Date of Award
2003
Document Type
Dissertation
Degree Name
Doctor of Education
Department
Fischler Graduate School of Education and Human Services
Advisor
Peter Gabor
Committee Member
Bruce Carl Brydges
Committee Member
Barbara Packer
Keywords
academic medical center, aggressive treatment, aging, baseline data, blacks, chronic illness, Chronic Obstructive Pulmonary Disease, clinical application, clinical variables, clinic patients, COPD, coping skills, current smokers, depression, depressive symptoms, determinants, emotional distress, ex post facto investigation, focus groups, former smokers, illness intrusiveness, ineffective coping, internal medicine, isolation, loneliness, low self-esteem, morbidity, multivariate procedures, nurse-delivered interventions, patient quality of life, prevalence, qualitative methodology, quantitative findings, randomized controlled clinical trial, self-efficacy, severe spirometric impairment, smoking, social networks, social support, socioeconomic stressors, stroke, structured interviews, treatment implications, univariate procedures, whites
Abstract
Patients with Chronic Obstructive Pulmonary Disease (COPD) frequently suffer from isolation and loneliness; have ineffective coping skills, poorly developed social networks and low self-esteem; and struggle with socioeconomic stressors (Dow & Mest, 1997). As a result, such people are frequently characterized in the literature as a population of chronically ill patients with a higher than normal prevalence of emotional distress (Van Ede, Yzermans & Brouwer, 1999). A study was conducted to (1) measure the prevalence of depression among clinic patients with COPD, (2) determine the demographic and clinical variables, and (3) assess the implications for treatment.
Methods: An ex post facto investigation was conducted using existing (baseline) data on 207 clinic patients aged 40 years and older with a registered diagnosis of COPD enrolled in a randomized controlled clinical trial comparing two nurse-delivered interventions at a large urban academic medical center. Both univariate and multivariate procedures were utilized to assess the prevalence and determinants of depression. Qualitative methodology utilizing expert focus groups and structured interviews was employed in order to explore the clinical application of the quantitative findings.
Results: The overall prevalence of depression was higher among (a) whites (43%) vs. blacks (20%), (b) current smokers (50%) vs. former smokers (35%), (c) people with selfreported stroke (68%) vs. no stroke (37%), and (d) people with severe spirometric impairment (56%) vs. mild (34%) and moderate impairment (37%). Other factors associated with depression were lower levels of self-efficacy and social support, and higher reported levels of illness intrusiveness. Early identification of depressive symptoms and aggressive treatment may decrease morbidity and improve patient quality of life.