The COPD Helplessness Index: a new tool to measure factors affecting patient self-management.
BACKGROUND
Psychologic factors affect how patients with COPD respond to attempts to improve their self-management skills. Learned helplessness may be one such factor, but there is no validated measure of helplessness in COPD.


METHODS
We administered a new COPD Helplessness Index (CHI) to 1,202 patients with COPD. Concurrent validity was assessed through association of the CHI with established psychosocial measures and COPD severity. The association of helplessness with incident COPD exacerbations was then examined by following subjects over a median 2.1 years, defining COPD exacerbations as COPD-related hospitalizations or ED visits.


RESULTS
The CHI demonstrated internal consistency (Cronbach alpha = 0.75); factor analysis was consistent with the CHI representing a single construct. Greater CHI-measured helplessness correlated with greater COPD severity assessed by the BODE (Body-mass, Obstruction, Dyspnea, Exercise) Index (r = 0.34; P < .001). Higher CHI scores were associated with worse generic (Short Form-12, Physical Component Summary Score) and respiratory-specific (Airways Questionnaire 20) health-related quality of life, greater depressive symptoms, and higher anxiety (all P < .001). Controlling for sociodemographics and smoking status, helplessness was prospectively associated with incident COPD exacerbations (hazard ratio = 1.31; P < .001). After also controlling for the BODE Index, helplessness remained predictive of COPD exacerbations among subjects with BODE Index </= median (hazard ratio = 1.35; P = .01), but not among subjects with higher BODE Index values (hazard ratio = 0.93; P = .34).


CONCLUSIONS
The CHI is an internally consistent and valid measure, concurrently associated with health status and predictively associated with COPD exacerbations. The CHI may prove a useful tool in analyzing differential clinical responses mediated by patient-centered attributes.
Omachi
Theodore A
TA
University of California, San Francisco, Box 0111, 505 Parnassus Ave, San Francisco, CA 94143-0111, USA. omachi@ucsf.edu
Katz
Patricia P
PP
Yelin
Edward H
EH
Iribarren
Carlos
C
Knight
Sara J
SJ
Blanc
Paul D
PD
Eisner
Mark D
MD
D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006380:Helplessness, Learned; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology; D012648:Self Care / Q000523:psychology*; D012720:Severity of Illness Index