Psychopathology and illness beliefs influence COPD self-management

Abstract

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 FEV 1% and no self-management plans ( P=.005). Higher PaCO 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.