Abstract
Purpose
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).
Methods
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.
Results
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.
Conclusions
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.
Similar content being viewed by others
References
Spilker, B. (1996). Quality of life and pharmacoeconomics in clinical trials (2nd ed.). New York: Lippincott-Raven.
Rokne, B., & Wahl, A. (2011). Quality of life assessment in health sciences. In Rsuchenbach, B., Mahler, C., Pflegebezogene Assessment Instrumente. Internationales Handbuch fur Pflegeforschung und –praxis (pp. 401–416). Bern: Verlag Hans Huber.
de los Monteros, M. J. E., Pena, C., Soto Hurtado, E. J., Jareno, J., & Miravitlles, M. (2012). Variability of respiratory symptoms in severe COPD. Archivos de Bronconeumologia, 48(1), 3–7.
Walke, L. M., Byers, A. L., Tinetti, M. E., Dubin, J. A., McCorkle, R., & Fried, T. R. (2007). Range and severity of symptoms over time among older adults with chronic obstructive pulmonary disease and heart failure. Archives of Internal Medicine, 167(22), 2503–2508.
Mroczek, D. K., & Spiro, A. (2005). Change in life satisfaction during adulthood: Findings from the veterans affairs normative aging study. Journal of Personality and Social Psychology, 88(1), 189–202.
Bausewein, C., Farquhar, M., Booth, S., Gysels, M., & Higginson, I. J. (2007). Measurement of breathlessness in advanced disease: A systematic review. Respiratory Medicine, 101(3), 399–410.
Jones, P., Miravitlles, M., van der Molen, T., & Kulich, K. (2012). Beyond FEV1 in COPD: A review of patient reported outcomes and their measurement. International Journal of Chronic Obstructive Pulmonary Disease, 7, 697–709.
Borge, C. R., Wahl, A. K., & Moum, T. (2010). Association of breathlessness with multiple symptoms in chronic obstructive pulmonary disease. Journal of Advanced Nursing, 66(12), 2688–2700.
Lohne, V., Heer, H. C., Andersen, M., Miaskowski, C., Kongerud, J., & Rustoen, T. (2010). Qualitative study of pain of patients with chronic obstructive pulmonary disease. Heart and Lung, 39(3), 226–234.
Bentsen, S. B., Wahl, A. K., Strand, L. I., & Hanestad, B. R. (2007). Relationships between demographic, clinical and pain variables and health-related quality of life in patients with chronic low back pain treated with instrumented fusion. Scandinavian Journal of Caring Sciences, 21(1), 134–143.
Blinderman, C. D., Homel, P., Billings, J. A., Tennstedt, S., & Portenoy, R. K. (2009). Symptom distress and quality of life in patients with advanced chronic obstructive pulmonary disease. Journal of Pain and Symptom Management, 38(1), 115–123.
Stridsman, C., Zingmark, K., Lindberg, A., & Skar, L. (2014). Creating a balance between breathing and viability: Experiences of well-being when living with chronic obstructive pulmonary disease. Primary Health Care Research & Development, 14, 1–11.
Fayers, P. M., & Machin, D. (2007). Quality of life: The assessment, analysis, and interpretation of patient-reported outcomes (2nd ed.). Chichester: John Wiley & Sons.
Dodge, R., Daly, A. P., Huton, J., & Sanders, L. (2012). The challenge of defining wellbeing. International Journal of Wellbeing, 2(2), 222–235.
Snyder, C. R., & Lopez, S. J. (2009). Oxford handbook of positive psychology. Oxford: Oxford University Press.
Bech, P. (2012). Subjective positive well-being. World Psychiatry, 11(2), 105–106.
Diener, E. (2000). Subjective well-being. The science of happiness and a proposal for a national index. American Psychologist, 55, 34–43.
Tsiligianni, I., Kocks, J., Tzanakis, N., Siafakas, N., & van der Molen, T. (2011). Factors that influence disease-specific quality of life or health status in patients with COPD: A review and meta-analysis of Pearson correlations. Primary Care Respiratory Journal, 20(3), 257–268.
Oga, T., Tsukino, M., Hajiro, T., Ikeda, A., & Nishimura, K. (2012). Analysis of longitudinal changes in dyspnea of patients with chronic obstructive pulmonary disease: An observational study. Respiratory Research, 13, 85.
Andenaes, R., Moum, T., Kalfoss, M. H., & Wahl, A. K. (2006). Changes in health status, psychological distress, and quality of life in COPD patients after hospitalization. Quality of Life Research, 15(2), 249–257.
