Psychological morbidity in interstitial lung disease: a study from India.

Abstract

Evaluation of mental health in chronic lung diseases like interstitial lung disease (ILD) and chronic obstructive pulmonary disease(COPD) has always been neglected and underrated. The aim of the study was to determine the psychological morbidity inpatients of ILD and to determine its various socio-clinical and psychological correlates. A cross-sectional clinic based descriptivestudy with 50 ILD patients, 30 COPD patients and 30 healthy controls was undertaken. Psychological distress was assessed using different psychological scales, like General HealthQuestionnaire-12 (GHQ-12), Patient Distress Thermometer (PDT), Coping Strategy Checklist (CSCL), WHO Quality of Life-Brief-26 (WHOQOL-Bref-26) and Depression Anxiety Stress Scale (DASS). The patients with a GHQ-12 score of ≥3 were considered as experiencing psychological distress and additionally referred to consultant psychiatrist for further detailed evaluationand management. Fifty-eight percent of ILD patients and 60% of COPD patients experienced psychological distress after screeningwith GHQ-12; 40% of all the ILD and COPD patients were ultimately diagnosed with a psychiatric disorder, after evaluation bythe psychiatrist. Patients of ILD and COPD had significantly higher scores on GHQ-12, CSCL and DASS, and significantly lower scores on WHOQOL-Bref-26 when compared with healthy controls.However, these scores, including PDT did not differ significantly between ILD and COPD patients. The scores on all thesescales in the patients of ILD and COPD who were experiencing psychological distress (GHQ ≥3) were significantly poorer thanthose without psychological distress (GHQ<3). GHQ-12 emerged as an excellent predictor of psychological morbidity. Various otherpsychological scales correlated with GHQ-12 and amongst each other in both the groups experiencing psychological distress.GHQ-12 and other different scales also significantly correlated with the different clinical indicators in ILD as well as COPD patients having psychological distress. Psychological distress andpoorer quality of life was present in a significant percentage of ILD patients, and was comparable to that seen in COPD. Mentalhealth evaluation should be incorporated in the routine management of these patients. Simple, easy and brief screening tools likeGHQ-12 can be of immense help.