The complexity of mental health care for people with COPD: a qualitative study of clinicians’ perspectives

Abstract

Anxiety and depression are common mental health illnesses in people with chronic obstructive pulmonary disease (COPD). However, patients often decline formal mental health care with barriers identified at the patient, health provider and health system levels. Currently clinicians’ perspectives on this issue are not well understood. A qualitative study using semi-structured interviews was undertaken to explore clinician perceived barriers and facilitators to acceptance of psychological care amongst people with COPD. Twenty-four Australian respiratory health professionals participated. Interview transcripts were analysed thematically. An overarching theme of ‘complexity’ was identified, which was evident across five domains: (1) physical and mental health illnesses; (2) psychosocial circumstances; (3) community views and stigma; (4) educational needs and knowledge gaps; (5) navigating the health system. Targeted patient education around psychological interventions and integration of mental health clinicians within multidisciplinary outpatient respiratory services are needed to address the current challenges.

Anxiety and Comorbidities Differences in Adults with Chronic Pulmonary Diseases: Serbian Single Center Experience

“…Unforeseen and chronic events in COPD can lead to the anxiety that provokes somatic and emotional symptoms of anxiety or panic. Such patients are more likely to seek medical help, more likely to go for routine and unscheduled check-ups, more likely to be prescribed anti-inflammatory therapy, and have more hospital treatments as well as longer duration [ 30 ]. The higher the level of anxiety, the worse the control of the disease, and the worse the quality of life.…”

“…The higher the level of anxiety, the worse the control of the disease, and the worse the quality of life. According to the literature, the prevalence of panic attack is nearly ten times higher in people with COPD than in the general population [ 30 ]. Mental health problems with COPD are associated with a reduced ability to cope with the disease itself, which is progressive, declining lung function and more pronounced dyspnea, poorer quality of life, more frequent exacerbations and hospitalizations, poor adherence to treatment [ 30 ].…”

Nonpharmacological management of psychological distress in people with COPD

“…Studies reported that in less than 44% of people with COPD, clinically relevant increased levels of depression and/or anxiety were adequately diagnosed and that only 31% of them had received any treatment for these comorbid psychological conditions [ 187 ]. These data have been subsequently confirmed [ 7 ], stressing that less than one-third of people with COPD and mental health problems receive adequate management, despite the recommendations of the Global Initiative for Chronic Obstructive Lung Disease guidelines to actively screen for and manage psychological comorbidities [ 188 ]. Hence, some important clinical and research-related challenges should be addressed in the future to optimise the management of psychological distress in COPD, which will be discussed below ( figure 2 ).…”

“…While several types of nonpharmacological interventions have been empirically validated, the availability of such interventions is limited in clinical practice, which is reported as a barrier to initiating discussions of mental health by respiratory clinicians [ 188 ]. An international survey among members of respiratory societies indicates that mental health specialists, e.g.…”

Psychometric Validity of the Anxiety Inventory for Respiratory Disease (AIR) Scale in an Indian Sample of Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study

“…Various studies suggest that routine screening for depression and anxiety in COPD patients and an integrated treatment approach may improve the treatment outcomes. Unfortunately, anxiety symptoms may go undetected in routine clinical practice due to factors such as physician-perceived barriers, system-related barriers [8,9], and difficulty in differentiating these anxiety symptoms from somatic symptoms of COPD like breathlessness. Therefore more than 50% of COPD patients with comorbid anxiety are not getting any appropriate treatment [8].…”