Relationship between psychopathology & socio-demographic and clinical variables in COPD and bronchial asthma: a comparative study.
Patients with COPD are more likely than age-matched peers to report symptoms of distress, especially depression and anxiety. In addition, psychological distress in patients with COPD is associated with impaired quality of life and restricted activities of daily living. Furthermore, functional capacity of patients with COPD is more strongly associated with emotional/psychosocial factors (e g, depression, anxiety, somatization, low self-esteem, attitudes toward treatment, social support) than with traditional physiological indicators. Although psychological factors are associated with functional performance, the influence of psychological factors on disease progression and mortality in patients with COPD is still unknown.
Six percent to 42% of patients with COPD have substantial symptoms of depression or clinical depression. Depression in patients with COPD is often marked by feelings of hopelessness and pessimism, reduced sleep, decreased appetite, increased lethargy, concentration difficulty, and social withdrawal. Depression is associated with impairment in functional abilities and performing activities of daily living, poorer self-reported health, impaired self-management of disease exacerbations, and poor health behaviors. The correlation between depressed mood and disease severity is modest, but depression symptoms are important correlates of perceived functioning, and subclinical depression symptoms are associated with greater self-reported physical disability and poorer quality of life.
Recent estimates indicate a prevalence of anxiety disorders ranging from 2% to over 50% in patients with COPD. Anxiety is associated with reduced functional ability and re hospitalization in patients with chronic lung disease. Symptoms of anxiety are manifested in a variety of ways, including physiological signs of arousal, such as tachycardia, sweating, and dyspnea. Symptoms of anxiety may overlap with symptoms of depression. (2)
According to Thompson and Thompson difficult breathing has many psychiatric implications. Patients react emotionally to discomfort of dyspnea, the loss of functional capacity and the threat of death, while hypoxia, hypercarbia, hyperventilation, respiratory failure and medications all have direct effect on the brain. (3)
Hypoxia is known to induce not only psychomotor slowing and memory impairment but also depressed mood. Both smoking and COPD generates hypoxia leading to neuropsychiatric disturbances in these patients. Depression in COPD is a heterogeneous entity with a potentially composite etiology including genetic predisposition, environmental losses and stressors, as well as direct damage to the brain mediated by the physiologic effects of chronic respiratory illness. As such, the relationship between depression COPD and smoking are not linear but, rather interconnected with each element influencing the others to different degrees in any given patients at any given time.
Smoking, COPD and depression are inter-related in a sort of trinity, with depression playing a role in the initiation and maintenance of smoking, smoking leading to the development of COPD and COPD, in turn contributing to the genesis of depression. (4) Catherine and Colleagues study found that psychiatric disorders are at least 3 times higher in COPD patients compared to general population and nearly two times higher in women than in men. Women also have greater psychological distress, worse perceived control of symptoms and greater functional impairment. (5)
Smoking in COPD, patient is considered to have both anxiolytic and anxiogenic effect and in a large community sample Breslau found that smokers who met the criteria for Nicotine dependence had elevated life time rates of anxiety disorders. (6) Yohannes AM et al compared the prevalence of depressive symptomatology in elderly outpatients with stable disabling COPD with that in healthy controls and age matched patients with other disabilities, and also assessed the relation between degree of disability, quality of life and depressive symptoms and concluded that depressive symptoms are common in elderly patients with COPD, prevalence and or severity of depressive symptoms may be greater in those who are most disabled. (7)
One epidemiological survey was done to identify the prevalence of anxiety, depression and panic fear in adults with asthma compared with that of the general population and to investigate whether there is a specific relationship between asthma and anxiety and authors concluded that a significant minority of people have high levels of panic fear, associated with asthma. However in adults with asthma there is also high prevalence of both generalized anxiety and depression, suggesting that the link of anxiety to asthma may be part of a broader relationship between psychological distress and chronic disease rather than a specific one. (8)
A comparative study done by Georgios Moussas and his co-workers to assess anxiety and depression in patients with bronchial asthma, chronic obstructive pulmonary disease and tuberculosis in a general hospital of chest diseases, using Spielberger state trait anxiety scale and Beck depression inventory. They found that patients with COPD and bronchial asthma had higher depression scores than patients with tuberculosis, and women had higher depression and anxiety scores than men. Depression was positively correlated with anxiety, age and time from diagnosis and anxiety was positively correlated with depression and time from diagnosis. (9)
One study examined factors that predicated depressed mood at discharge and 3 months after discharge for 124 elders with chronic obstructive pulmonary disease. After the use of control for physiologic status (forced expiratory volume in 1 second percent predicted), the factors of anxiety, perceived health competence, daily functioning and family emotional coping predicted depressed mood. (10)
AIMS AND OBJECTIVES:
1. To find out the correlation between socio-demographic variables and Psychopathology in patients with COPD, Bronchial Asthma and Healthy individuals.
