Psychopathology and illness beliefs influence COPD self-management.
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.


CONCLUSIONS
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.
Dowson
Claire A
CA
Canterbury Respiratory Research Group, Hagley Building, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand. claire.dowson@chmeds.ac.nz
Town
G Ian
GI
Frampton
Christopher
C
Mulder
Roger T
RT
D000368:Aged; D001008:Anxiety Disorders / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D001294:Attitude to Health; D003469:Culture; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D015203:Reproducibility of Results; D012648:Self Care; D011795:Surveys and Questionnaires