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

Figures & data

Table 1 Factors associated with symptoms of patient anxiety and depression

Factors	Patients with symptoms of anxiety (n=52)	Patients without symptoms of anxiety (n=60)	P-value	Patients with symptoms of depression (n=48)	Patients without symptoms of depression (n=64)	P-value
Age, years	70 (65–74)	73 (66–78.8)	0.135	66 (62–73)	74.5 (69.3–80)	<0.0005*
Sex (female), n (%)	20 (38.5)	24 (40)	0.868	18 (37.5)	26 (40.6)	0.738
Marital status, n (%)
Single	1 (1.9)	0	0.581	0	1 (1.6)	1
With partner	45 (86.5)	50 (84.7)		41 (85.4)	54 (85.7)
Separated/divorced/widowed	6 (11.5)	9 (15.3)		7 (14.6)	8 (12.7)
Living alone, n (%)	5 (9.6)	6 (10)	0.946	5 (10.4)	6 (9.4)	1
Educational level, n (%)
None	27 (67.5)	25 (52.1)	0.084	24 (66.7)	28 (53.8)	0.485
A level/O level	9 (22.5)	9 (18.8)		6 (16.7)	12 (23.1)
Higher	4 (10)	14 (29.2)		6 (16.7)	12 (23.1)
Income, n (%)
<£220/week	10 (20)	9 (16.7)	0.903	11 (25)	8 (13.3)	0.3
£221–£350/week	20 (40)	22 (40.7)		17 (38.6)	25 (41.7)
>£350/week	20 (40)	23 (42.6)		16 (36.4)	27 (45)
Patient–carer spousal relationship, n (%)	39 (76.5)	50 (84.7)	0.271	36 (76.6)	53 (84.1)	0.32
Patient–carer cohabitation, n (%)	44 (84.6)	54 (90)	0.39	41 (85.4)	57 (89.1)	0.564
Smoking status, n (%)
Current smoker	9 (17.3)	9 (15)	0.92	11 (22.9)	7 (10.9)	0.22
Former smoker	42 (80.8)	49 (81.7)		36 (75)	55 (85.9)
Never smoked	1 (1.9)	2 (3.3)		1 (2.1)	2 (3.1)
Duration of COPD	10 (6.3–15)	8 (5–13)	0.129	7 (4–13)	6.5 (3–12)	0.366
Disease-severity measures
% predicted FEV1, mean (SD)	43.7 (22.3)	34.9 (19.2)	0.154	37.8 (26.5)	38.3 (17.2)	0.941
mMRC dyspnea scale	4 (3–5)	4 (3–4)	0.507	4 (3–5)	4 (3–4)	0.226
Exacerbations requiring admission, n	0 (0–1)	0 (0–1)	0.652	0 (0–1)	0 (0–1)	0.972
Exacerbations at home, n	3 (2–5.5)	2 (0–3)	0.001*	3 (2–6)	2 (0–3)	0.011*
CRQ domains
Dyspnea	1.8 (1.4–2.8)	2.8 (2.2–4)	<0.0005*	1.8 (1.4–2.6)	3 (2.2–4)	<0.0005*
Fatigue	2.5 (2–3)	4.3 (3.1–4.9)	<0.0005*	2.5 (2–3)	3.8 (3–4.9)	<0.0005*
Mastery, mean (SD)	3.4 (1)	5.1 (1)	<0.0005*	3.6 (1.2)	4.8 (1.2)	<0.0005*
Patient comorbidities
Physical comorbidities,a n	4 (3–6)	3 (2–4)	0.002*	4 (3–6)	3.5 (2–4)	0.002*
Anxiety symptoms, n (%)	NA	NA	NA	34 (70.8)	18 (28.1)	<0.0005*
Depression symptoms, n (%)	24 (65.4)	14 (23.3)	<0.0005*	NA	NA	NA

Notes:

a Any of allergies, arthritis, asthma, back pain, cancer, diabetes, epilepsy, cardiac disease, hypertension, renal disease, hepatic disease, or stroke. All values medians (IQR) unless otherwise stated.

* P≤0.05.

Abbreviations: FEV₁, forced expiratory volume in 1 second; mMRC, modified Medical Research Council; CRQ, Chronic Respiratory Questionnaire; NA, not applicable.

