| Chronic obstructive pulmonary disease is a common respiratory disease, which ischaracterized by airflow limitation that is not fully reversible. With the increasing extentof air pollution and the population aging, it has become a significant disease threateningglobal public health. The main clinical symptoms of chronic obstructive pulmonarydisease are cough, expectoration, dyspnea, shortness of breath, and decreased exercisetolerance. Since its characteristics such as chronic persistent, frequent recurrent, pooreffect of treatment and irreversible aggravating of illness, patients often suffer poor qualityof life. Therefore, the negative emotions, such as anxiety and depression, are verycommon in patients with chronic obstructive pulmonary disease. Nowadays, most of thecurrent studies focused on the negative emotions in patients with chronic obstructivepulmonary disease and traditional psychological intervention, but few studies paidattention to developing systematic and practical psychological intervention models andpositive psychological interventions, which to some extent affected quality of clinicalpsychological care. Therefore, taking anxiety, depression and subjective well-being as the breakthrough points, the present status of mental health was investigated among thehospitalized patients with chronic obstructive pulmonary disease. On this basis, a targetedpsychological intervention model for them was developed based on the theories andmethods of both traditional psychology and positive psychology with nursing process asthe basic framework. And then a clinical psychological intervention trial was conducted toobserve the effect of the model on improving the psychological state of the patients. Bydoing this, theoretical basis and practical guidance were provided for clinicalpsychological care in the patients with chronic obstructive pulmonary disease.Objective1. To investigate the current state and the related influential factors of anxiety,depression and subjective well-being in patients with chronic obstructive pulmonarydisease, and to provide scientific basis for development of a targeted psychologicalintervention model.2. To develop a psychological intervention model for patients with chronicobstructive pulmonary disease, and to test the effect of the model on anxiety, depressionand subjective well-being through a clinical psychological intervention trial, and toprovide scientific and effective methods for the improvement of mental health in patientswith chronic obstructive pulmonary disease, as well as to provide systematic andactionable path and solution for clinical psychological nursing.Methods1. The level of anxiety，depression and subjective well-being were evaluated bySelf-Rated Anxiety Scale, Self-Rated Depression Scale and General Well-Being Scheduleamong patients with chronic obstructive pulmonary disease from four first-class ternaryhospitals.2. The psychological intervention model for patients with chronic obstructivepulmonary disease consists of the traditional psychological interventions, positivepsychological interventions, and nursing processes was developed based on the survey,experts’ discussion and literature study. The statistical analysis was carried out with SPSS 17.0. Chi-square test, One Sample t-Test, Independent Sample t-Test, Pearson correlationanalysis, Binary logistic regression analysis and ANOVA with repeated measures wereused in the process of analyzing. There was a significant difference at the0.05level(2-tailed).Results1The current state of anxiety, depression, subjective well-being and the influencingfactors in patients with chronic obstructive pulmonary disease.1.1The current state of anxiety, depression, and subjective well-being in patientswith chronic obstructive pulmonary disease.1.1.1anxiety and depression: Among the214patients with chronic obstructivepulmonary disease involved in the current research,59(27.6%) patients suffering fromanxiety, among which48(22.4%) patients sufferd from mild anxiety,10(4.7%) patientssuffered from moderate anxiety and1(0.5%) patients suffered from severe anxiety;Besides, for all these patients,100(46.7%) patients suffering from depression, amongwhich66(30.8%) patients suffered from mild depression and34(15.9%) patients sufferedfrom moderate depression; Furthermore, among the100patients suffering from depression,54ones suffering from anxiety at the same time, which accounted for25.2%of all thepaticipants; Both the anxiety total raw score and the depression total raw score werehigher than the Chinese norm, respectively36.55±9.51and40.56±7.80, which showedthere were significant differences (P <0.05).1.1.2Subjective well-being: Among the214patients, there were141ones whosesubjective well-being scores were lower than the mean of the Chinese norm (male:75;female:71), which accounted for65.9%of all participants. Subjective well-being scoresfor both male and female were lower than the Chinese norm, respectively68.55±11.73and66.51±15.84, and the differences were statistically significant (P<0.05).1.1.3Relations between the subjective well-being and anxiety or depression inpatients with chronic obstructive pulmonary disease: The subjective well-being score wasnegatively correlated to the scores of both anxiety and depression (r values were-0.741 and-0.654; P<0.05).1.2The main influential factors of anxiety, depression, and subjective well-being inpatients with chronic obstructive pulmonary disease.1.2.1The main influential factors of anxiety in patients with chronic obstructivepulmonary disease were the severity of illness and depression. Furthermore, the illness ofgrade Ⅲ and grade Ⅳ(OR=9.026,95%CI:2.547~31.992) and depressive (OR=28.628,95%CI:9.433~86.880) were the risk factors of anxiety.1.2.2The main factors that influence