Quality of Life Research

, Volume 28, Issue 2, pp 461–472 | Cite as

Anxiety, depression and quality of life in chronic obstructive pulmonary disease patients and caregivers: an actor–partner interdependence model analysis

  • Dhurata IvzikuEmail author
  • Marco Clari
  • Michela Piredda
  • Maria Grazia De Marinis
  • Maria Matarese



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.


COPD Quality of life Anxiety Depression Dyadic analysis SEM 



The authors wish to thank Alexandre Gareau and Semira Tagliabue for their advice.

Author contributions

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.

Ethical approval

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

Informed consent was obtained from all participants included in the study.

Supplementary material

11136_2018_2024_MOESM1_ESM.pdf (111 kb)
Supplementary material 1 (PDF 111 KB)
11136_2018_2024_MOESM2_ESM.pdf (172 kb)
Supplementary material 2 (PDF 173 KB)
11136_2018_2024_MOESM3_ESM.pdf (86 kb)
Supplementary material 3 (PDF 86 KB)


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Biomedicine and PreventionUniversity of Rome ‘Tor Vergata’RomeItaly
  2. 2.Research Unit of Nursing ScienceCampus Bio-Medico University of RomeRomeItaly
  3. 3.RomeItaly

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