Oga, T., Nishimura, K., Tsukino, M., Sato, S., Hajiro, T., & Mishima, M. (2007). Longitudinal deteriorations in patient reported outcomes in patients with COPD. Respiratory Medicine, 101(1), 146–153.
de Torres, J. P., Marin, J. M., Martinez-Gonzalez, C., de Lucas-Ramos, P., Mir-Viladrich, I., Cosio, B., et al. (2014). Clinical application of the COPD assessment test: Longitudinal data from the CHAIN cohort. Chest, 146(1), 111–122.
Strijbos, J. H., Postma, D. S., van Altena, R., Gimeno, F., & Koeter, G. H. (1996). A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months. Chest, 109(2), 366–372.
Ringbaek, T. J., Broendum, E., Hemmingsen, L., Lybeck, K., Nielsen, D., Andersen, C., et al. (2000). Rehabilitation of patients with chronic obstructive pulmonary disease. Exercise twice a week is not sufficient! Respiratory Medicine, 94(2), 150–154.
Hajos, T. R., Pouwer, F., de Grooth, R., Holleman, F., Twisk, J. W., Diamant, M., et al. (2012). The longitudinal association between glycaemic control and health-related quality of life following insulin therapy optimisation in type 2 diabetes patients. A prospective observational study in secondary care. Quality of Life Research, 21, 1359–1365.
Tepavcevic, D. K., Pekmezovic, T., Stojsavljevic, N., Kostic, J., Basuroski, I. D., Mesaros, S., et al. (2014). Change in quality of life and predictors of change among patients with multiple sclerosis: A prospective cohort study. Quality of Life Research, 23(3), 1027–1037.
Borge, C. R., Mengshoel, A. M., Omenaas, E., Moum, T., Ekman, I., Lein, M. P., et al. (2014). Effects of guided deep breathing on breathlessness and the breathing pattern in chronic obstructive pulmonary disease: A double-blind randomized control study. Patient Education and Counseling,. doi:10.1016/j.pec.2014.10.017.
GOLD (2015). Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. www.goldcopd.org. Accessed March 20, 2015.
Jones, P. W., Quirk, F. H., Baveystock, C. M., & Littlejohns, P. (1992). A self-complete measure of health status for chronic airflow limitation. The St. George’s Respiratory Questionnaire. The American Review of Respiratory Disease, 145(6), 1321–1327.
Bech, P., Gudex, C., & Johansen, K. S. (1996). The WHO (Ten) Well-Being Index: Validation in diabetes. Psychotherapy and Psychosomatics, 65(4), 183–190.
Bech, P., Olsen, L. R., Kjoller, M., & Rasmussen, N. K. (2003). Measuring well-being rather than the absence of distress symptoms: A comparison of the SF-36 Mental Health subscale and the WHO-Five Well-Being Scale. International Journal of Methods in Psychiatric Research, 12(2), 85–91.
Bonsignore, M., Barkow, K., Jessen, F., & Heun, R. (2001). Validity of the five-item WHO Well-Being Index (WHO-5) in an elderly population. European Archives of Psychiatry and Clinical Neuroscience, 251(Suppl 2), II27–II31.
de Wit, M., Pouwer, F., Gemke, R. J., Delemarre-van de Waal, H. A., & Snoek, F. J. (2007). Validation of the WHO-5 Well-Being Index in adolescents with type 1 diabetes. Diabetes Care, 30(8), 2003–2006.
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale. An updated literature review. Journal of Psychosomatic Research, 52(2), 69–77.
Puhan, M. A., Frey, M., Buchi, S., & Schunemann, H. J. (2008). The minimal important difference of the Hospital Anxiety and Depression Scale in patients with chronic obstructive pulmonary disease. Health and Quality of Life Outcomes, 6, 46.
Pellegrino, R., Viegi, G., Brusasco, V., Crapo, R. O., Burgos, F., Casaburi, R., et al. (2005). Interpretative strategies for lung function tests. European Respiratory Journal, 26(5), 948–968.
Wanger, J., Clausen, J. L., Coates, A., Pedersen, O. F., Brusasco, V., Burgos, F., et al. (2005). Standardisation of the measurement of lung volumes. European Respiratory Journal, 26(3), 511–522.
Hyatt, R. E., Scanlon, P. D., & Nakamura, M. (2009). Interpretation of pulmonary function tests. A practical guide (3rd ed.). Philadelphia: Lippincott Williams & Wilkins.
Jamieson, J. (2004). Analysis of covariance (ANCOVA) with difference scores. International Journal of Psychophysiology, 52(3), 277–283.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New Jersey: Lawrence Erlbaum Associates.
