This supporting paper supports the presentation on the link between Chronic Obstructive Pulmonary Disease and the psychosocial factor depression. The supportive paper will explore, define and conclude areas of which may influence the health and well-being of patient’s with COPD and the psychosocial depression factor. The discussion of depression tools, guidelines, statistics and the long term use of oxygen therapy and care pathways will also be explored in this supporting paper (Cornforth, 2012 and NICE, 2009c).
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The supporting paper will explore COPD and depression as a separate condition and then link the impact of health and well-being. COPD is a collective term used for emphysema and bronchitis and is primarily smoking related as a consequence this leads to progressive airflow obstruction (Booker, 2003). The symptoms of COPD patients include a debilitating cough, dyspnea, excess sputum, chest tightness, fatigue and frequent chest infections. COPD’s insidiously developing character means that patients often do not present these symptoms until consequential irreversible damage has happened (Britton, 2002). According to Vermiere (2002) when diagnosis is finally made healthcare professionals may chastise COPD patients for smoking, and causing a self inflicted disease. In turn not much constructive advice maybe given to help COPD patients to manage their condition and medication may not be prescribed in the mistaken belief that medication would not be beneficially (Vermiere, 2002). Healthcare professionals may also unjustly chastise COPD patients, as COPD can also be caused by long term inhalation of asbestos, coal dust and pollution. The lack advice and medication given to patients with COPD may have enormous impact on a patient’s health and well being (Lee, 2008). According to the Department of Health the condition COPD causes nearly 25,000 deaths per year in England and Wales, and in the years 2007 until 2009 4.8% of deaths were caused by COPD being the fifth greatest killer in the United Kingdom (DH, 2011).
Depression is the word used to refer to a variety of mood disorders, a collection of clinical conditions that differentiates the sense of loss and control and a subjective experience of momentous distress (Lazarou et al, 2011). Depression is a wide and heterogeneous diagnosis and can be presented in a variety of different ways. The psychological symptoms may include a continual low mood, feeling hopeless, feeling tearful, feeling irritable and anxious, having low self esteem, no motivation, self harm and suicidal thoughts and having no enjoyment out of life. The physical symptoms may include speaking or moving slowly, weight loss or gain, lack of energy, lack of interest in sexually activities, disturbed sleep and unexplained aches and pains. The social symptoms include decreased job related activities, social withdrawal from family and friends and neglecting hobbies and interest (NICE, 2009a and Elsherif and Noble, 2011). According to the National Institute for Health and Clinical Excellence (2009b) the depression disorder is generally known as a psychological response in patients with COPD and it can be found in 20% of COPD patients.
Healthcare professionals have a duty of care, therefore the recognition of depression in COPD is paramount (NICE, 2009a). Such tools have been developed to aid practitioners to diagnosis depression, for example the Health nine-item Questionnaire (PHQ9) and the Hospital Anxiety and Depression Scale (HADS), these tools are used so that the patient can be considered to see if they require drug or psychological support (Cornforth, 2012). The use of the diagnosis tools in COPD patients reduces the potential risk of an acute exacerbation. According to Jennings et al (2009) patients with COPD who suffer from depression are at a higher risk of an acute exacerbation in turn this may lead to an admission to hospital. COPD and depression may also be linked with the continual occurrences of admissions, and the extended stay in hospital (Yohanne, 2010). Furthermore depression along with COPD may reduce the desire to recover and comply with medication and medical treatment, in turn this could lead to a delay in the patients discharge from hospital (DiMatteo et al, 2004).The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines (World Health Organization, 2008a) and NICE guidelines (2009a) have highlighted the need for psychosocial factors such as depression to be diagnosis in COPD patients. The NICE care pathways are also available to help health care professionals identify, treat and manage depression in COPD patients (NICE, 2009c).
The Department of Health defines health as “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (Department of Health 2010, P.7).
