title: Identification of Anxiety Symptom Clusters in Patients with COPD: Implications for Assessment and Treatment.
abstract: BACKGROUND
  Treatment of chronic obstructive pulmonary disease (COPD) is palliative, and quality of life is important. Increased understanding of correlates of quality of life and its domains could help clinicians and researchers better tailor COPD treatments and better support patients engaging in those treatments or other important self-management behaviors.
  
  
  OBJECTIVE
  Anxiety is common in those with COPD; however, overlap of physical and emotional symptoms complicates its assessment. The current study aimed to identify anxiety symptom clusters and to assess the association of these symptom clusters with COPD-related quality of life.
  
  
  METHODS
  Participants (N = 162) with COPD completed the Beck Anxiety Inventory (BAI), Chronic Respiratory Disease Questionnaire, Patient Health Questionnaire-9, and Medical Research Council dyspnea scale. Anxiety clusters were identified, using principal component analysis (PCA) on the BAI's 21 items. Anxiety clusters, along with factors previously associated with quality of life, were entered into a multiple regression designed to predict COPD-related quality of life.
  
  
  RESULTS
  PCA identified four symptom clusters related to (1) general somatic distress, (2) fear, (3) nervousness, and (4) respiration-related distress. Multiple regression analyses indicated that greater fear was associated with less perceived mastery over COPD (β = -0.19, t(149) = -2.69, p < 0.01).
  
  
  CONCLUSIONS
  Anxiety symptoms associated with fear appear to be an important indicator of anxiety in patients with COPD. In particular, fear was associated with perceptions of mastery, an important psychological construct linked to disease self-management. Assessing the BAI symptom cluster associated with fear (five items) may be a valuable rapid assessment tool to improve COPD treatment and physical health outcomes.
authors.affiliation: Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.|Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94304, USA.
authors.forename: Jessica Y
authors.initials: JY
authors.lastname: Breland
authors.affiliation: Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.|Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA.|Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA.
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Hundt
authors.affiliation: Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.|Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA.|Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA.
authors.forename: Terri L
authors.initials: TL
authors.lastname: Barrera
authors.affiliation: Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.|Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA.|Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Mignogna
authors.affiliation: Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.|Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA.|Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Petersen
authors.affiliation: Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.|Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA.|Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA.
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Stanley
authors.affiliation: Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA. jcully@bcm.edu.|Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA. jcully@bcm.edu.|Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA. jcully@bcm.edu.
authors.forename: Jeffery A
authors.initials: JA
authors.lastname: Cully
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology*; D001008:Anxiety Disorders / Q000201:enzymology*; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology*; D011788:Quality of Life; D012648:Self Care; D013577:Syndrome
keywords: Anxiety; Beck Anxiety Inventory; COPD; Quality of life