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Home    Ψυχολογικά χαρακτηριστικά ασθενών με χρόνια αποφρακτική πνευμονοπάθεια και η μεταβολή τους σε πρόγραμμα πνευμονικής αποκατάστασης  

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Identifier 000388609
Title Ψυχολογικά χαρακτηριστικά ασθενών με χρόνια αποφρακτική πνευμονοπάθεια και η μεταβολή τους σε πρόγραμμα πνευμονικής αποκατάστασης
Alternative Title Psychological characteristics of patients with chronic obstructive pulmonary disease and the change in the pulmonary rehabilitation program
Author Τσελεμπής Αθανάσιος
Thesis advisor Τζανάκης, Νικόλαος
Reviewer Σιαφάκας, Νικόλαος
Βγόντζας, Αλέξανδρος
Abstract Introduction There is currently a paucity in the literature regarding the psychosocial aspects of Chronic Obstructive Pulmonary Disease (COPD); this is associated with the limited number of parameters examined, but mainly with the lack of assessment of the effects of pulmonary rehabilitation programs on psychological symptoms. Hypothesis-Objectives The aim of this research was to investigate the psychological characteristics of Greek patients with COPD, and to evaluate the potential changes in their psychological characteristics after attending a pulmonary rehabilitation program. Essentially, we investigated two primary assumptions: *If patients with COPD have higher rates of psychopathology than the general population and *If the psychological symptoms associated with the disease can be modified through a pulmonary rehabilitation program. Subjects and methods The study was conducted at the Pulmonary Rehabilitation Section of the Third Department of Pulmonary Medicine in "Sotiria" General Hospital of Athens in Greece, during the years 2008-2012. The study sample comprised of patients who had been diagnosed with COPD, uncomplicated by any other chronic disease. We assessed psychological characteristics of patients upon enrollment and at completion of this pulmonary rehabilitation program. The total study sample comprised of 144 patients (112 men). 43 (29.9%) of them did not complete the rehabilitation program. The measurement of psychological and psychosocial characteristics of patients with COPD was done using self-report scales and questionnaires validated and standardized in the general population. More in detail, we used the following questionnaires: 1. Beck's depression questionnaire (Beck Depression Inventory, BDI). 2. Spielberger's anxiety questionnaire (STAI). 3. The Toronto Alexithymia Scale Questionnaire (TAS-20). 4. Antonovsky's Sense of Coherence questionnaire (SOC). 5. The Family Support Scale (which was standardized in Greek population for the purposes of this study). 6. The Vital Exhaustion questionnaire (Maastricht questionnaire). 7. A general psychopathology questionnaire (SCL-90R). 12 The following parameters were recorded: gender, age, years of education, disease severity (as determined by pulmonary functions tests per GOLD consensus protocol) and disease duration. Results The sample was not statistically different compared to the population of greek COPD patients regarding gender (x2&γτ 0.05) and age (t-test p΄&γτ 0.05). Initial evaluation The average BDI score was significantly higher compared to the average BDI score in general population (11.61 versus 5.86, t-test p ΄&λτ0.01). The same was also noted regarding anxiety in both men and women (39.81 versus 34.54 and 44.47 versus 37.47, respectively, t-test p ΄&λτ0.01). Vital exhaustion in COPD patients was higher than the average score in general population (19.55 versus 15.00, t-test p΄& &λτ0.01). The average family support of COPD patients was higher than in the general male or female Greek population (55.31 versus 51.43, and 51.37 versus 47.21, respectively). The sense of Coherence of patients was also higher than the average in the general population (64.3 versus 60.0). Almost 56% of patients had abnormal findings: depression (36.1%), somatization (33.3%), obsession (30.65%) and anxiety (23.7%), psychotism (4.9%), phobic anxiety (12.9%) and paranoid ideation (16.7%). Women with COPD had higher anxiety and depression scores compared to men (STAI: t test p ΄&λτ0.05 and BDI: t test p ΄&λτ0.05 respectively) and expressed a lower sense of family support (FS: t test p ΄&λτ0.05). Evaluation with ANOVA did not show the average values of psychological parameters to be different among the groups according to severity (ANOVA p΄&γτ 0.05). Thus, all four groups were similar in severity of depression, anxiety, perception of family support, sense of coherence and vital exhaustion. There was no effect of FV1% upon Alexithymia, Vital Exhaustion, Depression, Anxiety, Sense of Coherence (Pearson Correlation p΄&γτ 0.05) whereas it showed a mild negative correlation with the sense of Family