The complexity of mental health care for people with COPD: a qualitative study of clinicians\u2019 perspectives

Juliet Wang,Karen Willis,Natasha Smallwood,Elizabeth Barson

doi:10.1038/s41533-021-00252-w

Abstract

Anxiety and depression are common mental health illnesses in people with chronic obstructive pulmonary disease (COPD). However, patients often decline formal mental health care with barriers identified at the patient, health provider and health system levels. Currently clinicians’ perspectives on this issue are not well understood. A qualitative study using semi-structured interviews was undertaken to explore clinician perceived barriers and facilitators to acceptance of psychological care amongst people with COPD. Twenty-four Australian respiratory health professionals participated. Interview transcripts were analysed thematically. An overarching theme of ‘complexity’ was identified, which was evident across five domains: (1) physical and mental health illnesses; (2) psychosocial circumstances; (3) community views and stigma; (4) educational needs and knowledge gaps; (5) navigating the health system. Targeted patient education around psychological interventions and integration of mental health clinicians within multidisciplinary outpatient respiratory services are needed to address the current challenges.

Highlights

Chronic obstructive pulmonary disease (COPD) is a highly prevalent, progressive condition leading to significant morbidity and mortality worldwide[1,2,3]
“Some of them [COPD patients] might be schizophrenic, some of them might have post-traumatic stress disorder (PTSD), some of them might have childhood abuse, so there’s other groups of people that we find really hard to help because their problems have been very long-standing and whatever’s been offered has probably already been offered to them before in the past.” (HP2, Community centre nurse, female)
Our study expands on previous research[16,23], by examining the barriers to mental health care, and provides new insights into the effects of fragmented care, psychosocial complexity, and community stigma on patients’ engagement with mental health treatments

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a highly prevalent, progressive condition leading to significant morbidity and mortality worldwide[1,2,3]. Depression is the second most common selfreported comorbidity amongst people with COPD6. The mean prevalence of depression and anxiety in individuals with COPD are estimated to be 40% (range 8–80%) and 36% (range 6–74%), respectively[7,8]. Mental health issues in COPD are associated with reduced ability to cope with physical aspects of the illness[10,11], poorer quality of life, lower pulmonary function[12,13], more frequent hospital admissions with longer length of stay, reduced medication compliance and lower adherence to rehabilitation and other treatment regimens[10,14,15,16,17,18]

Objectives

Results

Conclusion