2. To find out the correlation between clinical variables and Psychopathology in patients with COPD, Bronchial Asthma and Healthy individuals.
METHODOLOGY: SOURCE OF DATA: The clinical study was conducted in Father Muller Medical College, Kankanady, Mangalore, which is a multi-specialty hospital. All patients attending the outpatient and inpatient facilities of the department of Medicine with a clinical diagnosis of chronic obstructive pulmonary disease constituted the population for the study. The study was conducted from the [1.sup.st] September 2008 to the 31st of August 2010.
METHOD OF COLLECTION OF DATA: The sample for the study consisted of thirty consecutive patients with chronic obstructive pulmonary disease who satisfied the inclusion and exclusion criteria.
* Patients with clinical diagnosis of COPD according to GOLD's criteria. (1)
* Age group between 18 and 50 years
* Patients with family history or past history of psychiatric illness not attributable to COPD.
* Patients with COPD having other medical disorders like DM, Hypertension, thyroid and other endocrine disorders, renal failure and other chronic debilitating medical conditions known to cause cognitive impairment and psychiatric morbidity.
* Patients with substance dependence other than smoking.
* Patients who refused to give consent.
Consecutively selected 30 first degree male non-affected relatives of COPD patients between age 18 and 50 years and 30 male patients with bronchial asthma between age 18 and 50 years who met the same inclusion and exclusion criteria constituted the control groups for the study.
PROCEDURE: This study has been cleared by the institutional ethical committee. A written informed consent was obtained from all participants both in COPD patients and control groups. The socio demographic and clinical variables were recorded in a specific proforma prepared for this clinical study. All the participants underwent a thorough clinical examination to rule out psychopathology and medical disorders if any. Psychopathology was rated in all the participants using Comprehensive Psychopathological Rating Scale (CPRS).
DESCRIPTION OF THE TOOL USED: The Comprehensive psychopathological rating scale (CPRS). The scale has been constructed explicitly for the measurement of psychopathology and change in psychopathology. The items for the construction of this scale are selected from a wide range of psychiatric signs and symptoms chosen from clinical experiences and from the literature. This is a comprehensive selection of items relevant for all psychiatric illnesses. Personality dimensions (trait characteristics), habitual psychopathological defense mechanisms and traits which are normally measured rather than rated (intelligence) are avoided. It consists of 67 items which include 40 reported items (symptoms) and 23 observed items (signs). All the items are scored on a 4 point scale (0-3). CPRS has established reliability and variability.