Ellis, P. D. (2010). The essential guide to effect sizes. Statistical power, meta-analysis, and the interpretation of research results. Cambridge: Cambridge University Press.
Henly, S. J., Wyman, J. F., & Findorff, M. J. (2011). Health and illness over time: The trajectory perspective in nursing science. Nursing Research, 60(3 Suppl), S5–S14.
Priebe, S., McCabe, R., Junghan, U., Kallert, T., Ruggeri, M., Slade, M., et al. (2011). Association between symptoms and quality of life in patients with schizophrenia: A pooled analysis of changes over time. Schizophrenia Research, 133(1–3), 17–21.
Wardenaar, K. J., van Veen, T., Giltay, E. J., Zitman, F. G., & Penninx, B. W. (2014). The use of symptom dimensions to investigate the longitudinal effects of life events on depressive and anxiety symptomatology. Journal of Affective Disorders, 156, 126–133.
Oga, T., Nishimura, K., Tsukino, M., Sato, S., Hajiro, T., & Mishima, M. (2007). Analysis of longitudinal changes in the psychological status of patients with asthma. Respiratory Medicine, 101(10), 2133–2138.
Mulligan, K., Mehta, P. A., Fteropoulli, T., Dubrey, S. W., McIntyre, H. F., McDonagh, T. A., et al. (2012). Newly diagnosed heart failure: Change in quality of life, mood, and illness beliefs in the first 6 months after diagnosis. British Journal of Health Psychology, 17(3), 447–462.
Haave, E., & Hyland, M. (2008). Different short-term and longitudinal results on perceived health status for asthma and COPD patients after pulmonary rehabilitation. Patients living alone have the largest improvements in perceived quality of life. Chronic Respiratory Disease, 5(2), 69–73.
Diener, E., & Ryan, K. (2009). Subjective well-being: A general overview. South African Journal of Psychology, 39, 391–406.
Ng, T. P., Niti, M., Tan, W. C., Cao, Z., Ong, K. C., & Eng, P. (2007). Depressive symptoms and chronic obstructive pulmonary disease: Effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Archives of Internal Medicine, 167(1), 60–67.
Fletcher, C., & Peto, R. (1977). The natural history of chronic airflow obstruction. British Medical Journal, 1(6077), 1645–1648.
McCann, S. J. (2010). Subjective well-being, personality, demographic variables, and American state differences in smoking prevalence. Nicotine & Tobacco Research, 12(9), 895–904.
Bech, P. (1990). Measurement of psychological distress and well-being. Psychotherapy and Psychosomatics, 54, 77–89.
Primack, B. A. (2003). The WHO-5 Wellbeing Index performed the best in screening for depression in primary care. American College of Physicians Journal Club, 139(2), 48.
ATS/ERS Guidelines. (2004). American Thoracic Society. European Respiratory Society. Standards for the Diagnosis and Management of Patients with COPD. http://www.thoracic.org/clinical/copd-guidelines/. Accessed December 18, 2014.
Coventry, P. A., & Hind, D. (2007). Comprehensive pulmonary rehabilitation for anxiety and depression in adults with chronic obstructive pulmonary disease: Systematic review and meta-analysis. Journal of Psychosomatic Research, 63(5), 551–565.
Glymour, M. M., Weuve, J., Berkman, L. F., Kawachi, I., & Robins, J. M. (2005). When is baseline adjustment useful in analyses of change? An example with education and cognitive change. American Journal of Epidemiology, 162(3), 267–278.
Herbert, R., Jamtvedt, G., Hagen, K. B., & Mead, J. (2014). Practical evidence-based physiotherapy (2nd ed.). Edinburgh: Churchill Livingstone Elsevier.
Acknowledgments
This study was supported by the Norwegian Extra Foundation for Health and Rehabilitation through EXTRA funds, University of Oslo Department of Health Sciences, Lovisenberg Diaconal Hospital, Norwegian Union of Nursing, and The Norwegian Heart and Lung Patient Organization. The authors are grateful to all the participants in the study and to Lovisenberg Diaconal Hospital, Ullevål University Hospital, and Diakonhjemmet Hospital (all in Oslo), for help with the recruitment of participants.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There are no conflicts of interest to report.
Rights and permissions
About this article
Cite this article
Borge, C.R., Mengshoel, A.M., Moum, T. et al. Fluctuating patterns in quality of life outcomes among patients with moderate and severe stages of chronic obstructive pulmonary disease. Qual Life Res 25, 2041–2051 (2016). https://doi.org/10.1007/s11136-016-1227-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-016-1227-4