Kerstin Kühl

Mental disorders and quality of life in COPD patients and their spouses

In the current study, the prevalence of the most common psychological disorders in COPD patients and their spouses was assessed cross-sectionally. The influence of COPD patients’ and their spouses’ psychopathology on patient health-related quality of life was also examined. The following measurements were employed: Forced expiratory volume in 1 second expressed in percentage predicted (FEV1%), Shuttle-Walking-Test (SWT), International Diagnostic Checklists for ICD-10 (IDCL), questionnaires on generic and disease-specific health-related quality of life (St. George’s Respiratory Questionnaire (SGRQ), European Quality of Life Questionnaire (EuroQol), a modified version of a Disability-Index (CDI)), and a screening questionnaire for a broad range of psychological problems and symptoms of psychopathology (Symptom-Checklist-90-R (SCL-90-R)). One hundred and forty-three stable COPD outpatients with a severity grade between 2 and 4 (according to the GOLD criteria) as well as 105 spouses took part in the study. The prevalence of anxiety and depression diagnoses was increased both in COPD patients and their spouses. In contrast, substance-related disorders were explicitly more frequent in COPD patients. Multiple linear regression analyses indicated that depression (SCL-90-R), walking distance (SWT), somatization (SCL-90-R), male gender, FEV1%, and heart disease were independent predictors of COPD patients’ health-related quality of life. After including anxiousness of the spouses in the regression, medical variables (FEV1% and heart disease) no longer explained disability, thus highlighting the relevance of spouses’ well-being. The results underline the importance of depression and anxiousness for health-related quality of life in COPD patients and their spouses. Of special interest is the fact that the relation between emotional distress and quality of life is interactive within a couple.

The impact of chronic obstructive pulmonary disease-related fears on disease-specific disability

Anxiety is frequently observed in persons with chronic obstructive pulmonary disease (COPD). Although anxiety in persons with COPD is multifaceted, it is mostly assessed as a general psychopathological condition. Consequently, the objectives of this study were to revise an existing questionnaire assessing relevant anxieties for use in clinical practice and research, to examine the association between COPD-related fears and disability, and finally to develop norms for COPD-related fears. Disease severity (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, use of long-term oxygen), sociodemographic characteristics, COPD-specific disability (COPD assessment test), and psychopathology (depression, general anxiety, somatoform symptoms, and disease-related fears) were obtained from a sample of 1025 individuals with COPD via the Internet. We used the COPD Anxiety Questionnaire (German: CAF) for the assessment of different fears that have been found to be relevant in COPD: fear of dyspnea, fear of physical activity, fear of progression, fear of social exclusion, and sleep-related worries. Mean COPD-specific disability was high (22.87). After explanatory and confirmatory factor analyses, a revised version of the CAF was constructed. The economical and user-friendly CAF-R showed adequate reliability and expected correlations with convergent and discriminant constructs. Gender-specific norms are provided for use in clinical practice and research. Even after controlling for GOLD stage, sociodemographic variables, and psychopathology, COPD-related fears contributed incrementally to disease-specific disability. The CAF-R is an economical and reliable tool to assess different specific fears in COPD. Results indicate that disease-specific fears have an impact on disability, supporting the assumption that detailed assessment of anxiety in COPD should be included in clinical practice.

Der COPD-Angst-Fragebogen (CAF): Ein neues Instrument zur Erfassung krankheitsspezifischer Ängste bei COPD-Patienten

The study aimed to construct a questionnaire for COPD specific anxiety. Anxiety is a prevalent comorbid complication in COPD; however, assessment has focused on anxiety questionnaires in general and not on COPD related fears. Ninety-six patients with COPD (GOLD III/IV) participated in the study. Results of a principal component analysis with Varimax-rotation suggested 5 factors, jointly explaining 64.7% of variance. These factors depict: fear of social isolation, dyspnea related fear, fear of movement, fear of progression of disease, anxiety in relationships, and fear of LTOT. Satisfying internal consistencies (a=0.77-0.89) resulted for all factors. Validity analyses confirmed discriminant and convergent associations, as well as correlations with functional tests. Overall, the COPD-Anxiety-Questionnaire constitutes a reliable and valid measure to assess COPD-related fears. Moreover, it enables the early identification of COPD patients suffering from disease related anxiety.

