Anxiety, depression and quality of life in chronic obstructive pulmonary disease patients and caregivers: an actor–partner interdependence model analysis
We aimed to assess the influence of anxiety and depression on the physical and mental quality of life (QoL) in patient with chronic obstructive pulmonary disease (COPD) and caregiver dyads, detect the simultaneous effect of anxiety and depression of each partner on the other’s QoL and determine the dyadic patterns.
A cross-sectional descriptive design was used. The actor–partner interdependence model estimated by structural equation modeling was used for the dyadic analysis. Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and 12-Item Short-Form Health Survey (SF-12) were used to measure depression, anxiety and QoL, respectively.
Eighty COPD dyads were enrolled in the study. Patients presented higher depression symptoms and poorer physical and mental QoL than their caregivers, whereas comparable levels of anxiety were found in patients and caregivers. The model exploring the effects of depression and anxiety on mental QoL found that patients’ depressive symptoms negatively influence their mental QoL, and caregivers’ anxiety and depression symptoms negatively impact their mental QoL. The model exploring the effects of anxiety and depression on physical QoL detected one statistically significant actor effect with patients’ depressive symptoms negatively influencing their physical QoL, and two partner effects with caregivers’ anxiety worsening patients’ physical QoL and caregivers’ depression improving patients’ physical QoL.
The results suggest that caregivers’ psychological distress influences caregivers’ mental QoL and patients’ physical QoL. Therefore, health-care professionals should assess and treat anxiety and depression in both members of the COPD dyad to improve their QoL.
KeywordsCOPD Quality of life Anxiety Depression Dyadic analysis SEM
The authors wish to thank Alexandre Gareau and Semira Tagliabue for their advice.
The authors confirm that study design, data collection, analysis and interpretation, manuscript preparation and final approval of the version to be published have been carried out by all authors.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was approved by the Campus Bio Medico University of Rome (Prot: 32/16 OSS) and the Institute of Hospitalization and Scientific Care IRCCS-I.F.O. (Prot: 8393/17) Ethics Committees and was conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all participants included in the study.
- 1.GOLD-Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2017). Resource document. Accessed September 26, 2017, from http://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.
- 2.Disler, R. T., Gallagher, R. D., & Davidson, P. M. (2012). Factors influencing self-management in chronic obstructive pulmonary disease: An integrative review. International Journal of Nursing Studies, 49(2), 230–242.Google Scholar
- 3.Zhang, M. W., Ho, R. C., Cheung, M. W., Fu, E., & Mak, A. (2011). Prevalence of depressive symptoms in patients with chronic obstructive pulmonary disease: A systematic review, meta-analysis and meta-regression. General Hospital Psychiatry, 33(3), 217–223.Google Scholar
- 4.Hammonds, T. (2015). The influence of the caregiver on healthcare outcomes in patients with chronic obstructive pulmonary disease (COPD). Kent State University. ProQuest Dissertations Publishing, 2015. 3688322. Accessed March 3, 2018, from https://search.proquest.com/openview/c333a6542933959681e128db5fbf48b6/1?pq-origsite=gscholar&cbl=18750&diss=y.
- 5.Yohannes, A. M., Willgoss, T. G., Baldwin, R. C., & Connolly, M. J. (2010). Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: Prevalence, relevance, clinical implications and management principles. International Journal of Geriatric Psychiatry, 25(12), 1209–1221.Google Scholar
- 6.Maurer, J., Rebbapragada, V., Borson, S., Goldstein, R., Kunik, M. E., Yohannes, A. M., & Hanania, N. A. (2008). Anxiety and depression in COPD: Current understanding, unanswered questions, and research needs. Chest Journal, 134(4 suppl), 43S–56S. https://doi.org/10.1378/chest.08-0342.Google Scholar
- 7.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. https://doi.org/10.1001/archinte.167.1.60.Google Scholar
- 8.Atlantis, E., Fahey, P., Cochrane, B., & Smith, S. (2013). Bidirectional associations between clinically relevant depression or anxiety and chronic obstructive pulmonary disease (COPD): A systematic review and meta-analysis. Chest, 144(3), 766–777.Google Scholar
- 9.Di Marco, F., Verga, M., Reggente, M., Casanova, F. M., Santus, P., Blasi, F., … Centanni, S. (2006). Anxiety and depression in COPD patients: The roles of gender and disease severity. Respiratory Medicine, 100(10), 1767–1774.Google Scholar