The use of CPRS does not require special training. It is comprehensive enough to cover signs and symptoms which are relevant to ICD10 categories. This comprehensive scale includes positive and negative symptoms, psychotic and non-psychotic symptoms and organic and non-organic symptoms. (11)
Table 1: Relation between Age and Psychopathology (CPRS Score) Age N Mean Std. P-value Deviation REPORTED COPD 18-40yrs 15 5.26667 5.5480 0.001 HS 41-50yrs 15 12.86667 6.1628 Total 30 9.06667 6.9378 Bronchial 18-40yrs 15 2.312500 2.6512 0.015 Sig Asthma 41-50yrs 15 5.50000 4.0335 Total 30 3.80000 3.6803 Healthy 18-40yrs 15 1.50000 1.9110 0.009 HS 41-50yrs 15 4.0000 2.0976 Total 30 2.0000 2.1655 OBSERVED COPD 18-40yrs 15 1.66667 2.1269 0.002 HS 41-50yrs 15 4.66667 2.6903 Total 30 3.16667 2.8294 Bronchial 18-40yrs 15 .437500 0.8920 0.026 Sig Asthma 41-50yrs 15 1.6428571 1.8232 Total 30 1.00000 1.5085 Healthy 18-40yrs 15 .3750000 0.76966 0.389 41-50yrs 15 .66667 0.51639 Total 30 .433333 0.72793 TOTAL COPD 18-40yrs 15 6.93333 7.3333 0.001 HS 41-50yrs 15 17.53333 8.5345 Total 30 12.23333 9.4965 Bronchial 18-40yrs 15 2.750000 3.3763 0.015 Sig Asthma 41-50yrs 15 7.142857 5.7493 Total 30 4.80000 5.0678 18-40yrs 15 1.7916667 2.63717 0.023 Sig Healthy 41-50yrs 15 4.6667 2.50333 Total 30 2.36667 2.82212
As shown in table 1, psychopathology is more common in older age group compared to younger on all the domains of CPRS that is reported, observed and total CPRS score. There is highly significant difference in COPD patients on all the domains of CPRS. There is significant difference in all the domains of CPRS in bronchial asthma patients, and there is highly significant difference in the domain of observed and significant difference in total CPRS score among healthy controls.
Table 2 shows that other group which includes separated, divorced and widower had more psychopathology than the married and singles. Singles had least psychopathology among all the groups. There is highly significant difference in bronchial asthma group in all the domains of CPRS, and there is significant difference in healthy controls in all the domains. There is no significant difference found in COPD group related to their marital status.
Table 3 shows that there is more psychopathology in less educated persons compared to highly educated persons. Psychopathology is more common cases as evident by mean values followed by bronchial asthma group, but there was no statistically significant difference.
Occupation wise data reveal as shown in table 4, that semiskilled/unskilled worker group had more psychopathology in all the groups and among the three groups mean value is highest in cases. And there is statistically no significant difference.
Substance use data analysis reveals that psychopathology is more in the persons who were smoking as well as using alcohol. Cases are highest psychopathology followed by bronchial asthma group. There is highly significant difference in bronchial asthma group in all the domains of CPRS, and there is significant difference in healthy controls on all the domains. (table 5)
There is highly significant difference in COPD patients in all the domain of CPRS. And there is highly significant difference in the domain of reported and total score in bronchial asthma group. This indicates that duration of illness is directly proportional to psychopathology. Psychopathology is more common in COPD patients compared to bronchial asthma group (table 6)
There is highly significant difference in COPD group and significant difference found in bronchial asthma patients in psychopathology with respect to current medications. Patients who are only on bronchodilators have less psychopathology compared to other group patients. (table 7)
COPD patients who belongs to stage III and stage IV have more psychopathology compared to patients belongs to stage I and stage II. This difference is highly significant in all the domains of CPRS. (table 8).
DISCUSSION: The three samples do not significantly differ in terms of age, marital status, religion, domicile distribution, occupation and income. This fact indicates that the chronic obstructive pulmonary disease (COPD) patients and the two control groups are matched. In the case of education there is significant difference among the patients and both the control groups. The healthy individuals have significantly better educational status when compared to that of patients with bronchial asthma and COPD. Such findings are not reported in literature reviewed. It could be possible that the poorer education status in both groups of patients may be attributable to the chronic states of the respiratory diseases and their consequences.
About fifty percent of COPD patients and 33% bronchial asthma patients are smoking and using alcohol whereas 70% of healthy controls do not use them. The difference is statistically significant. It is likely that smoking is one of the causes for COPD and bronchial asthma, rather than the consequences. Smoking is one of the major risk factor in COPD patients (1). There is no statistically significant difference with respect to duration of illness in COPD patients and patients with bronchial asthma.
