title: Fluctuating patterns in quality of life outcomes among patients with moderate and severe stages of chronic obstructive pulmonary disease.
abstract: How changes in depression and anxiety and well-being may fluctuate with changes in disease-specific quality of life (QOL), and further how changes in well-being may fluctuate with changes in depression and anxiety among patients with moderate and severe chronic obstructive pulmonary disease (COPD).
  
  
  
  In a longitudinal study (as part of a randomized controlled trial), we investigated 150 patients with moderate and severe COPD at baseline, 143 at 4 weeks, and 130 at 4 months. Lung function was tested, and a questionnaire was completed at all appointments. The questions captured demographic variables, disease-specific QOL (St. George's Respiratory Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), and well-being (World Health Organization-5 Well-being Index). Multiple regression analyses were performed.
  
  
  
  At 4 weeks and 4 months, changes in disease-specific QOL (st. β = -0.35, p < 0.001, partial (p) R (2) = 11-12 %), depression (st. β = -0.32 to -0.36, p < 0.001, pR (2) = 9-12 %), and anxiety (st. β = -0.21 to -0.40, p < 0.02-0.001, pR (2) = 4-15 %) were significantly associated with changes in well-being. Changes in disease-specific QOL were significantly associated with changes in anxiety at 4 months (st. β = 0.21, p = 0.02, pR (2) = 4 %), but not with changes in depression.
  
  
  
  Changes in disease-specific QOL, depression, and anxiety were associated with changes in well-being. Changes in disease-specific QOL contributed slightly to changes in anxiety, but not to changes in depression. Well-being may capture some aspects of mental QOL in COPD patients better than depression and anxiety.
authors.affiliation: Department of Health Sciences, University of Oslo, Oslo, Norway. c.r.borge@medisin.uio.no.|Department of Medicine, Lovisenberg Diaconal Hospital, 0440, Oslo, Norway. c.r.borge@medisin.uio.no.|Department of Health Sciences, Institute of Health and Society, PB 1089 Blindern, 0317, Oslo, Norway. c.r.borge@medisin.uio.no.
authors.forename: Christine R
authors.initials: CR
authors.lastname: Borge
authors.affiliation: Department of Health Sciences, University of Oslo, Oslo, Norway.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Mengshoel
authors.affiliation: Department of Behavioral Sciences in Medicine, University of Oslo, Oslo, Norway.
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Moum
authors.affiliation: Department of Health Sciences, University of Oslo, Oslo, Norway.
authors.forename: Astrid K
authors.initials: AK
authors.lastname: Wahl
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000523:psychology*; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires
keywords: Chronic obstructive pulmonary disease; Outcomes; Quality of life; Symptoms; Well-being