- 10.Blakemore, A., Dickens, C., Guthrie, E., Bower, P., Kontopantelis, E., Afzal, C., & Coventry, P. A. (2014). Depression and anxiety predict health-related quality of life in chronic obstructive pulmonary disease: Systematic review and meta-analysis. International Journal of Chronic Obstructive Pulmonary Disease, 9, 501–512.Google Scholar
- 11.Miravitlles, M., Peña-Longobardo, L. M., Oliva-Moreno, J., & Hidalgo-Vega, Á. (2015). Caregivers’ burden in patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease, 10, 347–356.Google Scholar
- 12.Boyle, A. H. (2009). Living with a spouse with chronic obstructive pulmonary disease: The meaning of wives’ experiences. Journal of Nursing and Healthcare of Chronic Illness, 1(4), 273–282.Google Scholar
- 13.Grant, M., Cavanagh, A., & Yorke, J. (2012). The impact of caring for those with chronic obstructive pulmonary disease (COPD) on carers’ psychological well-being: A narrative review. International Journal of Nursing Studies, 49(11), 1459–1471.Google Scholar
- 14.Cruz, J., Marques, A., & Figueiredo, D. (2017). Impacts of COPD on family carers and supportive interventions: A narrative review. Health & Social Care in the Community, 25(1), 11–25.Google Scholar
- 15.Mi, E., Mi, E., Ewing, G., Mahadeva, R., Gardener, A. C., Butcher, H. H., … Farquhar, M. (2017). Associations between the psychological health of patients and carers in advanced COPD. International Journal of Chronic Obstructive Pulmonary Disease, 12, 2813–2821.Google Scholar
- 16.Jácome, C., Figueiredo, D., Gabriel, R., Cruz, J., & Marques, A. (2014). Predicting anxiety and depression among family carers of people with chronic obstructive pulmonary disease. International Psychogeriatrics, 26(7), 1191–1199.Google Scholar
- 17.Kühl, K., Schürmann, W., & Rief, W. (2008). Mental disorders and quality of life in COPD patients and their spouses. International Journal of Chronic Obstructive Pulmonary Disease, 3(4), 727–736.Google Scholar
- 18.Al-Gamal, E. (2014). Quality of life, anxiety and depression among patients with chronic obstructive pulmonary disease and their spouses. Issues in Mental Health Nursing, 35(10), 761–767.Google Scholar
- 19.Badr, H., Federman, A. D., Wolf, M., Revenson, T. A., & Wisnivesky, J. P. (2017). Depression in individuals with chronic obstructive pulmonary disease and their informal caregivers. Aging & Mental Health, 21(9), 975–982.Google Scholar
- 20.Kelley, H. H., & Thibaut, J. W. (1978). Interpersonal relations: A theory of interdependence. New York: Wiley.Google Scholar
- 21.Cook, W. L., & Kenny, D. A. (2005). The actor–partner interdependence model: A model of bidirectional effects in developmental studies. International Journal of Behavioral Development, 29(2), 101–109.Google Scholar
- 22.Marguerite, S., Laurent, B., Marine, A., Tanguy, L., Karine, B., Pascal, A., & Xavier, Z. (2017). Actor-partner interdependence analysis in depressed patient-caregiver dyads: Influence of emotional intelligence and coping strategies on anxiety and depression. Psychiatry Research, 258, 396–401.Google Scholar
- 23.Vaske, I., Thöne, M. F., Kühl, K., Keil, D. C., Schürmann, W., Rief, W., & Stenzel, N. M. (2015). For better or for worse: A longitudinal study on dyadic coping and quality of life among couples with a partner suffering from COPD. Journal of Behavioral Medicine, 38(6), 851–862.Google Scholar
- 24.Chung, M. L., Moser, D. K., Lennie, T. A., & Rayens, M. K. (2009). The effects of depressive symptoms and anxiety on quality of life in patients with heart failure and their spouses: Testing dyadic dynamics using Actor–Partner Interdependence Model. Journal of Psychosomatic Research, 67(1), 29–35.Google Scholar
- 25.Wan-Fei, K., Hassan, S. T. S., Sann, L. M., Ismail, S. I. F., Raman, R. A., & Ibrahim, F. (2017). Depression, anxiety and quality of life in stroke survivors and their family caregivers: A pilot study using an actor/partner interdependence model. Electronic Physician, 9(8), 4924–4933. https://doi.org/10.19082/4924. (eCollection 2017 Aug).Google Scholar
- 26.Kim, Y., Kashy, D. A., Wellisch, D. K., Spillers, R. L., Kaw, C. K., & Smith, T. G. (2008). Quality of life of couples dealing with cancer: Dyadic and individual adjustment among breast and prostate cancer survivors and their spousal caregivers. Annals of Behavioral Medicine, 35(2), 230–238.Google Scholar
- 27.Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9. Journal of General Internal Medicine, 16(9), 606–613.Google Scholar
- 28.Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2010). The patient health questionnaire somatic, anxiety, and depressive symptom scales: A systematic review. General Hospital Psychiatry, 32(4), 345–359.Google Scholar
