Coping styles associated with depression, health anxiety and health-related quality of life in pulmonary hypertension: cross-sectional analysis

Abstract

ObjectivesPulmonary hypertension (PH) is a life-shortening disease associated with early mortality and high morbidity. With advancements in medical treatment, people are living longer with the disease, and research is now needed to explore variables that help to enhance patient-reported outcomes. This study investigated the coping strategies of individuals with PH and examined the relationship between coping, depression, health anxiety and health-related quality of life (HRQoL).DesignA cross-sectional survey design was used.ParticipantsParticipants (n=121) were recruited from membership of Pulmonary Hypertension Association (PHA) UK.Outcome measuresParticipants completed a series of questionnaires assessing depression (Patient Health Questionnaire-9), health anxiety (Short Health Anxiety Inventory), HRQoL (emPHasis-10) and coping (Brief COPE). A principal component analysis was used to identify participants’ coping profile. A series of correlational, linear and moderated multiple regression analyses were performed to examine the relationship between coping and health-related outcomes.ResultsOverall, 43% participants met criteria for potential clinical depression. Depression and health anxiety were strongly associated with HRQoL, explaining 37% and 30% of variance respectively (p<0.001). A principal component analysis identified a four-component model of coping. Dimensions were named based on construct items: ‘cognitive and affirmation coping’ (seven items), ‘passive coping’ (four items), ‘external coping’ (seven items) and ‘substance use coping’ (two items). Cognitive and affirmation and external coping moderated the relationship between depression and HRQoL, with high use of these coping strategies reducing the impact of depression on HRQoL. External coping also moderated the effect of health anxiety on HRQoL.ConclusionsThe results uniquely highlight the importance of coping styles and psychological distress in predicting HRQoL in PH. Our findings indicate the importance to assess for psychological distress in this population and suggest the need to offer psychological interventions that take into account coping resources and strategies.

Relationships between sexual function, mental health, and quality of life of female patients with pulmonary arterial hypertension associated with congenital heart disease

“…The scores of SF‐36 of PAH patients complicated with severe mental diseases decreased significantly, and there was a significant negative correlation between depression and anxiety ( p < 0.05) and QoL. 21 , 23 The results showed that the better the sexual health status, the higher the mental health level and the better the QoL.…”

“…SF‐36 score was significantly decreased in PAH patients with severe mental illness, and there was a significant negative correlation between depression, anxiety, and QoL. 23 , 24 Psychological problems were common in PAH patients and lead to impaired QoL. 25 The patient's psychological problems such as depression and panic may reduce the sexual relationship and intimacy to some extent.…”

Cognitive and behavioral processes predict anxiety and depression in patients with pulmonary hypertension

“… 13 , 14 , 15 Anxiety and depression are typically highly comorbid in PH and both conditions have been shown to have a significant impact on HRQoL. 16 …”

“…[13][14][15] Anxiety and depression are typically highly comorbid in PH and both conditions have been shown to have a significant impact on HRQoL. 16 Identifying risk factors for anxiety and depression is an important agenda as it will help to identify those who may experience (or are currently suffering from) mood disorders, inform our understanding of how people with PH develop anxiety and depression, and highlight targets for intervention. 17 Most of the research in this area has focused on disease-related and objective factors, such as pulmonary vascular resistance; PH diagnosis; World Health Organisation functional classification system, which ranges from I to IV; or demographics including age, marital status and financial circumstance.…”

“…The picture is more concerning with evidence suggesting only the minority of patients with anxiety and/or depression and PH receive support 13‐15 . Anxiety and depression are typically highly comorbid in PH and both conditions have been shown to have a significant impact on HRQoL 16 …”