A significant proportion of patients of COPD are on steroids as well as bronchodilaters, whereas only thirty percent patients of bronchial asthma are on steroids. An earlier study on psychopathology in COPD patients postulates that the medication could be related to psychopathology. (3) But the nature of medications and the dosage of medications are not mentioned. Spirometry done on COPD patients reveals that fifty percent belongs to stage I and about thirty three percent belongs to stage II. Thirty percent patients with bronchial asthma had family history of psychiatric medial or substance use disorders, whereas no significant family history is reported in COPD patients.
Present investigation indicates that psychopathology in COPD patients is more common in older age group compared to the younger age group. This finding is consistent with one of the earlier study. (7) Psychopathology in terms of reported, observed and total is found to be more in the older age group. To find out the association between depression and anxiety with demographic, health-related quality of life and clinical characteristics of COPD patients Jennifer A Cleland et al conducted a Cross- sectional population-based postal survey and they found that depressive and anxious symptoms in COPD are related to age and high levels of symptoms. (12)
Current investigation reveals that psychopathology is less in single persons compared to other group which includes, widowers, separated and divorced. But the difference is statistically significant in bronchial asthma patients and healthy controls. In COPD patients the psychopathology does not have any significant difference related to marital status. Present investigator fails to find earlier studies which report relation of psychopathology to marital status. Present study reveals that there is more psychopathology in less educated persons. But the difference is not statistically significant. Similar finding is not reported in earlier studies. Earlier studies have not attempted to study the relation between occupation and psychopathology in COPD patients.
And current investigation finds that semiskilled/ unskilled laborers' have much more psychopathology but the difference is not statistically significant. It is possible that due to chronic respiratory diseases such patients are less educated and less qualified and are under constrained to take up manual labor.
In COPD patients psychopathology is significantly more in smokers. Present investigation find that in COPD patients psychopathology is significantly more in smokers and alcohol users. This finding is consistent with earlier studies. (4,6,13) COPD patients who smoke and use alcohol have higher prevalence of psychopathology when compared to those who smoke and those who do not smoke. The difference is also statistically significant. The current investigation reveals that duration of respiratory disease is significantly related to psychopathology. Present investigator fails to find such reports in earlier studies.
Possible relationship between duration of illness and psychopathology could be explained on the basis of the fact that the longer duration might lead to more chronic hypoxia and other consequences of COPD and asthma. Present investigator also reveals that COPD stage III and IV have more psychopothology compared to those in stage I and II. Airway obstruction leads to hypoxia which is a key factor in COPD. Current investigator found that psychopathology is related to [FEV.sub.1], smoking, hypoxia, severity of illness and staging of illness. These findings are consistent with earlier studies. (6,10,14)
Present investigation reveals that psychopathology is significantly related to steroids in COPD and bronchial asthma patients. Similar finding is reported in an earlier study (4). One study attempted to quantify the prevalence of psychiatric morbidity relative to asthma severity, quality of life (QOL), and Inhaled corticosteroids dose. They concluded that Psychiatric morbidity is more prevalent in this population and Use of high-dose inhaled corticosteroids benefited pulmonary function and "physical" QOL, yet may have negatively affected patients' mental well-being. (15)
(1.) Reilly JJ, Silverman EK, Shapiro SD. chronic obstructive pulmonary disease: In Harrison's Principles of Internal Medicine., eds-Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. The McGrow Hill Companies. 2005; pp: 1547-1553.
(2.) Emery CF, Green MR, Suh S. Neuropsychiatric Function in Chronic Lung Disease: the Role of Pulmonary Rehabilitation. Respiratory Care 2008; 53 (9): 1208-1216.
(3.) Thompson WL; and Thompson II TL. "Pulmonary disease". In: Principles of medical psychiatry. Editors: Stodermire and Fogel. Grune and Stratton inc. orlando 1987, 553-570.
(4.) Norwood RJ. A review of etiologies of depression in COPD. International Journal of COPD 2007; 2 (4): 485-491.
(5.) Catherine L, Kim LL, Simon BL, Gilles D, Guillaume L, Andre C, Manon L. Sex differences in the prevalence of psychiatric disorders and psychological distress in patients with COPD. Chest, the cardiopulmonary and critical care Journal 2007; 132 (1): 148-155.