- 29.Rizzo, R., Piccinelli, M., Mazzi, M. A., Bellantuono, C., & Tansella, M. (2000). The Personal Health Questionnaire: A new screening instrument for detection of ICD-10 depressive disorders in primary care. Psychological Medicine, 30(4), 831–840.Google Scholar
- 30.Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.Google Scholar
- 31.Stoop, C. H., Nefs, G., Pommer, A. M., Pop, V. J. M., & Pouwer, F. (2015). Effectiveness of a stepped care intervention for anxiety and depression in people with diabetes, asthma or COPD in primary care: A randomized controlled trial. Journal of Affective Disorders, 184, 269–276.Google Scholar
- 32.Ware, J. E. Jr., Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.Google Scholar
- 33.Resnick, B., & Nahm, E. S. (2001). Reliability and validity testing of the revised 12-item Short-Form Health Survey in older adults. Journal of Nursing Measurement, 9, 151–161.Google Scholar
- 34.Gandek, B., Ware, J. E., Aaronson, N. K., Apolone, G., Bjorner, J. B., Brazier, J. E., … Sullivan, M. (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: Results from the IQOLA Project. Journal of Clinical Epidemiology, 51(11), 1171–1178.Google Scholar
- 35.Menn, P., Weber, N., & Holle, R. (2010). Health-related quality of life in patients with severe COPD hospitalized for exacerbations-comparing EQ-5D, SF-12 and SGRQ. Health and Quality of Life Outcomes, 8(1), 39.Google Scholar
- 36.Currow, D. C., Dal Grande, E., Ferreira, D., Johnson, M. J., McCaffrey, N., & Ekström, M. (2017). Chronic breathlessness associated with poorer physical and mental health-related quality of life (SF-12) across all adult age groups. Thorax, 72(12), 1151–1153.Google Scholar
- 37.Bestall, J. C., Paul, E. A., Garnham, R., Jones, P. W., Wedzicha J. A. (1999). Usefulness of the Medical Research Council (MRC) dyspnea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax , 54(7), 581–586.Google Scholar
- 38.Jones, P. W., Harding, G., Berry, P., Wiklund, I., Chen, W. H., & Leidy, N. K. (2009). Development and first validation of the COPD Assessment Test. European Respiratory Journal, 34(3), 648–654.Google Scholar
- 39.Jones, P. W., Tabberer, M., & Chen, W. H. (2011). Creating scenarios of the impact of COPD and their relationship to COPD Assessment Test (CAT™) scores. BMC Pulmonary Medicine, 11(1), 42.Google Scholar
- 40.Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159.Google Scholar
- 41.Kenny, D. A., & Ledermann, T. (2010). Detecting, measuring, and testing dyadic patterns in the actor–partner interdependence model. Journal of Family Psychology, 24(3), 359–366.Google Scholar
- 42.Fitzpatrick, J., Gareau, A., Lafontaine, M. F., & Gaudreau, P. (2016). How to use the actor-partner interdependence model (APIM) to estimate different dyadic patterns in Mplus: A step-by-step tutorial. The Quantitative Methods for Psychology, 12, 74–86.Google Scholar
- 43.Kenny, D. A., Kashy, D. A., & Cook, W. L. (2006). Dyadic data analysis. New York: Guilford.Google Scholar
- 44.Ledermann, T., & Kenny, D. A. (2017). Analyzing dyadic data with multilevel modeling versus structural equation modeling: A tale of two methods. Journal of Family Psychology, 31, 442–452.Google Scholar
- 45.Stas, L., Kenny, D. A., Mayer, A., & Loeys, T. (2018). Giving dyadic data analysis away: A user-friendly app for actor-partner interdependence models. Personal Relationships, 25(1), 103–119.Google Scholar
- 46.World Medical Association. (2018). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. Accessed March 19, 2018, from, https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/.
- 47.Mirowsky, J., & Ross, C. E. (2002). Measurement for a human science. Journal of Health and Social Behavior, 152–170.Google Scholar
- 48.Hynninen, K. M. J., Breitve, M. H., Wiborg, A. B., Pallesen, S., & Nordhus, I. H. (2005). Psychological characteristics of patients with chronic obstructive pulmonary disease: A review. Journal of Psychosomatic Research, 59(6), 429–443.Google Scholar
- 49.Kim, Y., Ryn, M., Jensen, R. E., Griffin, J. M., Potosky, A., & Rowland, J. (2015). Effects of gender and depressive symptoms on quality of life among colorectal and lung cancer patients and their family caregivers. Psycho-Oncology, 24(1), 95–105.Google Scholar
- 50.Segrin, C., Badger, T. A., & Harrington, J. (2012). Interdependent psychological quality of life in dyads adjusting to prostate cancer. Health Psychology, 31(1), 70–79.Google Scholar
- 51.Ackerman, R. A., & Kenny, D. A. (2016). APIMPowerR: An interactive tool for actor-partner interdependence model power analysis [computer software]. Accessed June 1, 2016, https://robert-a-ackerman.shinyapps.io/APIMPowerRdis/.