQ impact, mean (SD)	46.2 (22.3)	45.9 (20.8)	0.91
SGRQ symptoms, mean (SD)	56.7 (27.5)	60.9 (25.2)	0.30

^† Low refers to primary school only, medium refers to lower vocational training or lower general education, high refers to higher vocational training, secondary school, higher professional education and university training.

Range of the BDI is 0–63, with 0 as the most favorable outcome; range of SGRQ total scale and subscales is 0–100, with 0 as the most favorable score; range of the SCL Anxiety scale is 1–50, with 1 as the most favorable outcome.

Table 3.  Outcomes on quality of life, depression and anxiety

	Usual Care N = 91 Mean (SE)*	N**	MPI N = 96 Mean (SE)*	N**	Mean difference (UC-MPI) (95%CI)	p-value	Effect size D
Depression and anxiety scales
BDI
After 1 week	17.31 (0.77)	68	15.45 (0.80)	64	1.85 (−0.36 to 4.06)	0.10	0.29
After 3 months	17.57 (0.82)	63	15.59 (0.87)	57	1.98 (−0.39 to 4.36)	0.10	0.31
After 9 months	17.96 (0.96)	59	15.04 (1.00)	58	2.92 (0.17 to 5.68)	0.04	0.39
SCL Anxiety
After 1 week	21.43 (0.69)	66	20.76 (0.73)	61	0.67 (−1.31 to 2.64)	0.51	0.11
After 3 months	21.66 (0.74)	61	20.87 (0.78)	55	0.79 (−1.34 to 2.91)	0.47	0.14
After 9 months	23.54 (0.84)	58	19.85 (0.87)	57	3.69 (1.29 to 6.09)	0.003	0.57
SGRQ subscales
Activity subscale
After 1 week	70.51 (1.75)	54	62.99 (1.92)	46	7.52 (2.39 to 12.66)	0.004	0.59
After 3 months	68.91 (1.86)	48	62.54 (2.07)	41	6.37 (0.87 to 11.87)	0.02	0.49
After 9 months	70.64 (2.09)	47	65.32 (2.25)	45	5.32 (−0.78 to 11.43)	0.09	0.37
Impact subscale
After 1 week	44.95 (1.58)	60	41.43 (1.70)	52	3.52 (−1.03 to 8.07)	0.13	0.29
After 3 months	46.51 (1.83)	51	40.16 (1.93)	49	6.35 (1.10 to 11.61)	0.02	0.48
After 9 months	46.48 (1.96)	50	37.86 (2.03)	49	8.62 (3.04 to 14.21)	0.003	0.62
Symptoms subscale
After 1 week	60.08 (2.53)	64	57.58 (2.67)	57	2.50 (−4.71 to 9.70)	0.50	0.12
After 3 months	59.16 (2.61)	58	53.91 (2.84)	48	5.25 (−2.33 to 12.84)	0.17	0.27
After 9 months	57.48 (2.67)	54	52.37 (2.75)	52	5.11 (−2.43 to 12.65)	0.18	0.26
Total SGRQ scale
After 1 week	55.63 (1.57)	49	50.48 (1.71)	42	5.14 (0.59 to 9.70)	0.03	0.47
After 3 months	56.09 (1.64)	44	49.12 (1.82)	38	6.97 (2.14 to 11.80)	0.005	0.64
After 9 months	56.08 (1.86)	42	48.14 (1.98)	42	7.94 (2.67 to 13.32)	0.004	0.65

Abbreviations: SE, standard error; BDI, Beck Depression Inventory; SCL Anxiety, Symptom Checklist Anxiety; SGRQ, Saint George's Respiratory Questionnaire.

Range of the BDI is 0–63, with 0 as the most favorable outcome; range of SGRQ total scale and subscales is 0–100, with 0 as the most favorable score; range of the SCL Anxiety scale is 1–50, with 1 as the most favorable outcome.

N represents the number of persons with a valid scale score on that FU measurement.

*Estimates from mixed model regression analyses, corrected for age, gender, level of education and baseline value of the outcome measure.

**The maximum number of patients across measurements for whom imputation of items was not possible was 2 for the BDI, 5 for the SCL, 32 for Activity, 21 for Impact, 15 for Symptoms and 41 for the SGRQ total score.