دانلود مقاله ISI انگلیسی شماره 29577
عنوان فارسی مقاله

خودمدیریتی تنگی نفس در بیماران مبتلا به بیماری انسدادی مزمن ریوی: تعدیل اثرات خلق و خوی افسرده

کد مقاله سال انتشار مقاله انگلیسی ترجمه فارسی تعداد کلمات
29577 2005 9 صفحه PDF سفارش دهید 4350 کلمه
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عنوان انگلیسی
Dyspnea Self-Management in Patients With Chronic Obstructive Pulmonary Disease: Moderating Effects of Depressed Mood
منبع

Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)

Journal : Psychosomatics, Volume 46, Issue 5, September–October 2005, Pages 402–410

کلمات کلیدی
- خودمدیریتی - خلق و خوی افسرده -
پیش نمایش مقاله
پیش نمایش مقاله خودمدیریتی تنگی نفس در بیماران مبتلا به بیماری انسدادی مزمن ریوی: تعدیل اثرات خلق و خوی افسرده

چکیده انگلیسی

The effects of three versions of a dyspnea self-management program on depressed mood and the moderating effects of baseline depression risk on improvements in dyspnea severity, exercise performance, and physical and social functioning were examined over a 2-month period in 100 patients with moderate to severe chronic obstructive pulmonary disease (COPD). All three versions of the dyspnea self-management programs, which differed in the amount of supervised exercise (no sessions or four or 24 sessions), equally and significantly improved depressed mood. Subjects at high risk for depression at study entry who received 24 sessions had greater reduction in dyspnea than those who received four sessions or no sessions. Patients with COPD at high risk for depression are likely to achieve greater relief of dyspnea with self-management programs that include more intensive supervised exercise. Depression is a commonly reported emotional problem associated with chronic obstructive pulmonary disease (COPD); the prevalence of depression in COPD patients has been estimated to range from 25% to 74%.1,2 The wide range in estimated prevalence is primarily due to differences in the demographic characteristics of the study samples, measurement properties of instruments, and cut-off values used to define depression.3 Nonetheless, the finding that COPD patients are at high risk for depression is consistent. The disease likely serves as an antecedent that increases the level of mediating variables such as depression and dyspnea, which, in turn, diminish functional status and quality of life.4,5 It is important to note that most of the studies of depression that are cited in this article are based on psychological questionnaires rather than clinical diagnoses, unless otherwise stated. In one case-control study, van Manen et al.1 found the risk for depression to be 2.5 times greater for patients with severe COPD (forced expiratory volume in 1 second [FEV1]<50% predicted) than for comparison subjects with similar demographic characteristics. Greater severity of depression in patients with COPD has been associated with diminished health-related quality of life,6., 7., 8. and 9. diminished functional status,10 impaired coping,11 greater COPD symptoms,1,9,12., 13. and 14. and failure of treatment for COPD exacerbations.15 Mortality risk was three times greater for patients who had depressive symptoms during hospitalization for COPD exacerbations, compared to those who did not have depressive symptoms.16 Compared to patients with other chronic illnesses, such as heart failure, arthritis, angina, and diabetes, patients with COPD have been found to have worse psychological functioning.17 Depressed mood and/or depression have been measured as an outcome of multipronged treatments such as pulmonary rehabilitation or self-management interventions, both of which typically include some form of exercise. Some18., 19., 20., 21. and 22. but not all23,24 of these studies have demonstrated a positive effect on depression. Exercise is often implicated as the active ingredient in modifying depressed mood in these investigations; however, the granular effects (i.e., dose frequency, duration, and intensity) of exercise in improving depressed mood have not been examined sufficiently in healthy people and not at all in patients with COPD.25 In addition, few studies have assessed the moderating effects of depressed mood on changes in health outcomes from such treatments in patients with COPD We previously reported the main results from an experimental study evaluating three dyspnea self-management (DM) programs, two of which included additive doses of supervised exercise in addition to a standard program of individualized education and home-based walking for patients with COPD.26 We found that the effect on dyspnea severity, exercise performance, and health-related quality of life was largely dependent on the “dose” of supervised exercise (no, four, or 24 sessions) in that subjects who received the extended training outperformed the other two groups. In this article, we report on the effects of the three DM programs on depressed mood and present subgroup analyses of the moderating effects of baseline depression risk on improvement in the primary study outcome variables of dyspnea severity, exercise performance, and social and physical functioning.

