Effect Of Coping Skills Intervention On Coping Style And Quality Of Life For Patients With Chronic Obstructive Pulmonary Disease

ObjectiveFirst, to estimate the prevalence of depression and anxiety of patients with AcuteExacerbation Chronic Obstructive Pulmonary Disease(AECODP), and to analyze theirinfluencing factors. Second, to explore the effects of coping skills intervention ondepression, anxiety and quality of life of patients with chronic obstructive pulmonarydisease.MethodsFrom March2013to December2014, a total of169patients with AECOPD hospitalizedin the first and second affiliated hospital of University of South China were enrolled. Datawere collected from the self-designed demographic and medical questionnaire, Self-RatingAnxiety Scale(SAS) and Self-Rating Depression Scale(SDS). Totally80patients withAECOPD were recruited into this research, they were randomly and evenly divided intothe intervention group(n=40) and the control group(n=40). The patients in the controlgroup received routine nursing care while the patients in the intervention group got copingskills intervention and routine nursing care. All patients were asked to complete aself-designed demographic and medical questionnaire, Medical Coping ModesQuestionnaire(MCMQ), Clinical COPD Questionnaire(CCQ), Self-Rating AnxietyScale(SAS), Self-Rating Depression Scale(SDS), the modified medical research councildyspnea scale(mMRC) before the intervention, the day before they discharged and the lastday of three months after intervention. EpiData software version3.1was used for datarecord and Statistical Package for Social Sciences(SPSS) version13.0was used for allstatistical analysis. The statistical methods included Descriptive Statistics Analysis, Independent-Sample T Test, variance analysis, Wilcoxon，Chi-Square Test, ANOVA ofReapeted Measures and Leaner Regression.Results1. A total of169patients finished the questionnaires, all data were valid. It showed that themean score of anxiety of the patients was (48.52±9.11) and the mean score of depressionwas (57.06±10.74). The occurrence of depression and anxiety were68.0%and41.4%,respectively. Multiple linear regression analysis showed that depression, severity ofdyspnea and gender were correlated with anxiety(P<0.05),which could explain65.9%ofthe total variance. The main influencing factors for depression were anxiety, severity ofdyspnea, age, smoking and income(P<0.05), which could explain49.4%of the totalvariance.2. Before intervention, there were no statistically differences on demography, medicalrecords, level of dyspnea and BMI, score of SAS, SDS, MCMQ and CCQ between the twogroups(P>0.05).3. After intervention, the patients in the intervention group got higher scores of facingcoping mode and lower scores of avoiding coping mode and yielding coping mode.Meanwhile, the scores of facing coping mode in the intervention group were highercompared with the control group on the day before discharge and the last day of threemonths after intervention(P<0.05), the scores of avoiding coping mode and yieldingcoping mode were lower than that in the control group(P<0.05). Nevertheless, there wereno statistical differences for the scores of avoiding coping mode and yielding coping modebetween before and after intervention in the control group(P>0.05).4. There were no obvious differences for mMRC between two groups（P>0.05）. The lastday of three months after intervention, in the intervention group, the constituent ratio ofpatients in grade4of mMRC declined from30.0%to10.0%, that of patents in grade3declined from22.5%to20.0%, that of patients in grade2was not significantly different,that of patients in grade1or0went up from20.0%to42.5%. It was significantlyimproved a lot compared with the control group(P<0.05).5. After intervention, patients in the intervention group got lower score of SAS on the day before discharge(P<0.01) and the last day of three months after intervention(P<0.01), aswell as the score of SDS(P<0.01).6. The quality of life of patients in both groups were improved. After intervention, the totalscore of CCQ and its dimensional scores in the intervention group were significantlydecreased compared with before intervention(P<0.05), and the patients in the interventiongroup got lower total scores of CCQ as well as scores in syndrome, function status andemotion status than that in the control group the day before discharge and the last day ofthree months after intervention. However, there were no statistical differences for thescores of mental status of patients in the control group in the last day of three months afterintervention and the day before discharge(P>0.05).Conclusions1. The prevalence of anxiety and depression in patients with COPD was high, especiallyin patients with AECOPD.2. Morbidity of anxiety in patients with COPD had positive correlation with the severityof dyspnea, especially in female patients who had easily anxiety. Morbidity ofdepression in patients with COPD had positive correlation with the severity of dyspneawhile negatively correlated with family income, and had relationship with smoking.3. Coping skills intervention could positively and effectively help patients with COPDcoping with disease. It might improve patients’ respiratory function, and alleviateanxious and depressive symptoms.