Structural Equation Modeling-Based Study Of The Relationship Between Inhaler Medication Adherence And Depression,Anxiety,Self-Compassion,and Coping Styles In COPD Patients

ObjectivesTo investigate the current situation of inhalant medication adherence,mental health,coping style and self-compassion in patients with chronic obstructive pulmonary disease(COPD);to analyze the factors influencing inhalant medication adherence in COPD patients;to explore the relationship between inhalant medication adherence,mental health,coping style and self-compassion in COPD patients;to analyze the pathways and mechanisms of the effects of mental health,coping style and self-compassion on inhalant medication adherence based on structural equation modeling,with the ABC theory of emotion and triadic interaction determinism as the theoretical framework.Based on the structural equation model,we analyzed the pathways and mechanisms of the effects of mental health,coping style and selfcompassion on inhalant adherence,and provided the theoretical basis for clinical intervention studies to improve the adherence of COPD patients to inhalant medication.Methods1.Patients with COPD hospitalized in the respiratory department of a tertiary care hospital in a city were selected for the study,and 236 patients who met the inclusion criteria were surveyed from June 2022 to December 2022.2.The Patient Health Questionnaire-9(PHQ-9),Generalized Anxiety Disorde7(GAD-7),Short Form of the Self-Compassion Scale(SCS-SF),Medical Coping Modes Questionnaire(MCMQ),Test of the adherence to inhalers(TAI)to assess depressive and anxiety symptoms,self-compassion levels,coping modes,and inhalant medication adherence in COPD patients.and the adherence to inhalers.3.SPSS 26.0 was used for data processing and statistical analysis.Descriptive analysis,independent samples t-test,Pearson correlation analysis,analysis of variance,and multiple linear regression analysis were included.Structural equation modeling was performed using AMOS 24.0 software.Results1.The inhaler adherence score of COPD patients was(46.09±3.24).Among 236 COPD patients,49 patients(20.8%)had high inhaler adherence,100 patients(42.4%)had moderate inhaler adherence,and 87 patients(36.8%)had low inhaler adherence.The results of univariate analysis of medication adherence showed that the differences in gender,work status,type of health insurance,dyspnea index,whether home oxygen therapy,whether they had side effects to medication,and whether they smoked were statistically significant(P<0.05).Multiple linear regression analysis showed that dyspnea index(β=0.132),whether home oxygen therapy(β=0.156),avoidance coping style(β=-0.165),depression(β=-0.234),confrontation coping style(β=0.160),and self-compassion(β=0.216)were the main influencing factors of inhaler medication adherence in COPD patients,explaining 41.1%of the total variance.2.Correlation analysis showed that inhalant medication adherence in COPD patients was significantly and negatively correlated with the submission and avoidance dimensions of depression,anxiety and medical coping styles(r=-0.456,-0.398,-0.465,-0.372,P<0.05);inhalant medication adherence was significantly and positively correlated with the confrontation dimension of self-compassion and medical coping styles(r=0.526,0.489,P<0.05);self-compassion was significantly negatively correlated with depression,anxiety,and avoidance and submission dimensions of medical coping styles(r=-0.492,-0.451,-0.536,0.370,P<0.05);depression was significantly negatively correlated with confrontation dimension of medical coping styles(r=-0.534,P<0.05),and with avoidance and submission dimensions(r=0.422,0.450,P<0.05);anxiety was significantly and negatively correlated with the confrontation dimension of medical coping styles(r=-0.549,P<0.05)and with the avoidance and submission dimensions(r=0.394,0.426,P<0.05).3.Based on structural equation modeling,this study explored the pathways and mechanisms of the effects of depression,coping style and self-compassion on inhalant medication adherence,and the final model fit indicators were CMIN/DF=2.007,RMSEA=0.065,NFI=0.978,IFI=0.989,TLI=0.960,CFI=0.989,all within the standard range,and the model fit was good and acceptable.The main pathways of influence were:depression→inhaler adherence test;depression→self-compassion→ coping style→inhaler adherence test;depression→coping style→inhaler adherence test,all with statistically significant pathway coefficients(P<0.05).Conclusion1.The investigated COPD patients had low levels of inhalant medication adherence,where dyspnea index,whether home oxygen therapy,confrontation coping style,avoidance coping style,self-compassion,and depression were the main influencing factors of inhalant adherence.Patients with lower dyspnea index,those who were not on home oxygen therapy,those who adopted an avoidance coping style,and those with higher levels of depression had poorer inhalant medication adherence.Therefore,in future interventions to improve inhalant adherence behavior in COPD patients,attention should be paid to these main influencing factors and targeted measures should be taken to improve individual medication adherence.2.Depression is associated with inhaler adherence in COPD patients,where the higher the level of depression,the lower the inhaler adherence.Depression directly affects individual inhaler adherence,but it can also indirectly affect individual inhaler adherence through coping style and self-compassion,while self-compassion can improve individual inhaler adherence behavior by regulating individual coping style.Therefore,health care workers can improve individual coping style by reducing individual negative psychology and increasing individual self-compassion level,which in turn can improve individual inhaler adherence and reduce individual disease burden.