مقدمه انگلیسی

The effects of three versions of a dyspnea self-management program on depressed mood and the moderating effects of baseline depression risk on improvements in dyspnea severity, exercise performance, and physical and social functioning were examined over a 2-month period in 100 patients with moderate to severe chronic obstructive pulmonary disease (COPD). All three versions of the dyspnea self-management programs, which differed in the amount of supervised exercise (no sessions or four or 24 sessions), equally and significantly improved depressed mood. Subjects at high risk for depression at study entry who received 24 sessions had greater reduction in dyspnea than those who received four sessions or no sessions. Patients with COPD at high risk for depression are likely to achieve greater relief of dyspnea with self-management programs that include more intensive supervised exercise. Depression is a commonly reported emotional problem associated with chronic obstructive pulmonary disease (COPD); the prevalence of depression in COPD patients has been estimated to range from 25% to 74%.1,2 The wide range in estimated prevalence is primarily due to differences in the demographic characteristics of the study samples, measurement properties of instruments, and cut-off values used to define depression.3 Nonetheless, the finding that COPD patients are at high risk for depression is consistent. The disease likely serves as an antecedent that increases the level of mediating variables such as depression and dyspnea, which, in turn, diminish functional status and quality of life.4,5 It is important to note that most of the studies of depression that are cited in this article are based on psychological questionnaires rather than clinical diagnoses, unless otherwise stated. In one case-control study, van Manen et al.1 found the risk for depression to be 2.5 times greater for patients with severe COPD (forced expiratory volume in 1 second [FEV1]<50% predicted) than for comparison subjects with similar demographic characteristics. Greater severity of depression in patients with COPD has been associated with diminished health-related quality of life,6., 7., 8. and 9. diminished functional status,10 impaired coping,11 greater COPD symptoms,1,9,12., 13. and 14. and failure of treatment for COPD exacerbations.15 Mortality risk was three times greater for patients who had depressive symptoms during hospitalization for COPD exacerbations, compared to those who did not have depressive symptoms.16 Compared to patients with other chronic illnesses, such as heart failure, arthritis, angina, and diabetes, patients with COPD have been found to have worse psychological functioning.17 Depressed mood and/or depression have been measured as an outcome of multipronged treatments such as pulmonary rehabilitation or self-management interventions, both of which typically include some form of exercise. Some18., 19., 20., 21. and 22. but not all23,24 of these studies have demonstrated a positive effect on depression. Exercise is often implicated as the active ingredient in modifying depressed mood in these investigations; however, the granular effects (i.e., dose frequency, duration, and intensity) of exercise in improving depressed mood have not been examined sufficiently in healthy people and not at all in patients with COPD.25 In addition, few studies have assessed the moderating effects of depressed mood on changes in health outcomes from such treatments in patients with COPD We previously reported the main results from an experimental study evaluating three dyspnea self-management (DM) programs, two of which included additive doses of supervised exercise in addition to a standard program of individualized education and home-based walking for patients with COPD.26 We found that the effect on dyspnea severity, exercise performance, and health-related quality of life was largely dependent on the “dose” of supervised exercise (no, four, or 24 sessions) in that subjects who received the extended training outperformed the other two groups. In this article, we report on the effects of the three DM programs on depressed mood and present subgroup analyses of the moderating effects of baseline depression risk on improvement in the primary study outcome variables of dyspnea severity, exercise performance, and social and physical functioning.

نتیجه گیری انگلیسی

All three versions of a dyspnea self-management program significantly improved depressed mood in patients with moderate to severe COPD. Patients who were at high risk for depression at study entry benefited greatly in terms of greater reductions in dyspnea if they received more intensive supervised exercise training along with the dyspnea self-management program. Our findings will need to be replicated in a larger study that employs a factorial design and includes sufficient numbers of patients with depressed mood and/or a diagnosis of depression.55 Nonetheless, we recommend that self-management programs for patients with COPD screen for depression and tailor exercise regimens accordingly, e.g., providing more supervision for patients with depressed mood/depression, in order to maximize symptomatic improvements.

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