Coping and psychological distress in hospitalized patients with chronic obstructive pulmonary disease.

BACKGROUND: Previous studies have emphasized the importance of coping in patients with chronic obstructive pulmonary disease (COPD). In other medical conditions, inadequate coping is associated with higher levels of psychological distress. Therefore, the types of coping strategies that patients use may also influence the distress that accompanies an acute exacerbation of COPD.

OBJECTIVES: The objective was to examine the prevalence of psychological distress in patients hospitalized for an acute exacerbation COPD, assess how they appraise and cope with the recent stressful event, and examine the relationships among coping, appraisal, and psychological distress. THEORETIC FRAMEWORK: Lazarus and Folkman's cognitive-motivational-relational meta-theory guided this study.

METHODS: A descriptive, cross-sectional design was used to analyze baseline data from 92 participants of a longitudinal study of patients hospitalized with an acute exacerbation of COPD and followed for up to 9 months after discharge. The baseline interview included an assessment of demographic and clinical characteristics, coping, appraisal, and psychological distress.

RESULTS: The majority of patients demonstrated psychological distress (64%), identified their current breathing problem as their stressful event (68.5%), and appraised the mean intensity of the event at 5.57+/-1.55 (scale range: 1, not stressful to 7, most stressful). Approximately half of the respondents (51%) characterized the stressful event as representing a threat, 26% as harmful, 7.6% as a loss, 4.3% as a challenge, and 11% chose other terms to characterize the stressful event. The majority of patients (61%) reported that the stressful event was something they had to accept, 21.7% thought they could change or do something about it, and the remainder needed more information. There were no significant differences between patients with and without psychological distress with regard to demographic characteristics, disease severity (forced expiratory volume in 1 second), types of stressful event, stress intensity, primary or secondary appraisal, or number of coping strategies used. However, problem-solving coping strategies were inversely related to psychological distress.

CONCLUSIONS: Timely identification and use of problem-solving coping strategies may help reduce the psychological distress experienced during acute hospitalizations for COPD.