Associations between the psychological health of patients and carers in advanced chronic obstructive pulmonary disease25 Jan 2018
Objective: Anxiety and depression are highly prevalent in patients with chronic obstructive pulmonary disease (COPD) and their informal carers, and associated with numerous risk factors. However, few studies have investigated these in primary care or the link between patient and carer anxiety and depression. We aimed to determine this association, and factors associated with anxiety and depression in patients, carers, and both(dyads), in a population-based sample. Methods: Prospective, cross-sectional study of 119 advanced COPD patients and their carers. Patient and carer scores ≥8 on the Hospital Anxiety and Depression Scale defined symptoms of anxiety and depression. Chi-square tests determined associations between patient and carer symptoms of anxiety/depression. Chi-square and independent-t tests for normally distributed variables (otherwise Mann-Whitney U tests) were used to identify other variables significantly associated with these symptoms in the patient or carer. Patient-carer dyads were categorised into four groups relating to the presence of anxious/depressive symptoms in: (1) both patient and carer, (2) patient only, (3) carer only and (4) neither. Factors associated with dyad symptoms of anxiety/depression were determined with Chi-square and one-way ANOVA tests for normally distributed variables (otherwise Kruskal-Wallis tests). Results: Prevalence of symptoms of anxiety and depression was 46.4% (n=52) and 42.9% (n=48) in patients, and 46.0% (n=52) and 23.0% (n=26) in carers, respectively. Patient and carer symptoms of anxiety/depression were significantly associated. Anxious and depressive symptoms in the patient were also significantly associated with more physical co-morbidities, more exacerbations, greater dyspnoea, greater fatigue, and poor mastery, and depressive symptoms with younger age. Symptoms of carer anxiety were significantly associated with being female and separated/divorced/widowed, and depressive symptoms with younger age, higher educational level, and more physical co-morbidities, and symptoms of carer anxiety and depression with more unmet support needs, greater subjective caring burden and poor patient mastery. Dyad symptoms of anxiety/depression were significantly associated with greater patient fatigue. Conclusion: Symptoms of anxiety and depression in COPD patients and carers are significantly associated. Given their high prevalence, considerable impact on mortality, quality-of-life and healthcare use, and associations with each other, screening for and addressing patient and carer anxiety and depression in advanced COPD is recommended.