(6.) Breslau N, Kilbey M, Andreski P. Nicotine dependence, major depression and anxiety in young adults. Arch Gen Psychiatry 1991; 48: 1069-74.
(7.) Yohannes AM, Roomi J, Baldwin RC, Connolly MJ. Depression in elderly outpatients with disabling chronic obstructer primary disease Age Ageing 1998; 27 (2): 155-66.
(8.) Cooper CL, Parry GD, Squl C, Morice AH, Hutchcrost BJ, Moore J, Esmonde L. Anxiety and panic fear in adults with asthma. Prevalence in primary case. BMC faring practice 2007; 8: 62.
(9.) Moussas G, Tselebis A, Karkanias A, Stamouli D, Ilias I, Bratis D, Vassila-Demi K. A comparative study of anxiety and depression in patients with bronchial asthma, chronic obstructive pulmonary disease and tuberculosis in a general hospital of chest diseases. Annals of General psychiatry 2008; 7: 7.
(10.) Narsavage GL, Chen KY. Factors related to depressed mood in adults with chronic obstructive pulmonary disease after hospitalization. Home Health Nurse 2008; 26 (8): 474-82.
(11.) Asberg M, Montgomery SA, Perris C, Schalling D, Sedvall, A comprehensive Psychopathological Rating Scale. Acta Psychiatrica Scandinavia Suppl. 1978; 271: 5-27.
(12.) Cleland JA, Lee AJ, Hall S. Associations of depression and anxiety with gender, age, health- related quality of life and symptoms in primary care COPD patients. Family Practice (2007) 24 (3): 217-223.
(13.) Mikkelsen RL, Middelboe T, Pissinger C, stage K, Anxiety and depression in patients with chronic obstructive pulmonary disease: A review Nord J. Psychiatry 2004; 58: 65-70.
(14.) Gore JM, Brophy C, Greenstone MA. Palliative care and anxiety and depression in end stage chronic obstructive pulmonary disease: A comparison with lung cancer. Thorax 1997; 52 (65), 77A.
(15.) Bonala SB, Pina D, Silverman BA, Amara S, Bassett CW, Schneider AT. Asthma Severity, Psychiatric Morbidity, and Quality of Life: Correlation with Inhaled Corticosteroid Dose. Journal of Asthma, Informa Healthcare 2003, Vol. 40, No. 6, Pages 691-699.
Mayank Sarawag , Sameer Saharan , Manju Bhaskar , Rajinderpal Singh , Kuldeep Singh Yadav 
[1.] Mayank Sarawag
[2.] Sameer Saharan
[3.] Manju Bhaskar
[4.] Rajinderpal Singh
[5.] Kuldeep Singh Yadav
PARTICULARS OF CONTRIBUTORS:
[1.] Assistant Professor, Department of Medicine, Jhalawar Medical College and Hospital, Jhalawar, Rajasthan.
[2.] Resident, Department of Psychiatry, Mahatma Gandhi Medical College and Hospital, Jaipur.
[3.] Assistant Professor, Department of Psychiatry, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan.
[4.] Resident, Department of Psychiatry, Mahatma Gandhi Medical College and Hospital, Jaipur.
[5.] Resident, Department of Psychiatry, Mahatma Gandhi Medical College and Hospital, Jaipur.
NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:
Dr. Mayank Sarawag, # 12, Jaishree Nagar, Behind Fortis Hospital, Malviya Nagar, Jaipur, Rajasthan. Email: email@example.com
Date of Submission: 28/10/2014.
Date of Peer Review: 28/10/2014.
Date of Acceptance: 06/11/2014.
Date of Publishing: 10/11/2014.