For better or for worse: a longitudinal study on dyadic coping and quality of life among couples with a partner suffering from COPD

In chronic obstructive pulmonary disease, impairments of dyadic coping are associated with reduced quality of life. However, existing studies have a cross-sectional design. The present study explores changes in dyadic coping over time and its long-term effects on quality of life of both patients suffering from COPD and their partners. Dyadic coping, psychological distress, health-related quality of life, and exercise capacity were assessed in 63 patients suffering from COPD with their partners, at baseline and 3-year-follow-up. Correlation analyses and actor-partner interdependence models (APIMs) were conducted. Patients’ delegated dyadic coping (taking over tasks) and common dyadic coping (mutual coping efforts when both partners are stressed) rated by the spouses decreased. Correlation analyses showed that patients’ quality of life at follow-up was positively influenced by partners’ stress communication (signaling stress). Partners’ quality of life at follow-up was negatively influenced by patients’ negative dyadic coping (reacting superficially, ambivalently or hostilely) and positively influenced by partners’ delegated dyadic coping rated by patients (taking over tasks). APIMs mostly supported these results. It seems important that both partners communicate about stress and provide appropriate instrumental and emotional support to maintain quality of life.

Prediction of end-of-life fears in COPD – hoping for the best but preparing for the worst

Objective: The diagnosis of a life-threatening illness can trigger end-of-life fears. Early studies show that end-of-life fears play an important role in chronic obstructive pulmonary disease (COPD). However, predictors of these fears have not yet been identified. This study investigated the relevance of socio-demographic variables, illness severity, psychological distress and disease-specific anxieties as predictors of end-of-life fears in COPD. Design: A total of 131 COPD patients participated at two time points. Regression and mediation analyses, as well as cross-lagged panel analyses were conducted. Main outcome measures: The participants completed questionnaires assessing end-of-life fears (Multidimensional Orientation toward Dying and Death Inventory), psychological distress (Hospital Anxiety and Depression Scale), and disease-specific anxieties (COPD Anxiety Questionnaire). Pulmonary function and a 6-min walk test served as measures of illness severity. Results: Illness severity was not predictive of end-of-life fears. However, gender and psychological distress explained incremental variance. When disease-specific anxieties were included as additional predictors, psychological distress was no longer significant. Cross-lagged panel analyses mostly supported these results. Moreover, disease-specific anxieties mediated the association between psychological distress and end-of-life fears. Conclusion: Administration and intensity of end-of-life care (especially concerning end-of-life fears) in COPD patients should be based not only on illness severity, but rather on psychological distress and disease-specific anxieties.

[Chronic obstructive pulmonary disease (COPD): spouses' quality of life and burden during the course of disease].

Little is known about the effect of chronic diseases like COPD on the well-being of caring partners. The aim of the present study was the prospective longitudinal evaluation of quality of life as well as psychological distress with consideration to further psychosocial variables. Therefore a group of 143 consecutive COPD-outpatients and their spouses (n=105) were followed-up over a period of 3 years to assess changes in quality of life (EuroQol), psychological distress (SCL-90-R) and social support (F-SozU). Complete data were available in 64 couples. Spouses showed reduced quality of life and nearly one out of four reported increased psychological distress. Among others, initial social distress predicted quality of life and psychological distress. Given the results, it is time to take action in order to prevent caring spouses to become dependent on care themselves.

