TY - JOUR
T1 - Prevalence and correlates of suicide ideation in patients with COPD
T2 - A mixed methods study
AU - Fleehart, Sara
AU - Fan, Vincent S.
AU - Nguyen, Huong Q.
AU - Lee, Jungeun
AU - Kohen, Ruth
AU - Herting, Jerald R.
AU - Matute-Bello, Gustavo
AU - Adams, Sandra G.
AU - Pagalilauan, Genevieve
AU - Borson, Soo
N1 - Publisher Copyright:
© 2014 Fleehart et al.
PY - 2014/12/4
Y1 - 2014/12/4
N2 - Purpose: The purpose of this study was to examine the prevalence and correlates of suicidal ideation (SI) in patients with stable moderate to very severe chronic obstructive pulmonary disease (COPD). Patients and methods: We conducted an exploratory mixed methods analysis of data from participants in a longitudinal observational study of depression in COPD. We measured depression with the Patient Health Questionnaire-9 (PHQ-9), which includes an item on SI. We compared participants with and without SI in relation to sociodemographics, symptoms, anxiety, and healthcare resource use with independent t-tests and chi-square tests. Content analysis was performed on qualitative data gathered during a structured SI safety assessment. Results: Of 202 participants, 121 (60%) had depressive symptoms (PHQ $6); 51 (25%) had a PHQ-9 s10, indicating a high likelihood of current major depression; and 22 (11%) reported SI. Compared to the 99 depressed participants without SI, those with SI were more likely to be female (59% vs 27%, P=0.004); had worse dyspnea (P=0.009), depression (P,0.001), and anxiety (P=0.003); and were also more likely to have received treatment for depression and/or anxiety (82% vs 40%, P,0.001) and more hospitalizations for COPD exacerbations (P=0.03) but had similar levels of airflow obstruction and functioning than participants without SI. Themes from the qualitative analysis among those with SI included current or prior adverse life situations, untreated or partially treated complex depression, loss of a key relationship, experience of illness and disability, and poor communication with providers. Conclusion: Our findings suggest that current SI is common in COPD, may occur disproportionately in women, can persist despite mental health treatment, and has complex relationships with both health and life events. Adequate management of SI in COPD may therefore require tailored, comprehensive treatment approaches that integrate medical and mental health objectives.
AB - Purpose: The purpose of this study was to examine the prevalence and correlates of suicidal ideation (SI) in patients with stable moderate to very severe chronic obstructive pulmonary disease (COPD). Patients and methods: We conducted an exploratory mixed methods analysis of data from participants in a longitudinal observational study of depression in COPD. We measured depression with the Patient Health Questionnaire-9 (PHQ-9), which includes an item on SI. We compared participants with and without SI in relation to sociodemographics, symptoms, anxiety, and healthcare resource use with independent t-tests and chi-square tests. Content analysis was performed on qualitative data gathered during a structured SI safety assessment. Results: Of 202 participants, 121 (60%) had depressive symptoms (PHQ $6); 51 (25%) had a PHQ-9 s10, indicating a high likelihood of current major depression; and 22 (11%) reported SI. Compared to the 99 depressed participants without SI, those with SI were more likely to be female (59% vs 27%, P=0.004); had worse dyspnea (P=0.009), depression (P,0.001), and anxiety (P=0.003); and were also more likely to have received treatment for depression and/or anxiety (82% vs 40%, P,0.001) and more hospitalizations for COPD exacerbations (P=0.03) but had similar levels of airflow obstruction and functioning than participants without SI. Themes from the qualitative analysis among those with SI included current or prior adverse life situations, untreated or partially treated complex depression, loss of a key relationship, experience of illness and disability, and poor communication with providers. Conclusion: Our findings suggest that current SI is common in COPD, may occur disproportionately in women, can persist despite mental health treatment, and has complex relationships with both health and life events. Adequate management of SI in COPD may therefore require tailored, comprehensive treatment approaches that integrate medical and mental health objectives.
KW - Chronic obstructive
KW - Depression
KW - PHQ-9
KW - Pulmonary disease
KW - Qualitative
KW - Suicide
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U2 - 10.2147/COPD.S65507
DO - 10.2147/COPD.S65507
M3 - Article
C2 - 25587219
AN - SCOPUS:84937568249
SN - 1176-9106
VL - 9
SP - 1321
EP - 1329
JO - International Journal of COPD
JF - International Journal of COPD
ER -