Table 2: Relation between Marital Status and psychopathology (CPRS score) Marital N Mean Std. P-value Status Deviation REPORTED COPD Single 7 6.71 7.45 .483 NS Married 21 9.48 6.43 Others 2 13.00 12.73 Total 30 9.07 6.94 Bronchial Single 8 2.25 3.06 .000 HS Asthma Married 18 3.11 2.74 Others 4 10.00 2.45 Total 30 3.80 3.68 Healthy Single 10 .600000 1.07496 .031 Sig Married 17 2.588235 2.20960 Others 3 3.3333 2.88675 Total 30 2.0000 2.16556 OBSERVED COPD Single 7 2.43 3.15 .531 NS Married 21 3.24 2.36 Others 2 5.00 7.07 Total 30 3.17 2.83 Bronchial Single 8 .50 1.07 .000 HS Asthma Married 18 .61 .92 Others 4 3.75 1.71 Total 30 1.00 1.51 Healthy Single 10 .0000 .0000 .040 Sig Married 17 .5882353 .79520 Others 3 1.0000 1.0000 Total 30 .43333 .727932 TOTAL COPD Single 7 9.14 10.57 .480 NS Married 21 17.71 8.41 Others 2 18.00 19.80 Total 30 12.23 9.50 Bronchial Single 8 2.75 3.92 .000 HS Asthma Married 18 3.72 3.58 Others 4 13.75 3.86 Total 30 4.80 5.07 Healthy Single 10 .60000 1.07496 .035 Sig Married 17 3.058823 2.967966 Others 3 4.3333 3.785938 Total 30 2.36667 2.82212 Table 3: Relation between Educational Status and psychopathology (CPRS score) Educational N Mean Std. P-value Status Deviation REPORTED COPD Higher 11 5.909090 7.09160 .056 NS Professional/ MA/Msc/BA/Bsc Intermediate/ 19 10.89474 6.32363 Higher School/Middle Pass/Primary School Total 30 9.06667 6.937819 Bronchial Higher 11 3.636363 3.93122 .857 NS Asthma Professional/ MA/Msc/BA/Bsc Intermediate/ 19 3.8947368 3.63462 Higher School/Middle Pass/Primary School Total 30 3.80000 3.680329 Healthy Higher 16 1.75000 2.113449 .509 NS Professional/ MA/Msc/BA/Bsc Intermediate/ 14 2.28714 2.267786 Higher School/Middle Pass/Primary School Total 30 2.000 2.165561 OBSERVED COPD Higher 11 2.272727 3.37908 .193 NS Professional/ MA/Msc/BA/Bsc Intermediate/ 19 3.684210 2.404916 Higher School/Middle Pass/Primary School Total 30 3.16667 2.82944 Bronchial Higher 11 1.09090 1.868397 .807 NS Asthma Professional/ MA/Msc/BA/Bsc Intermediate/ 19 .947368 1.311220 Higher School/Middle Pass/Primary School Total 30 1.0000 1.50859606 Healthy Higher 16 .3125000 .704154 .340 NS Professional/ MA/Msc/BA/Bsc Intermediate/ 14 .571428 .753928 Higher School/Middle Pass/Primary School Total 30 .43333 .727932 TOTAL COPD Higher 11 8.818182 10.42898 .075 NS Professional/ MA/Msc/BA/Bsc Intermediate/ 19 14.57895 8.30873 Higher School/Middle Pass/Primary School Total 30 12.23333 9.496581 Bronchial Higher 11 4.72727 5.71123 .954 NS Asthma Professional/ MA/Msc/BA/Bsc Intermediate/ 19 4.8421053 4.82197 Higher School/Middle Pass/Primary School Total 30 4.80000 5.06781 Healthy Higher 16 2.062500 2.71952 .537 NS Professional/ MA/Msc/BA/Bsc Intermediate/ 14 2.71428 2.99816 Higher School/Middle Pass/Primary School Total 30 2.3667 2.82212 Table 4: Relation between Occupation and Psychopathology (CPRS score) Occupation N Mean Std. P-value Deviation REPORTED COPD High 8 6.2500 7.5734498 .208 NS Professional/ Semi professional Clerical 9 8.000 7.106335 shop/Farm Owner/Skilled