The presence of COPD and the psychosocial depression factor is the major cause of morbidity, disability and mortality and this can have a physical, mental and social impact on patients lives (NICE, 2009b). Factors that may contribute to depression in COPD patients are weight loss, sleep deprivation and fitness levels. Weight loss is associated with COPD in particular the loss of fat as the disease progresses furthermore many patients lose weight as a consequence of decreased food intake as a result of dyspnea (Kelly 2007). In addition poor quality of sleep is frequent in COPD patients for numerous reasons. Firstly, coughing and excessive mucus may interrupt the onset of sleep, particularly since these symptoms may be worsened in the supine position. Breathlessness may also be worsened by the position and COPD patients may have numerous incidents of nocturnal dyspnea, which causes recurring awakenings (George and Bayliff, 2003). Finally COPD patients may avoid physical exercise or excessive hard work due to the unpleasant symptoms of breathlessness, as a result the patient’s fitness levels may reduce and this may lead to muscle weakness which increases disability, dyspnea, loss of confidence and social isolation (Booker, 2005). According to Yohanne (2010) the chronic character of COPD and its related stigma can also lead to social isolation.
COPD patients with chronic hypoxaemia rely on long term oxygen therapy (LTOT) to increase their survival rate. However the psychological effects it has on patient’s daily living are somewhat restricted in their capability to participate in indoor and outdoor activities, resulting in the patient suffering from depressive symptoms. Patients with chronic hypoxaemia who rely on LTOT for survival suffer from a diminishing quality of life and are susceptible to emotional lability, loneliness and social isolation in turn this may lead to clinical depression (Yohannes, 2010).
The Department of Health defines wellbeing as “A positive state of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment” (Department of Health 2010, P.7)
COPD and the psychosocial factor depression can not only affect every aspect of a sufferer’s life but it can have enormous impact on the sufferer’s family lives. The ability to cope with the loss of an active role in their family and society and the loss of intimacy and functional impairment is considered a burden to a patient’s state of mind (Gray et al, 2009).The British Lung Foundation (2005) carried out a survey regarding COPD patients daily activities, and the findings were 90% of patients with severe COPD were unable to do their gardening, 66% were unable to go on holiday and 33% had disabling breathlessness all factors that increase depressive symptoms. Patients with COPD who suffer from a disability can eventually become reliant on others to carry out every aspect of daily living this may include personal hygiene and grooming, functional transfers, eating and drinking, medicine management, bowel and bladder management and managing money as a result this can have a enormous impact on a patients mental well being in turn this may result in clinical depression (Mooney and O’Brien 2006 and Gray et al 2009). A patient’s state of mind and the ability to cope with COPD may cause the patient to experience negative thoughts and feelings such as feeling guilty, loss of independence, low self esteem and a sense of worthlessness they frequently criticise themselves for lacking in confidence, feeling irritable, impatient and frustrated all the factors may contribute to clinical depression. In some circumstances patients with depression and COPD may cause injury to themselves, experience suicidal thoughts and in extreme circumstances may attempt suicide (NICE 2009a and Gray et al 2009).
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This supporting paper has supported the presentation on the link between COPD and the psychosocial depression factor. The supportive paper has explored, defined and concluded areas of which influence the health and well-being of patients with COPD and the psychosocial depression factor. To conclude the main focal points, COPD is the fifth greatest killer in the United Kingdom and as a mortality rate of 25,000 per year (DH, 2011). Twenty percent of patients with COPD suffer from depression with extreme symptoms of self harm and suicide (NICE 2009a, NICE 2009b and Gray et al 2009). The symptoms of both COPD and depression have been emphasised to highlight the need for diagnosis tools, guidelines and care pathways. The main importance of this paper is the physical, mental, social, state of mind and ability to cope with COPD and depression and the impact it has on the patient’s lives (Cornforth 2012 and NICE 2009c).
Word count – 1374
References/References in text and headings and quotes – 699
Total word count – 2073
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