Associations between the psychological health of patients and carers in advanced COPD

Ella Mi, Emma Mi, Gail Ewing, Ravi Mahadeva, Carole Gardener, Hanne Holt Butcher, Sara Booth, Morag Farquhar, Living with Breathlessness Study Team

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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 in a dyad, in a population-based sample.

Methods: Prospective, cross-sectional analysis of data from 119 advanced COPD patients and their carers. Patient and carer scores ≥8 on the Hospital Anxiety and Depression Scale were defined as cases of anxiety and depression; Chi-square, independent-t and Mann-Whitney U tests were used to determine variables significantly associated with these. Patient-carer dyads were categorised into four groups relating to the presence of anxiety or depression: (1) in both the patient and carer, (2) patient only, (3) carer only and (4) neither; factors associated with dyad anxiety or depression were determined with Chi-square, one-way ANOVA and Kruskal-Wallis tests.

Results: Prevalence 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 anxiety and depression were significantly associated. Patient anxiety and depression was also significantly associated with younger age, more physical co-morbidities, more exacerbations, greater dyspnoea, greater fatigue,
and poor mastery. Carer anxiety and depression was significantly associated with younger age, being female and separated/divorced/widowed, higher educational level, more physical co-morbidities, unmet support needs, greater subjective caring burden and poor patient mastery. Dyad anxiety or depression was significantly associated with greater patient fatigue.

Conclusion: Anxiety and depression of patients and carers are associated. Dyad anxiety or depression was associated with greater patient fatigue. It is necessary to identify and address patient, carer and dyad psychological morbidity in advanced COPD.
Original languageEnglish
Pages (from-to)2813—2821
Number of pages9
JournalInternational Journal of Chronic Obstructive Pulmonary Disease
Issue number12
Publication statusPublished - 30 Sep 2017


  • COPD
  • anxiety
  • depression
  • informal carers
  • patient-carer dyad

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