worker/Service Worker Semi-Skilled 13 11.5384 6.036215 Worker/ Unskilled Worker Total 30 9.06667 6.937819 Bronchial High 10 3.30000 4.110960 .188 NS Asthma Professional/ Semi professional Clerical 10 2.60000 2.98868 shop/Farm Owner/Skilled worker/ Service Worker Semi-Skilled 10 5.50000 3.56682 Worker/ Unskilled Worker Total 30 3.80000 3.6803298 Healthy High 11 1.909090 2.165850 .286 NS Professional/ Semi professional Clerical 8 1.25000 1.807721 shop/Farm Owner/ Skilled worker/Service Worker Semi-Skilled 11 2.72727 2.32769 Worker/ Unskilled Worker Total 30 2.0000 2.165561 OBSERVED COPD High 8 2.375000 3.5831990 4Q7 NS Professional/ Semi professional Clerical 9 2 8888 2.619372 shop/Farm Owner/ Skilled worker/Service Worker Semi-Skilled 13 3.8461538 2.511511 Worker/ Unskilled Worker Total 30 3.16667 2.829442 Bronchial High 10 .90000 1.85292 .412 NS Asthma Professional/ Semi professional Clerical 10 .60000 1.07496 shop/Farm Owner/Skilled worker/Service Worker Semi-Skilled 10 1.50000 1.509230 Worker/ Unskilled Worker Total 30 1.0000 1.508596 Healthy High 11 .363636 .809039 .497 NS Professional/ Semi professional Clerical 8 .25000 .4629100 shop/Farm Owner/Skilled worker/Service Worker Semi-Skilled 11 .636363 .80903983 Worker/ Unskilled Worker Total 30 .43333 .727932 TOTAL COPD High 8 8.62500 11.109037 .258 NS Professional/ Semi professional Clerical 9 10.8889 9.518986 shop/Farm Owner/Skilled worker/Service Worker Semi-Skilled 13 15.38462 8.047136 Worker/ Unskilled Worker Total 30 12.23333 9.49658 Bronchial High 10 4.20000 5.8840651 .226 NS Asthma Professional/ Semi professional Clerical 10 3.20000 3.88158 shop/Farm Owner/Skilled worker/Service Worker Semi-Skilled 10 7.0000 4.94413 Worker/ Unskilled Worker Total 30 4.80000 5.067815 Healthy High 11 2.272727 2.86673 .397 NS Professional/ Semi professional Clerical 8 1.375000 2.1998 shop/Farm Owner/Skilled worker/Service Worker Semi-Skilled 11 3.181818 3.15622 Worker/ Unskilled Worker Total 30 2.36667 2.82212 Table 5 Relation between substances used habits and psychopathology (CPRS score) Substance N Mean Std. P-value used habits Deviation REPORTED COPD Smoking 16 8.31250 6.42618 .794 NS Smoking & 9 10.3333 8.17006 Alcohol Nil 5 9.20000 7.39594 Total 30 9.06667 6.9378 Bronchial Smoking 10 2.50000 1.957891 .001 HS Asthma Smoking & 10 7.10000 3.634709 Alcohol Nil 10 1.80000 2.85968 Total 30 3.8000 3.680329 Healthy Smoking 4 2.75000 2.217355 .033 Sig Smoking & 5 4.0000 2.54930 Alcohol Nil 21 1.3809 1.802115 Total 30 2.0000 2.165561 OBSERVED COPD Smoking 16 3.312500 2.77413 .813 NS Smoking & 9 3.3333 3.53533 Alcohol Nil 5 2.4000 1.8165902 Total 30 3.6667 2.829442 Bronchial Smoking 10 .30000 0.6749 Asthma Smoking & 10 2.30000 1.7669 .001 HS Alcohol Nil 10 .10000 .96609 Total 30 1.0000 1.50859 Healthy Smoking 4 1.000 .81649 .015 Sig Smoking & 5 1.000 1.0000 Alcohol Nil 21 .19047 .51176 Total 30 .4333 .72793 TOTAL COPD Smoking 16 11.62500 9.0397 .872 NS Smoking & 9 13.6667 11.5717 Alcohol Nil 5 11.6000 8.67756 Total 30 12.2337 9.49658 