Support (Pearson Correlation p ΄&λτ0.05, r = -0,209). Results of stepwise multiple regression analyses revealed that anxiety accounted for 65% of the variance of depression, vital exhaustion for 9% and sense of coherence for 2%, whereas family support and alexithymia were not involved significantly. The variation of anxiety could be attributed at a rate of 65.95% to depression, 3% to vital exhaustion and 1.7% to family support, while sense of coherence and alexithymia were not involved significantly. Final Evaluation 80 men and 21 women, who completed the rehabilitation program, were finally evaluated. The average depression score was statistically lower at this stage: at baseline the mean BDI score for the patients 13 who completed the program was 10.7, statistically greater (t-test p ΄&λτ0.05) than the corresponding (5.86) score observed in the general population, whereas at the end of the program the actual BDI average was 6.33, statistically invariable from the corresponding in the general population (t-test p΄&γτ 0.05). Regarding the percentage of patients who had depressive symptoms (BDI΄&γτ 9) at baseline this was 47.5% (48 patients) and finally 14.9% (15 patients), indicating a statistically significant reduction (x2 p ΄&λτ0.05). The average anxiety score in patients who attended the program decreased statistically in the final evaluation (paired t-test p ΄&λτ0.01). The same applies to patients’ subgroups (by disease stage; paired ttest p ΄&λτ0.05). Checking changes in anxiety among groups of different disease severity no statistical difference was noted (ANOVA p΄&γτ 0.05); furthermore there were no differences between men and women (t-test p΄&γτ 0.05). Regarding anxiety, we observed at baseline average scores higher than in the corresponding general population. Specifically, women had mean anxiety score of 42.62 (versus 37.47 in the general female population, t-test p ΄&λτ0.01), whereas men had an average of 38.87 (compared to 34.54 in the general male population, t -test p ΄&λτ0.01). In the final assessment, the average anxiety in women fell to 36.29 and in men to 33.4, values that do not differ statistically from those of the general population (t-test p΄&γτ 0.05). The percentage of women with clinically significant anxiety symptoms (STAI΄&γτ 45) at baseline was 47.6%, which dropped to 19% at the end of the program (x2 p ΄&λτ0.05); in men the proportion of patients with clinically significant anxiety symptoms (STAI΄&γτ 43) in the beginning of the program was 25% and decreased to 12.5% (x2 p ΄&λτ0.05) at the end of the program. Significant changes occurred in the final assessment of the SCL-90R scale. Changes were noted in the average scores and in the proportion of patients who had abnormal values. The average final measurements after rehabilitation were statistically significant for all SCL-90R parameters (paired t-test, p ΄&λτ0.05) except for the scales of paranoid ideation and psychotism, where no change were found (paired t-test, p΄&γτ 0.05). In the final assessment statistically significant decreases were observed in vital exhaustion/alexithymia scores (paired t-test, p ΄&λτ0.05) and increases in sense of coherence and family support (paired t-test, p ΄&λτ0.05), respectively. Conclusions • Patients with COPD have higher rates of depression, anxiety and vital exhaustion compared to the general population. • Only 44.4% of the study population had no psychopathology. • Symptoms of depression, somatization, anxiety and compulsions were predominant. • Only 25% of women had no abnormal value in at least one measured parameter versus 50% of men. Women showed higher percentages in obsessive-compulsiveness, depression and anxiety compared with men. 14 • Disease severity stages as per the GOLD criteria do not appear to have different values in psychological characteristics, although FEV1% showed a negative correlation with Family Support. • Family Support and sense of coherence showed a negative correlation with the other psychological factors; this might be protective against anxiety and depression. • In most scales (and also in rates of abnormal values) significant changes were noted at the end of the rehabilitation program: notable decreases were observed in depression, anxiety, vital exhaustion and increases in family support and sense of coherence. • A decrease was observed in psychopathology rates and average scores of SCL-90R scales, with the exception of psychotism and paranoid ideation.
Language English
Subject Anxiety
COPD
Depression
Phychological characteristics
Rehabilitation program
Άγχος
Κατάθλιψη
Πρόγραμμα αποκατάστασης
ΧΑΠ
Ψυχολογικά χαρακτηριστικά
Issue date 2014-04-10
Collection   School/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
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