Health Anxiety in COPD V1.0
Research type
Research Study
Full title
The Impact of Health Anxiety in Chronic Obstructive Pulmonary Disease (COPD)
IRAS ID
325752
Contact name
Adele Smith
Contact email
Sponsor organisation
University of Oxford/ Research Governance, Ethics and Assurance
Duration of Study in the UK
0 years, 8 months, 30 days
Research summary
Research Summary
Chronic obstructive pulmonary disease (COPD) is a debilitating life-long physical health condition which has been identified as the third leading cause of death worldwide (WHO, 2019). COPD is a condition which impacts the lungs, resulting in symptoms such as breathlessness, tightness of chest, chronic cough (with or without mucus) and tiredness. Research has shown that individuals with COPD often experience high levels of anxiety, higher than that of the general population without a COPD diagnosis.Research of other chronic physical health conditions, such as multiple sclerosis or stroke, have found that health anxiety (HA) is significantly prevalent. Individuals with a chronic physical health condition and high HA were more likely to have lower quality of life, higher disability, higher general anxiety and higher depression scores on self-report outcome measures.
In addition, one study found that individuals diagnosed with multiple sclerosis who scored high on HA were more likely to misperceive themselves as being more impaired on a physical functioning task than they really were. This was in comparison to a group with multiple sclerosis and who scored low on the HA outcome measure. Furthermore, they were more likely to attribute their functioning to their chronic condition, more so than those with low HA.
We are interested in exploring the impact that high HA has on a community NHS sample of individuals with a COPD diagnosis who are referred for a pulmonary rehabilitation program. We would explore whether HA impacts upon perceptions of physical functioning on a 6-minute walk task. This 6-minute walk task is completed as part of a routine assessment prior to engagement in pulmonary rehabilitation program. Furthermore, to explore whether HA impacts upon self-reported quality of life, disability, and mood.
Summary of Results
Health anxiety (HA) can be a debilitating mental health condition. When someone has HA, they may worry excessively about their physical health, with fears that they may develop a serious and life-threatening illness. Research has shown that people with pre-existing chronic physical health conditions, such as multiple sclerosis or stroke, can also experience HA. People with HA and a chronic physical health condition interpret ambiguous physical health symptoms as indicating that their chronic physical health condition is worsening or that they are developing a life-threatening condition.Previous studies have explored HA in people with chronic physical health conditions, comparing those with high levels of HA to those with low HA. People with chronic health conditions and high HA were more likely to perceive themselves as being more impaired on a physical functioning task than they really were and were more likely to attribute their perfor-mance to their chronic health condition. Additionally, the high HA groups generally had lower mood, greater self-reported disability and a lower quality of life compared to people with the same chronic health condition but lower HA. These groups often did not significantly differ in terms of their physical health symptoms or severity.
There is not enough research exploring the impact or prevalence of HA on people diagnosed with Chronic Obstructive Pulmonary Disease (COPD) in a community setting. COPD is a chronic health condition which affects the lungs and results in breathing difficulties, coughing, wheezing and increased risk of chest infections. Symptoms of COPD progressively get worse over time. The primary recommended intervention to manage COPD symptoms is pulmonary rehabilitation.
Based on previous research, it was predicted that individuals with high HA and COPD, compared to low HA and COPD, will be more likely to misperceive themselves as being more physically impaired on a routine walking task and more likely to attribute their performance to the COPD. Additionally, those with high HA will report a lower quality of life, poorer mood, and greater self-reported disability compared to those with low HA.
What was done?
This study recruited 62 participants; 22 participants had COPD and high HA, 20 with COPD and low HA and 20 healthy control participants. COPD participants were recruited from a community NHS service and invited for their initial assessment for pulmonary rehabilitation. All patients invited to the assessment clinic received study information in the post before attending the clinic. Healthy control participants were recruited from the community. All participants completed a physical task (6-minute walking test); COPD patients completed this with a trained physiotherapist in the clinic whereas the chief investigator delivered the physical task with healthy control participants. Following this, participants completed several questionnaires exploring to measure their level of HA, mood, generalised anxiety, quality of life, self-reported disability, and perceptions of physical functioning.What was found?
Out of the participants with COPD, 16% met clinically significant levels of HA and 31% showed a high number of HA symptoms, this is a much higher prevalence of HA compared to the general population.
Participants with COPD and high HA were more likely to misperceive their performance on a physical walking test as being more impaired compared to the low HA group and healthy controls. When comparing the distance walked during the walking test, there were no significant differences between the COPD participants, in fact, the high HA group walked further on average compared to the low HA group.Participants with COPD, compared to healthy controls, had greater self-reported disability. No difference was found between the COPD participants in terms of mood or quality of life, suggesting that HA did not impact this population.
Implications
Given the high prevalence of HA and it’s on perceptions of physical performance and self-reported disability, it would be beneficial to routinely screen for and treat HA in individuals diagnosed with COPD. If individuals with high HA perceive themselves as performing more poorly on physical tasks, they may be less likely to engage in a pulmonary rehabilitation program and avoid physical activity. Both of which would negatively impact their functioning and increase the risk of exacerbations and disease progression. High HA may explain why people drop out of pulmonary rehabilitation programs, and this needs to be explored further. Further research is needed to understand the underlying cognitions people with high HA and COPD may hold about their health and physical tasks. Additionally, to explore the effectiveness of a psychological in-tervention on symptoms of HA in people with COPD.REC name
Wales REC 7
REC reference
23/WA/0290
Date of REC Opinion
18 Oct 2023
REC opinion
Further Information Favourable Opinion