Bronchial Smoking 10 2.80000 2.52982 .001 HS Asthma Smoking & 10 9.40000 5.2535 Alcohol Nil 10 2.20000 3.64539 Total 30 4.80000 5.06781 Healthy Smoking 4 3.750000 2.98607 .019 Sig Smoking & 5 5.0000 3.316624 Alcohol Nil 21 1.47619 2.24986 Total 30 2.36667 2.82212 Table 6: Relation between duration of illness and psychopathology (CPRS Score) Duration N Mean Std. P-value of illness Deviation REPORTED COPD 2 to 5 yrs 13 5.1538 5.6986 .008 HS 5- 10 yrs 8 9.87500 6.5995 More than 9 14.000 5.8949 10yrs Total 30 9.06667 6.9378 Bronchial 2 to 5 yrs 12 2.16667 3.21455 .006 HS Asthma 5- 10 yrs 10 3.10000 2.60128 More than 8 7.2500 3.64250 10yrs Total 30 3.8000 3.6803 OBSERVED COPD 2 to 5 yrs 13 1.5384 2.1838 .003 HS 5- 10 yrs 8 3.25000 2.31455 More than 9 5.444 2.65099 10yrs Total 30 31.16667 2.82944 2 to 5 yrs 12 .5000 1.0000 .017 Sig Bronchial 5- 10 yrs 10 .6000 1.074967 Asthma More than 8 2.250000 1.9820 10yrs Total 30 1.0000 1.50859 Total COPD 2 to 5 yrs 13 6.6923 7.50982 .004 HS 5- 10 yrs 8 13.1250 8.60958 More than 9 19.4444 8.263036 10yrs Total 30 12.3333 9.49658 Bronchial 2 to 5 yrs 12 2.6667 .28867 .006 HS Asthma 5- 10 yrs 10 3.70000 1.3333 More than 8 9.3375 0.99103 10yrs Total 30 4.8000 1.02833 Table 7: Comparison of Current Medications with Psychopathology (CPRS score) Current N Mean Std. P-value Medications Deviation REPORTED COPD Bronchodilators 8 13.000 3.3570 .005 HS Steroids, 22 22.000 11.1363 Bronchodilators and other medications Total 30 22.000 9.0666 Bronchial Bronchodilators 21 2.71428 2.9350 .011 Sig Asthma Steroids, 9 6.3333 4.1533 Bronchodilators and other medications Total 30 3.8000 3.6803 OBSERVED COPD Bronchodilators 8 1.37500 2.3260 .005 HS Steroids, 22 3.8181 2.7539 Bronchodilators and other medications Total 30 3.1667 2.8290 Bronchial Bronchodilators 21 .5714 1.0821 .011 Sig Asthma Steroids, 9 2.000 2.000 Bronchodilators and other medications Total 30 1.000 1.5085 TOTAL COPD Bronchodilators 8 4.7500 6.6922 .007 HS Steroids, 22 14.9545 8.9733 Bronchodilators and other medications Total 30 12.233 9.4965 Bronchial Bronchodilators 21 3.2857 3.8359 .010 Sig Asthma Steroids, 9 8.3333 6.0207 Bronchodilators and other medications Total 30 4.8000 5.0678 Table 8: Comparison of Staging of COPD or Spirometry with Psychopathology (CPRS Score) Staging N Mean Std. P-value Deviation REPORTED COPD Stage I 15 5.333 5.459 .004 HS Stage II 10 11.500 6.1508 Stage III and IV 5 15.400 6.5038 Total 30 8.0667 6.9378 OBSERVED COPD Stage I 15 1.600 2.0632 .006 HS Stage II 10 4.7000 2.8303 Stage III and IV 5 4.8000 2.5884 Total 30 3.1667 2.8294 TOTAL COPD Stage I 15 6.9333 7.1859 .003 HS Stage II 10 16.2000 8.7279 Stage III and IV 5 20.2000 8.8147 Total 30 12.2333 9.4965
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|Title Annotation:||ORIGINAL ARTICLE|
|Author:||Sarawag, Mayank; Saharan, Sameer; Bhaskar, Manju; Singh, Rajinderpal; Yadav, Kuldeep Singh|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Date:||Nov 10, 2014|
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