Analysis Of Physiological-psychological Causal Effects In Patients With Chronic Obstructive Pulmonary Disease Based On Cross-Lagged Panel Model

Objective:Chronic obstructive pulmonary disease(COPD)is a chronic progressive airway disease.As COPD progresses,most patients experienced complications,leading to a decline in quality of life and a serious impact on mental health,such as anxiety and depression.In this study,PRO was included in the follow-up management of COPD patients.Based on longitudinal data,generalised estimating equations and cross-lagged models were used to analyse the factors influencing the physical and psychological domains in PRO and the causal relationship existing between them,to detect changes in patients’ quality of life at an early stage and to provide theoretical support for optimising treatment plans and improving patients’ quality of life.Methods:Patients diagnosed with COPD from September 2021 to September 2022 were selected as the subjects of this study at the Second Hospital of Shanxi Medical University and Taiyuan People’s Hospital,and information on the COPD patients reported-outcomes scales were collected at discharge(T1)and in the third month after discharge(T2),respectively.One-way analysis was conducted using non-parametric tests,with the significant effect variables from the non-parametric test analyses used as between-group variables,respectively,and the changes of physical domain and psychological domain scores with measurement time were analyzed by generalized estimating equations;the cross-lagged panel model was used to explore the causal relationship between the physical and psychological domains,and furthermore,the three dimensions of specificity symptoms,general symptoms and independence included in the physical domain and the two dimensions of anxiety and depression included in the psychological domain were cross-lagged separately to explore the causal relationship between the different dimensions more precisely.Results:1.This study found that the duration of the disease affected COPD patients’ scores in the physical and psychological domains,and gender and family history affected patients’ scores in the psychological domain.2.Repeated measurements showed the factorial of time were significant in physical domains.And the factorial of time were significant in psychological domains when duration of illness and family history were used as between-group variables,with T2 physical domain scores higher than T1 physical domain scores and T2 psychological domain scores higher than T1 psychological domain scores.3.The results of the correlation analysis showed that the correlation coefficient between the physical and psychological domains at T1 was 0.685(P<0.001)and the correlation coefficient between the physical and psychological domains at T2 was 0.708(P<0.001),both showing a significant positive correlation.The correlation coefficient between the two measured physical domains was 0.196(P<0.01)and the correlation coefficient between the two measured psychological domains was 0.234(P<0.01),indicating that COPD patients had some stability in both the physical and psychological domains.4.The results of the cross-lagged analysis showed that physical and psychological domain scores of COPD patients could positively predict each other at both measurement time points.In terms of dimensionality,atopic symptoms and anxiety and depressive symptoms positively predicted each other at both measurement time points;anxiety and depressive symptoms at T1 positively predicted systemic symptoms at T2,but systemic symptoms at T1 did not predict anxiety and depressive symptoms at T2;independence symptoms and anxiety and depressive symptoms did not predict each other at both measurement time points.Conclusion:Based on data from two measures of the COPD-PRO scale,this study used non-parametric tests and generalised estimating equations to analyse the factors influencing physical and psychological symptoms in patients with COPD and changes over time,and to explore the variables affecting patients’ quality of life more objectively.The cross-lagged model was further used to analyse the causal relationship that existed between patients’ physical and psychological symptoms.Unlike previous cross-sectional studies,a point-in-time effect was incorporated to explore the existence of a mutual positive predictive relationship between the physical and psychological domains,which was important for guiding clinicians to make early personalised interventions to improve patients’ prognosis and enhance their quality of life.