Most Canadians with COPD report excellent mental health

Despite the links between chronic obstructive pulmonary disease (COPD) and poor mental health, nearly 90% of older Canadians with COPD do not suffer from mental illness, and more than two-thirds report complete mental health, according to a new study .

People who were socially isolated and lacking emotional support were at higher risk for poor mental health. In contrast, those who had support from at least one person were more likely to have no mental illness and to report excellent mental health.

“This high level of mental fulfillment is truly phenomenal considering they are dealing with COPD,” said study author Esme Fuller-Thomson, PhD, professor of family and community medicine and director from the Institute for Life Course and Aging at the University of Toronto, says Medscape Medical News.

“COPD is a very unpleasant disease, which makes it difficult for individuals to breathe,” she said. “Our results underscore the wonderful resilience of the vast majority of older people with COPD.”

The study was published on December 6 in the International Journal of Environmental Research and Public Health.

Who thrives?

COPD, which consists of a group of progressive lung diseases including emphysema and chronic bronchitis, is the third leading cause of death in the United States, the study authors write. In previous studies, COPD has been linked to mental health issues such as anxiety, depression, and substance use disorders. However, little is known about people with COPD who report positive mental health.

Researchers analyzed factors associated with mental health among 703 Canadians aged 50 and older who had been diagnosed with COPD and who responded to the 2012 Canadian Community Health Survey – Mental Health. who reported having complete mental health met three criteria – happiness or satisfaction with living almost daily in the past month, high levels of social and psychological well-being in the past month, and freedom from anxiety and depression, suicidal thoughts and substance abuse. for the past year.

In general, poor mental health was more prevalent among respondents with COPD. About 86.7% of respondents with COPD had no psychiatric disorder, compared to 95% of the 10,189 survey respondents without COPD. Additionally, 66.7% of participants with COPD reported having complete mental health, compared to 77% of those without COPD. Respondents with COPD were more likely to be older, have a lower household income, have a history of smoking, suffer from debilitating chronic pain, and have a history of anxiety, depression or substance use disorders.

Several factors have contributed to poorer mental health, including childhood physical and sexual abuse. For each additional negative childhood experience, the likelihood of not having a mental health condition decreased by 31%. Childhood adversities can halt the development of positive coping strategies and emotional regulation, the study authors write. Negative experiences can also exacerbate maladaptive attachment styles and lead to unhealthy behaviors, such as smoking and substance abuse.

On the other hand, several factors were significantly associated with better mental health in older people with COPD. These included being married, having a confidant, being physically active, and having no history of generalized anxiety disorder or major depressive disorder. Those who had at least one person in their life with whom they could discuss important decisions were eight times more likely to have no mental illness and seven times more likely to report complete mental health. Additionally, those who engaged in moderate or vigorous physical activity were four times more likely to have no mental illness and twice as likely to report excellent mental health.

“It was a paradigm shift for me. I have spent the last 25 years of my career studying mental illness, including depression, anxiety and suicidality, among people with chronic debilitating conditions such as COPD,” Fuller-Thomson said. “I finally realized that my real interest is in knowing who thrives emotionally with COPD and what factors are associated with mental flourishing. Ultimately, that’s what patients and caregivers want to know. “

Fuller-Thomson and her colleagues are conducting additional studies on mental health and “mental flourishing” in older adults who live with chronic, debilitating pain.

“It’s so hard to stay mentally healthy and happy in the midst of daily pain,” she said. “We want to know more about who is thriving and what could be done to help more people reach that elevated state of well-being.”

The authors recommend targeted outreach to older adults with COPD who are most vulnerable to poorer mental health outcomes, particularly those who are socially isolated. Additionally, they suggest mental health interventions, such as cognitive-behavioral therapy, that may reduce symptoms of mental illness in patients with anxiety, depression, and a history of negative childhood experiences. .

Screening for mood disorders

Commenting on the Medscape findings, Kim Lavoie, PhD, professor of psychology at the University of Quebec at Montreal, said, “Clinicians have long known that patients with COPD have cognitive problems and are susceptible to cognitive impairment. mood and anxiety. However, some clinicians may attribute these conditions to the effects of aging and the impact of COPD on patients’ quality of life.”

Lavoie, who was not involved in this study, has researched the links between COPD and mental health. She and her colleagues recommend guided psychotherapy, drug therapy and exercise programs for patients with COPD.

“Clinicians caring for patients with COPD should become familiar with screening tools for these associated conditions,” she said. “In the future, treatments may become available that not only alter the course of these neuropsychological disorders, but also potentially alter the critical outcomes of COPD.”

The study was funded by a grant from the Social Sciences and Humanities Research Council. Fuller-Thomson and Lavoie did not disclose any relevant financial relationship.

Int J Environ Res Public Health. Published December 6, 2022. Full text

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.

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