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Relationship between psychopathology & socio-demographic and clinical variables in COPD and bronchial asthma: a comparative study.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) has been defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), an international collaborative effort to improve awareness, diagnosis, and treatment of COPD, as a disease state characterized by airflow limitation that is not fully reversible. GOLD estimates suggest that COPD will rise from the sixth to the third most common cause of death worldwide by 2020. In India, COPD is the second most common lung disorder after pulmonary tuberculosis. (1)

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.

INCLUSION CRITERIA:

* Patients with clinical diagnosis of COPD according to GOLD's criteria. (1)

* Age group between 18 and 50 years

EXCLUSION CRITERIA:

* 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)

RESULTS:
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)

DOI: 10.14260/jemds/2014/3792

REFERENCES:

(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 [1], Sameer Saharan [2], Manju Bhaskar [3], Rajinderpal Singh [4], Kuldeep Singh Yadav [5]

AUTHORS:

[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: manjubhaskar123@gmail.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
Words:5191
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