Exploring the relationship between psychological dysfunction and perceived symptoms in the Wessex AsThma CoHort of difficult asthma (WATCH) study F(2,111)=6.63, p=.002, R2=.11.
B
1,2* Ainsworth ,
E
5 Bain ,
J
5 Griffiths ,
R
2,4 Kurukulaaratchy ,
M
3,4 Thomas
1. Psychology, Faculty of Social, Human & Mathematical Sciences, Uni. Southampton, UK 2. NIHR Southampton Respiratory Biomedical Research Unit. UK 3. Primary Care and Population Sciences, Faculty of Medicine, Uni. Southampton, UK 4. University Hospital Southampton NHS Foundation Trust, Southampton, UK 5. Faculty of Medicine, University of Southampton, UK.
2. WHAT IS THE WESSEX ASTHMA COHORT?
1. INTRODUCTION Asthma affects 5 million people in the UK and costs the NHS in excess of £1 billion. Although pharmacotherapy is effective and can provide control for many patients, surveys repeatedly show that outcomes remain sub-optimal, with over half surveyed patients reporting significant symptoms and current quality of life impairment.
The University Hospitals Southampton Foundation Trust (UHSFT) delivers a Regional Difficult Asthma Service that cares for nearly 700 people, of which 250 travel from outside Southampton.
port The association between chronic respiratory diseases (like asthma) and
The Wessex Asthma Cohort of Difficult Asthma aims to create a database of patients that can help to more fully understand the nature of asthma and why it does not always respond to treatment, by recording information that is routinely collected on the clinic (in both questionnaires and routine medical tests). Currently 280 consented patients are in the cohort.
anxiety-related psychological dysfunction has become increasingly apparent in recent years epidemiologically and is associated with poor long- and short-term outcomes.
The effectiveness of psychological interventions is however not well established. Research and treatment guidelines increasingly emphasise a need to improve functional outcomes with psychological interventions likely to be an innovative and cost-effective approach1.
4. RESULTS
3. METHOD and MATERIALS
Psychological Self-report measures - Hospital Anxiety & Depression Scale5: ‘Borderline or above’ scores on the Hospital Anxiety & Depression Scale were present in 24% of patients for depression (M 5.3, SD 4.5), and 32% for anxiety (M 7.1, SD 4.7). - Mindfulness Attention Awareness Scale6: Participants reported higher mindfulness than a healthy volunteer sample (M 4.5, SD 1.1) - Attention Control Scale7: Patients reported lower attentional control than healthy volunteer studies have previously demonstrated (M 43.8, SD 9.4).
Anxiety (HADS-A)
Depression (HADS-D)
Mindfulness (MAAS)
Attention Control (ACS)
Presence of dysfunctional breathing (Nijmegen)
.64***
.53***
-.33***
.21**
Asthma control (ACQ)
.25***
.37***
-.10
.06
Quality of Life (SGRQ)
.44***
.56***
-.26**
.17
Note: (*** is p < .001); (** is p < .01).
Fig 1: Bivariate associations between psychological self-report measures and asthma-related outcome measures. A multiple linear regression model (age/gender corrected), including both anxiety and depression strongly predicted asthmarelated quality of life, F(4,108)= 15.5, p 20) - Asthma control questionnaire3 (M 2.6, SD 1.6). 10% of patients were well-controlled (4.5 on MARS-A 10-item; mean = 4.14)
HADS Scores of Anxiety & Depression
HADS Scores of Anxiety & Depression
A similar age/gender corrected regression model also found that anxiety and depression weakly predicted asthma control, F(4,162)= 8.52, p < .001, R2=.18 (Fig 2). References:
5. CONCLUSION
1. Thomas et al 2015. Prim Care Resp J, 25. 2. Van Dixhoorn & Duivenvoorden 1985.
Our findings highlight the need to understand psychological predictors of disease-related outcomes and the possible benefits of psychological interventions. In line with existing epidemiological findings, anxiety is an important predictor of both perceived breathlessness, and asthma control. The close association between anxiety and symptom perception supports the use of psychological interventions such as mindfulness for helping patients to manage long-term conditions, reducing symptom burden and improving quality of life. The longitudinal nature of the WATCH study allows future study of how psychological interventions can benefit patients.
J Psychosomatic Res, 29. 3. Juniper et al 1999. Eur Respir J, 14. 4. Jones et al 1992, Am Rev Respir Dis, 145. 5. Zigmond & Snaith 1983, Acta Psychiatrica Scandinavicam, 67. 6.Brown & Ryan 2003. J Personality & Social Psychol, 84. 7. Derryberry & Reed 2002, J Abnormal Psychol, 111. 8. Thomas et al 2011, Prim Care Resp J, 20.
*Further correspondence email:
[email protected]
