Breathing New Life: Investigating ways to improve the mental health of people living with chronic obstructive pulmonary disease in Western Australia

Anxiety and depression are common comorbidities in people with chronic obstructive pulmonary disease (COPD), contributing to greater morbidity and mortality in an already vulnerable population. Despite the prevalence, few recommendations exist in global management guidelines for the detection and treatment of these comorbidities, reflecting the limited literature available on effective strategies for dealing with mental health issues in COPD populations. There is promising evidence that cognitive behavioural therapy (CBT) improves mental health outcomes in people with COPD. However, investigational studies have commonly reported participants’ lack of transport, lack of time and illness as barriers to recruitment and successful completion. This thesis was undertaken in response to a need identified in the literature for an alternative modality of CBT delivery for people with COPD suffering from psychological symptomatology. Thus, a novel home-based self-management CBT learning resource in a DVD format was developed with an accompanying manual. To investigate the primary aim of this thesis, a randomised controlled trial called the ‘Breathing New Life’ study was conducted to determine the efficacy of CBT to treat anxiety and depression in people living with COPD via two formats: group therapy with a reduced number of sessions or this novel home-based self-management DVD resource, compared to usual care. The secondary aim was to investigate the efficacy of these interventions on improvement in health-related quality of life (HRQoL). This thesis is presented as a series of papers (i.e. PhD with publication) from data collected from the Breathing New Life study (ACTRN12616001039471). Study One investigates the risk factors associated with concomitant anxiety and depression and found younger age and having no previous psychological medical history were risk factors for psychological symptomatology compared to those without psychological symptomatology. Study Two investigates the most suitable screening tool for detecting clinically significant anxiety and depression in COPD populations and found simple modifications to the commonly used Hospital Anxiety and Depression Scale (HADS) improved optimal sensitivity and specificity, whilst the Beck Inventories had acceptable sensitivity and specificity without any modifications. Study Three reports the results from the randomised controlled trial investigating the efficacy of CBT delivered in the two different formats. No significant differences over time between those receiving CBT and usual care for anxiety, depression or HRQoL were found in this COPD cohort. However, opinions of benefit expressed in Study Four—a qualitative investigation into the facilitators and barriers COPD participants face when enrolling and completing CBT—provide support that this population find CBT useful, despite being unable to detect any measureable difference. Globally, this thesis adds new knowledge to the body of literature supporting the importance of early screening and treatment for psychological symptomology in people living with COPD. Despite the inability of CBT to improve anxiety and depression, findings from this thesis have important implications towards industry discussion surrounding routine screening for concomitant anxiety and depression, the continued use of the HADS and Beck Inventories as appropriate screening tools in COPD populations and how best to engage and retain COPD participants in CBT