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Psychological distress and maladaptive coping styles in patients with severe versus moderate asthma.

Chest. 2010 Jan 22. Lavoie KL, Bouthillier D, Bacon SL, Lemière C, Martin J, Hamid Q, Ludwig M, Olivenstein R, Ernst P. 1Department of Psychology, University of Quebec at Montreal (UQAM), P.O. Box 8888, Succursale Center-Ville, Montreal, Quebec, H3C 3P8, Canada.

BACKGROUND: Though several biological factors have been suggested to play a role in the development and persistence of severe asthma, those associated with psychological factors remain poorly understood. This study assessed levels of psychological distress and a range of disease-relevant emotional and behavioural coping styles in patients with severe versus moderate asthma.

METHODS: 84 patients (50% female, M age 46 yrs) with severe (n=42) and moderate (n=42) asthma were recruited. Severe asthma was defined according to ATS criteria. Patients underwent demographic and medical history interviews, pulmonary function and allergy testing. Patients also completed questionnaires measuring asthma symptoms and the Millon Behavioural Medicine Diagnostic Inventory (MBMDI), which assesses psychological distress and emotional/behavioural coping factors that influence disease progression and treatment.

RESULTS: After adjustment for covariates and applying a correction factor that reduced the significant p-level to <.01, patients with severe vs. moderate asthma reported experiencing more psychological distress including worse cognitive dysfunction [F=6.72, p<.01]) and marginally worse anxiety-tension [F=4.02, p<.05]. They also reported worse emotional coping (higher illness apprehension [F=9.57, p<.01], pain sensitivity [F=10.65, p<.01], future pessimism [F=8.53, P<.01], and interventional fragility [F=7.18, p<.01]), and marginally worse behavioral coping (more functional deficits [F=5.48, p<.05] and problematic compliance [F=4.32, p<.05]).

CONCLUSION: Patients with severe asthma have more psychological distress and difficulty coping with their disease both emotionally and behaviorally relative to moderate asthmatics. Future treatment studies should focus on helping severe asthma patients manage distress and cope more effectively with their illness, which may improve outcomes in these high-risk patients