In COPD, Patient Temperament Influences Anxiety & Depression Risk

Photo Credit: iStock.com/Mohammed Haneefa Nizamudeen

Temperamental traits like briskness and emotional reactivity were associated with the risk for depression and anxiety in patients with COPD and/or asthma.

Patient temperament influenced the risk for depression and anxiety in a cohort of adults with COPD and/or asthma, prompting researchers to encourage clinicians to screen for temperament traits during telemedicine appointments. The findings were published in the Journal of Clinical Medicine.

Chronic respiratory conditions like COPD and asthma are associated with increased rates of anxiety and depression, but these comorbidities often go undetected, according to Paula Zdanowicz, MD, and colleagues.

“With properly implemented treatment, even incurable diseases, such as asthma and COPD, can be controlled to the extent that their negative impact on the patient’s quality of life is minimized,” the researchers said. “Proper adherence to treatment relies, however, on patients’ mental condition. It requires the patient to be ready, willing, and able to follow the therapeutic instructions.”

Therefore, the study authors investigated mental health risks through the lens of the regulatory theory of temperament, which describes the following traits:

• Briskness: an individual’s tendency to favor a quick reaction, maintaining a high tempo of activities and ease in shifting reactions in response to dynamically changing environmental factors.
• Perseverance: recurrence and persistence of actions, marked by a stubborn tendency to continue and/or repeat behavior even after cessation of the stimuli that evoked the behavior in the first place.
• Sensory sensitivity: the ability to react to all manners of sensory stimuli; high sensitivity allows an individual to respond to even the slightest stimulus.
• Endurance: personal endurance against distractions and fatigue, ie, the ability to maintain adequate reactions in situations demanding long-lasting and high-stimulative activity.
• Emotional reactivity: a combination of emotional sensitivity and emotional endurance; a tendency to react to emotion-generating stimuli.
• Activity: a tendency to partake in highly stimulative behaviors or seek external stimulation through one’s own behavior.

Self-Assessments Offer Insight

The study enrolled 210 patients from a university hospital and pulmonology clinics in Poland. To ensure the data reflected only those who developed depression or anxiety secondary to their pulmonary disease, patients were excluded if they had a prior history of mental health disorders.

The patients completed three assessments: the Formal Behavioral Characteristics—Temperament Questionnaire, the Beck Depression Inventory, and the State-Trait Anxiety Inventory Self-Assessment Questionnaire.

Temperament Traits Linked to Mental Health

Per the findings, two temperament traits significantly predict depression and anxiety. Patients with more intense briskness had a lower likelihood of developing mental health disorders, while those with greater emotional reactivity had a higher risk.

“We have found no statistically significant correlations between any of the remaining four temperament traits and depression or anxiety,” the researchers said. “We have shown that high briskness and low emotional reactivity constitute protective factors in the context of secondary depression and anxiety. An analytic and adaptable temperament is a key to withstanding hardships without suffering overwhelming emotional burdens in the form of stress and depression.”

Based on their findings, the study authors recommended that clinicians screen for temperament traits during patient visits and refer patients to psychological specialists as needed. Temperament screening represents a low-cost assessment that can be conducted via telemedicine and help reduce stigma, enhance accessibility, and bridge the gap between psychiatric and pulmonary support.

“Upon recognizing these two factors in a patient, the attending physician should strongly consider facilitation of a consult with a mental health specialist to better prepare the patient for the challenges of living with a chronic disease and managing expectations,” the researchers said. “Screening patients based on their temperamental traits can be helpful in differential diagnosis since symptoms presented in asthma, COPD, anxiety, and depression are often overlapping, and this symptom-independent diagnostic tool will prove helpful in differentiating the source of the problem.”

The most commonly used tools for evaluating temperament are the temperament and character inventory, the regulative theory of temperament, and the Memphis, Pisa, Paris, and San Diego questionnaire.