Kognitive Verhaltenstherapie bei komplizierter Trauer

Akute Trauer als normale Reaktion auf den Verlust einer nahestehenden Person wird in der Regel schmerzhaft erlebt. Dennoch bewältigen die meisten Betroffenen ihre Trauer ohne professionelle Hilfe. Eine Minderheit erlebt anhaltende und schwerwiegende Trauersymptome, die das Bild einer komplizierten Trauerstörung erfüllen können. Die Aufmerksamkeit für komplizierte Trauer als eigenständiges Störungsbild nimmt zu, auch bedingt durch die Berücksichtigung in den Neuauflagen der Klassifikationssysteme «International Statistical Classification of Diseases and Related Health Problems» (ICD-11) und «Diagnostisches und Statistisches Manual Psychischer Störungen» (DSM-5). Die Diagnostik muss allerdings die Gefahr einer Pathologisierung normaler Trauerreaktionen sowie Fehlklassifikationen berücksichtigen. Interventionen, die sich an alle Trauernden richten (universelle Prävention), zeigen nur minimale Effekte. Die Möglichkeit der Prävention komplizierter Trauer in Risikogruppen oder bei hochbelasteten Akuttrauernden wird kritisch diskutiert. Aktuelle randomisiert-kontrollierte Studien belegten aber die Überlegenheit störungsspezifischer gegenüber anderen Behandlungsansätzen (interpersonelle Psychotherapie) bei komplizierter Trauer. Bezüglich kognitiv-verhaltenstherapeutischer Interventionen sind die Exposition gegenüber trauer- oder verlustassoziierten Stimuli sowie die kognitive Umstrukturierung trauerspezifischer dysfunktionaler Gedanken hochgradig evidenzbasiert. Ein weiteres Behandlungselement ist die Etablierung neuer Ziele für ein Leben ohne die verstorbene Person. Auch die Verhaltensaktivierung zeigte erste positive Effekte. Neben der klassischen Face-to-Face-Psychotherapie sind dabei auch Internet-basierte Behandlungsangebote vielversprechend. Dennoch besteht weiterer Forschungsbedarf, beispielsweise hinsichtlich der differenziellen Effektivität einzelner Behandlungskomponenten.

Unterschätzte Komorbidität?: Angst und Depression bei COPD

ZusammenfassungTrotz der hohen Prävalenz psychischer Probleme bei COPD-Patienten werden diese erstaunlich selten vom Arzt und vom Patienten angesprochen. Dabei verschlechtern Angst und Depression nicht nur die Lebensqualität der Betroffenen. Es kommt auch häufiger zu Exazerbationen, und die Zahl der Krankenhausaufenthalte steigt. Die Autoren des nach folgenden Beitrags plädieren deshalb dafür, diese oft «totgeschwiegenen Prob leme» zu erfragen und bei der Behandlung mit zu berücksichtigen.

Entwicklung eines Fragebogens zur asthmabezogenen Lebensqualität von Kindern (FALK)

Development of a Children’s Questionnaire for Asthma-Related Quality of Life (CQAQL) Introduction: The aim of the following study was to construct a questionnaire which assesses illness and healthrelated aspects of quality of life in children with asthma, the most frequent chronic disease in children and adolescents. Patients and Methods: A pool of 37 items was created, based on other questionnaires as well as on statements made by children who took part in an asthma-specific behavioural training. Participants were 119 children (7–17 years) with different degrees of asthma. Results: A principal component analysis and varimax rotation of the questionnaire suggested three factors: (i) subjective distress, (ii) fear of medical interventions and asthma related anxiety and (iii) subjective health. Internal consistencies can be considered as sufficient (α = 0.74 to 0.80). There is no sex differences in the three scales but younger children reveal higher treatmentand asthmarelated anxiety. Compared to children with less severe asthma, children with severe asthma report higher subjective distress – and at the same time better subjective health. Conclusion: A German economic and multi-dimensional self-report instrument was developed which assesses asthma-related quality of life in a way that is suitable for children. Schlüsselwörter Asthma bronchiale · Kinder · Lebensqualität · Fragebogen