depression in patients with chronic obstructivepulmonary disease were the age, educational level, self-assessment of economic stress,anxiety and subjective well-being. Age of more than70years old (OR=0.120,95%CI:0.025~0.588), junior high school educational level and above (the OR values for juniorhigh school, high school or technical secondary school, college and above wererespectively0.224,0.007and0.028, and the95%confidence intervals for them wererespectively0.067~0.752,0.001~0.045,0.005~0.163), higher level of subjectivewell-being (OR=0.110,95%CI:0.037~0.328) were all the protective factors of depression.While the higher level self-assessment of economic pressures (OR=4.864,95%CI:1.177~20.104) and anxiety (OR=141.474,95%CI:27.635~723.792) both were the riskfactors of depression.1.2.3The main factors that influence subjective well-being in patients with chronicobstructive pulmonary disease were the self-assessment of economic stress,self-assessment of health and depression. Ⅱ grade of illness and above (the OR valuesfor Ⅱ grade of illness, Ⅲ or Ⅳ grade of illness were respectively6.618and3.607, andthe95%confidence intervals for them were respectively2.494~17.898and1.446~9.001),moderate level self-assessment of economic pressure and above(the OR values formoderate and higher level self-assessment of economic pressure were respectively5.927and3.889, and the95%confidence intervals for them were respectively2.435~14.428and1.498~10.098), poor self-assessment of health (OR=3.855,95%CI:1.739~8.543) anddepression (OR=4.593,95%CI:2.025~10.414) were all the risk factors of lower level subjective well-being2The psychological intervention model for hospitalized chronic obstructivepulmonary disease patients.To improve the anxiety, depression, and subjective well-being of the patients withchronic obstructive pulmonary disease, a targeted psychological intervention model wasdeveloped based on the theories and methods of both traditional psychology and positivepsychology, as well as with nursing process as the basic framework.The psychological intervention model consists of two parts. One was traditionalpsychological interventions which included catharsis therapy, psychosocial support,cognitive behavioral therapy and relaxation therapy. The other part was positivepsychological interventions which consisted of several activities called “Three goodthings”,“Gratitude visit”,“You at your best”,“Your quality time”and “Fulfilling your life”.The intervention lasts eight weeks with once a week and40to50minutes for eatch time;Face to face individual psychological intervention was used during hospitalization andtelephone intervention was used when patients were discharged.3The effect of the psychological intervention model for hospitalized chronicobstructive pulmonary disease patients on anxiety, depression and subjective well-being.3.1Effect on anxiety: Compared with the control group (49.56±8.48VS48.86±7.60), the anxiety score in the test group (47.91±5.80VS41.72±4.78) decreased moresignificantly after the intervention, and the difference was statistically significant (P<0.05).3.2Effect on depressive: Compared with the control group (54.62±7.01VS53.79±6.28), the depression score in the test group (54.53±8.41VS45.78±5.80) decreasedmore significantly after the intervention, and the difference was statistically significant(P<0.05).3.3Effect on subjective well-being: compared with the control group (61.50±10.60VS62.26±8.04), the subjective well-being score in the test group (62.75±9.54VS78.94±6.20) increased more significantly after the intervention, the difference was statistically significant (P<0.05). Accordingly, the scores of the5factors of subjective well-being,namely “life satisfaction and interest”(9.44±1.61VS12.59±1.16),“concern forheath”(8.84±2.41VS11.88±2.32),“sad or happy mood”(15.16±3.14VS19.09±1.75),“control of emotion and behavior”(13.63±2.61VS17.38±1.50),“relaxation or stress”(13.44±3.53VS17.94±2.40) in the test group were all increased significantly comparedwith the control group (8.59±2.08VS9.24±2.02;8.65±2.91VS9.65±2.23;14.15±3.59VS15.09±2.83;12.94±2.00VS12.74±1.69;13.82±4.09VS14.09±3.35), and the differenceswere statistically significant (P<0.05). However, compared with the control group(17.21±3.66VS17.06±2.77), the factor of “energy” in the test group (17.44±4.58VS19.56±3.53) did not increase significantly after the intervention, and the difference wasnot statistically significant (P>0.05).Conclusions1. The levels and prevalence rates of anxiety and depression are high, and the level ofsubjective well-being is low in the patients with chronic obstructive pulmonary disease.2. The subjective well-being was negatively correlated to both anxiety and depressionin patients with chronic obstructive pulmonary disease.3. The main influential factors of anxiety in patients with chronic obstructivepulmonary disease are the severity of illness and depression.4. The main influential factors of depression in patients with chronic obstructivepulmonary disease are the age, educational level, self-assessment of economic stress,anxiety and subjective well-being.5. The main influential factors of subjective well-being in patients with chronicobstructive pulmonary disease are the severity of illness, self-assessment of economicstress, self-assessment of health and depression.6. The psychological intervention model for hospitalized patients with chronicobstructive pulmonary disease was developped basing on the theories and methods of bothtraditional psychology and positive psychology as well as with nursing process as basic framework, which can improve the anxiety, depression and subjective well-beingeffectively in patients with chronic obstructive pulmonary disease. |
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