Associations between the psychological health of patients and carers in advanced COPD

Abstract

Objective

Anxiety and depression are highly prevalent in patients with COPD and their informal carers, and associated with numerous risk factors. However, few studies have investigated these in primary care or the link between patient and carer anxiety and depression. We aimed to determine this association and factors associated with anxiety and depression in patients, carers, and both (dyads), in a population-based sample.

Materials and methods

This was a prospective, cross-sectional study of 119 advanced COPD patients and their carers. Patient and carer scores ≥8 on the Hospital Anxiety and Depression Scale defined symptoms of anxiety and depression, χ² tests determined associations between patient and carer symptoms of anxiety/depression, and χ² and independent t-tests for normally distributed variables (otherwise Mann–Whitney U tests) were used to identify other variables significantly associated with these symptoms in the patient or carer. Patient–carer dyads were categorized into four groups relating to the presence of anxious/depressive symptoms in: both patient and carer, patient only, carer only, and neither. Factors associated with dyad symptoms of anxiety/depression were determined with χ² tests and one-way analysis of variance for normally distributed variables (otherwise Kruskal–Wallis tests).

Results

Prevalence of symptoms of anxiety and depression was 46.4% (n=52) and 42.9% (n=48) in patients, and 46% (n=52) and 23% (n=26) in carers, respectively. Patient and carer symptoms of anxiety/depression were significantly associated. Anxious and depressive symptoms in the patient were also significantly associated with more physical comorbidities, more exacerbations, greater dyspnea, greater fatigue, poor mastery, and depressive symptoms with younger age. Symptoms of carer anxiety were significantly associated with being female and separated/divorced/widowed, and depressive symptoms with younger age, higher educational level, and more physical comorbidities, and symptoms of carer anxiety and depression with more unmet support needs, greater subjective caring burden, and poor patient mastery. Dyad symptoms of anxiety/depression were significantly associated with greater patient fatigue.

Conclusion

Symptoms of anxiety and depression in COPD patients and carers are significantly associated. Given their high prevalence, considerable impact on mortality, impact on quality of life and health care use, and associations with each other, screening for and addressing patient and carer anxiety and depression in advanced COPD is recommended.

Keywords:

• COPD
• anxiety
• depression
• informal carers
• patient–carer dyad

Acknowledgments

We are grateful to Silvia Mendonca for providing statistical support. The Living with Breathlessness Study program thanks: all participating patients, informal carers, and health care professionals; the former Primary Care Research Networks and all recruiting practices (East of England and South London); the British Lung Foundation Breathe Easy support groups and additional patient and carer representatives for their PPI (patient and public involvement) roles; Kevin Houghton for administrative support; Sam Barclay for additional data entry; and the program funders Marie Curie and the National Institute for Health Research. The Living with Breathlessness Study program is independent research supported by Marie Curie (grant C28845/A14129) and the National Institute for Health Research (grant CDF-2012-05-218). RM is supported by Cambridge National Institute for Health Research Biomedical Research Centre. The views expressed in this publication are those of the author(s), and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health, or other funders. Funding sources had no involvement in study design, collection, analysis and interpretation of data, writing of the report, or decision to submit the article for publication.

Author contributions

MF conceived and designed the study. GE, RM, SB, and HHB participated in conducting the study. MF and ACG acquired the data. Ella M and Emma M analyzed and interpreted the data. Ella M, Emma M, and MF drafted the manuscript. All authors contributed to revision of the manuscript for important intellectual content. All authors approve the final version to be published, and agree to be accountable for all aspects of the work. Ella M and Emma M are siblings.

Disclosure

The authors report no conflicts of interest in this work.