Table 2 Factors associated with symptoms of carer anxiety and depression

	Carers with symptoms of anxiety (n=52)	Carers without symptoms of anxiety (n=61)	P-value	Carers with symptoms of depression (n=26)	Carers without symptoms of depression (n=87)	P-value
Age, years	63 (53–71)	68.5 (60.3–77)	0.079	60 (51–69.3)	69 (60–76)	0.017*
Sex (female), n (%)	44 (84.6)	38 (62.3)	0.008*	20 (76.9)	62 (71.3)	0.57
Marital status, n (%)
Single	3 (5.9)	4 (6.7)	0.023*	1 (3.8)	6 (7.1)	0.635
With partner	40 (78.4)	55 (91.7)		22 (84.6)	73 (85.9)
Separated/divorced/widowed	8 (15.7)	1 (1.7)		3 (11.5)	6 (7.1)
Living alone, n (%)	1 (1.9)	1 (1.6)	1	0 (0)	2 (2.3)	1
Educational level, n (%)
None	28 (66.7)	23 (52.3)	0.131	12 (60)	39 (59.1)	0.044*
A/O level	5 (11.9)	13 (29.5)		1 (5)	17 (25.8)
Higher	9 (21.4)	9 (18.2)		7 (35)	10 (15.2)
Income, n (%)
<£220/week	12 (26.1)	5 (9.8)	0.109	5 (21.7)	12 (16.2)	0.797
£221–£350/week	16 (34.8)	22 (43.1)		8 (34.8)	30 (40.5)
>£350/week	18 (39.1)	24 (47.1)		10 (43.5)	32 (43.2)
Patient–carer spousal relationship, n (%)	40 (76.9)	51 (83.6)	0.371	21 (80.8)	70 (80.5)	1
Patient–carer cohabitation, n (%)	43 (84.3)	55 (93.2)	0.135	22 (84.6)	76 (90.5)	0.473
Duration of caring	6 (2.5–12)	7 (3–13)	0.395	9.5 (3–13.5)	7 (3–12)	0.728
Hours of caring/week, n (%)
<19	18 (37.5)	23 (41.8)	0.687	9 (36)	32 (41)	0.143
20–49	15 (31.3)	13 (23.6)		4 (16)	24 (30.8)
>50	15 (31.3)	19 (34.5)		12 (48)	22 (28.2)
Patient disease-severity measures
% predicted FEV1, mean (SD)	39.1 (22.2)	37.5 (19.1)	0.774	41.8 (25.2)	40 (18.7)	0.463
mMRC dyspnea scale	4 (3–4.3)	4 (3–5)	0.602	4 (3–5)	4 (3–4)	0.143
Exacerbations requiring admission, n	0 (0–1)	0 (0–1)	0.939	0 (0–1)	0 (0–1)	0.545
Exacerbations at home, n	2 (1–4.5)	2 (0–4)	0.085	2 (1.5–5)	2 (0–4)	0.214
Subjective caring burden (FACQ)
Not enough time for myself	3 (2–4)	2 (2–3)	0.002*	3 (2.5–4)	2 (2–3)	0.003*
Losing control over my own life	3 (2–4)	2 (1–2)	<0.0005*	3 (2.5–4)	2 (1–2)	<0.0005*
Feel tired and run-down	3 (2–4)	2 (1–3)	<0.0005*	4 (2.5–5)	2 (1.5–3)	<0.0005*
Isolated and alone	3 (2–4)	2 (1–2)	0.002*	3 (2–4)	2 (1–3)	0.001*
Guilty about not being able to do more	4 (2–4)	2 (2–3)	0.001*	4 (3–5)	2 (2–4)	<0.0005*
My own health has suffered	3 (2–4)	2 (1–2)	<0.0005*	3 (3–4.5)	2 (1–2)	<0.0005*
Had to give up social life	2 (2–3)	2 (1–2)	0.028*	3 (2–4)	2 (1–3)	0.001*
Not been able to work or study as well	2 (2–4)	2 (1–2)	0.004*	3 (2–4.5)	2 (1–2)	<0.0005*
Financial difficulties	2 (2–3)	2 (1–3)	0.013*	3 (2–4)	2 (1–3)	<0.0005*
Unmet support needs (CSNAT)
CSNAT domains, n	4 (2–8)	2 (0–3)	<0.0005*	4.5 (2.3–8.8)	2 (0–4)	0.001*
Patient self-management
CRQ mastery	4 (1.3)	4.5 (1.3)	0.047*	4.1 (1.5)	4.4 (1.3)	0.31
Carer comorbidities
Physical comorbidities,a n	1 (1–2)	1 (0–2)	0.08	2 (1–3)	1 (0–2)	0.005*
Anxiety symptoms, n (%)	NA	NA	NA	23 (88.5)	29 (33.3)	<0.0005*
Depression symptoms, n (%)	23 (44.2)	3 (4.9)	<0.0005*	NA	NA	NA

Notes:

a Any of allergies, arthritis, asthma, back pain, cancer, diabetes, epilepsy, cardiac disease, hypertension, renal disease, hepatic disease, or stroke. All values medians (IQR) unless otherwise stated.

* P≤0.05.

Abbreviations: FEV₁, forced expiratory volume in 1 second; mMRC, modified Medical Research Council; FACQ, Family Appraisal of Caregiving Questionnaire; CSNAT, Carer Support Needs Assessment Tool; CRQ, Chronic Respiratory Questionnaire; NA, not applicable.

Figure 1 Dyad symptoms of anxiety or depression associated with patient fatigue. Notes: No AD (n=29), patient only AD (n=28), carer only AD (n=15), dyad AD (n=37). Data analyzed with one-way analysis of variance with Bonferroni post hoc test. Error bars represent 95% CIs.

Abbreviations: AD, anxiety/depression; CRQ, Chronic Respiratory Questionnaire.