Psychological Distress And Its Associated Factors Among Patients With Stable Chronic Obstructive Pulmonary Disease

Objectives（1）To evaluate psychological distress of patients with stable COPD,and to investigate the current status of psychological distress in this population.（2）To analyze associated factors of psychological distress in patients with stable COPD.（3）To test the relationship between type D personality,coping style,social support and psychological distress in stable COPD patients through structural equation modeling.Methods This was a cross-sectional study.From June 2021 to February 2022,351 patients with stable COPD were selected by cluster random sampling for a questionnaire survey.Instruments used in this research included the General Information Questionnaire,Kessler Psychological Distress Scale（K10）,Medical Coping Modes Questionnaire（MCMQ）,Social Support Revalued Scale（SSRS）,Type D Personality Scale（DS-14）,Chronic Obstructive Pulmonary Disease Knowledge Question（COPD-Q）,COPD Assessment Test（CAT）,modified Medical Research Council Dyspnea Score（m MRC）.Data analysis was conducted by SPSS 26.0 through using descriptive statistics,the Spearman correlation analysis,nonparametric tests,and multivariate analysis.Using Amos 23.0 to conduct a structural equation model.Results（1）Moderate psychological distress was common among351 stable COPD patients,with a median total score of 25(P₂₅=19.0).Among them,307 had psychological distress,and an incidence rate is87.5%.44 patients（12.5%）had no psychological distress,71 patients（20.2%）had mild psychological distress,130 patients（37.0%）had moderate psychological distress,and 106 patients（30.2%）had severe psychological distress.（2）There were significant differences in psychological distress scores among patients with stable COPD with different education levels（H=9.122,P<0.05）and exercise frequency（H=17.190,P<0.05）.There was no significant difference between the other variables and psychological distress（P>0.05）.In the Spearman correlation analysis,the duration of disease（r_s=0.123,P=0.021）,the number of acute exacerbation（r_s=0.129,P=0.015）,m MRC score（r_s=0.292,P<0.001）,CAT score（r_s=0.389,P<0.001）,type D personality（r_s=0.307,P<0.01）,and the coping scores（r_s=0.257,P<0.01）were positively correlated psychological distress.The scores of social support（r_s=-0.110,P<0.05）were negatively correlated with psychological distress.However,the level of disease knowledge is not correlated with psychological distress（P>0.05）.The results of the generalized linear model（GLM）showed that exercise frequency was an independent protective factor of psychological distress in patients with stable COPD,while m MRC score,CAT score,coping style and type D personality were independent risk factors.（3）Structural equation model fitting results showed that type D personality（β=4.00,P<0.001）in patients with stable COPD had a direct and positive effect on their psychological distress.Type D personality can indirectly affect psychological distress through the two chain mediating effects of social support,surrender and confrontation coping styles,namely（1）Type D personality→social support→surrender→psychological distress（β=0.302,95%CI 0.106～0.740,P<0.01）;（2）Type D personality→social support→face→psychological distress（β=-0.294,95%CI-0.738～-0.054,P<0.05）.The model fit index fits well,χ²/df=2.512,RMSEA=0.066,CFI=0.948,NFI=0.921,GFI=0.982,AGFI=0.940,RMR=0.338.Conclusions（1）The incidence of psychological distress in patients with stable COPD is high,and they are generally in a state of moderate psychological distress.（2）Psychological distress among stable COPD patients is associated with education level,monthly family income,duration of disease,exercise frequency,number of acute exacerbation,m MRC scores,CAT scores,type D personality,coping style,and social support.Among them,exercise frequency is an independent protective factor,while m MRC score,CAT score,coping style and type D personality are independent risk factors.（3）Social support and coping style are mediating factors in the relationship between type D personality and psychological distress in stable COPD patients,and type D personality can affect psychological distress through the chain mediating effect of social support and coping style.