Psychiatric–Medical ComorbidityFamily factors are associated with psychological distress and smoking status in chronic obstructive pulmonary disease☆
Introduction
Approximately 85% of all cases of chronic obstructive pulmonary disease (COPD) are attributable to smoking. Smoking cessation is the most important behavioral intervention to alleviate symptoms and delay progression of COPD [1], [2]. Research is needed to understand modifiable social and psychological factors that influence smoking behavior among individuals with COPD. With a better understanding of these factors, there is a greater opportunity to develop comprehensive smoking cessation interventions to assist this population.
Social support is important for successful smoking cessation. In the Lung Health Study, support for quitting smoking predicted initial quitting and relapse rate within 24 months [3]. Support from family members may be particularly important. Prospective research indicates that partner support predicts success in quit attempts [4], [5]. In addition, negative behaviors of spouses (such as commenting that smoking is a dirty habit) predict relapse among individuals who are trying to quit smoking [6]. The association between family relationship quality and smoking behavior among individuals with COPD has not been studied, nor have potential mechanisms through which family relationships affect smoking behavior.
The influence of family relationships on smoking behavior may be mediated through psychological distress. Longitudinal research indicates that family relationships influence the onset [7] and course [8], [9], [10] of depression and anxiety. In turn, prospective studies indicate that symptoms of depression and anxiety predict the initiation and maintenance of smoking behavior [11], [12]. Depression also reduces smoking cessation rates and increases the risk of relapse among individuals who are trying to quit smoking [13], [14]. Psychological distress is especially important in COPD because there is a high prevalence of depression and anxiety among individuals with COPD [15], [16].
Although the independent influences of family relationships and psychological distress on smoking behavior have been established, no research to date has investigated the joint influence of both of these factors on smoking behavior. Such research is particularly important for individuals with COPD, as smoking behavior affects symptoms and progression of COPD. The aim of this study was to test the following hypotheses: (1) unsupportive family relationships are associated with psychological distress; (2) psychological distress is associated with smoking status and (3) unsupportive family relationships are indirectly associated with smoking status via psychological distress.
Section snippets
Sample and procedures
Participants were studied under a protocol approved by the Institutional Review Board at National Jewish Health and the Colorado Multiple Institutional Review Board. This protocol was judged to be exempt by both review boards because the protocol solely involved the use of survey procedures which cannot be linked to subjects. Anonymous, cross-sectional data were collected from individuals with physician-diagnosed COPD by mailing questionnaires to people who had been assessed or treated for COPD
Preliminary analyses
Table 1 presents demographic characteristics of the sample. Participants from the two hospitals differed with regard to age, race/ethnicity, relationship status, education, and income. Table 2 presents health and disease characteristics of the sample. Of note, 90% of participants from the tertiary-care hospital had quit smoking, while only 52% of participants from the university-affiliated hospital had quit smoking. Among current smokers, participants from the university-affiliated hospital
Discussion
This study extends the research on social and psychological factors that influence smoking behavior by considering a model of the joint influence of family relationships and psychological distress on smoking status of individuals with COPD. Results support the premise that unsupportive family relationships lead to psychological distress, which in turn affects smoking status. Since the data in the present study were cross-sectional, the direction of causality cannot be inferred solely from these
Acknowledgments
We thank Richard Albert, MD; Thomas MacKenzie, MD, MSPH; Holly Batal, MD, MBA; Rebecca Hanratty, MD; and Jeanne Rozwadowski, MD; for their help recruiting participants for this study.
References (33)
Treatment of stable chronic obstructive pulmonary disease
Lancet
(2004)- et al.
Long-term associations of helpful and harmful spousal behaviors with smoking cessation
Addict Behav
(1996) - et al.
Marital relationship and the treatment of panic disorder with agoraphobia: a critical review
Clin Psychol Rev
(2003) - et al.
Surprisingly high prevalence of anxiety and depression in chronic breathing disorders
Chest
(2005) - et al.
Chronic obstructive pulmonary disease, anxiety, and depression: state of the science
Heart Lung
(2009) - et al.
Anxiety and depression are related to the outcome of emergency treatment in patients with obstructive pulmonary disease
Chest
(2002) - et al.
Non-pharmacological treatment for chronic obstructive pulmonary disease
Med Sci Monit
(2003) - et al.
Predictors of initial smoking cessation and relapse through the first 2 years of the Lung Health Study
J Consult Clin Psychol
(1995) - et al.
An investigation of self-efficacy, partner support and daily stresses as predictors of relapse to smoking in self-quitters
Addiction
(1995) - et al.
Family-focused smoking cessation:enhanced efficacy by the addition of partner support and group therapy
Subst Abus
(2004)
Marital dissatisfaction and incidence of major depressive episode in a community sample
J Abnorm Psychol
Expressed emotion and psychiatric relapse: a meta-analysis
Arch Gen Psychiatry
Predictors of relapse in unipolar depressives: expressed emotion, marital distress, and perceived criticism
J Abnorm Psychol
Depression, anxiety, and smoking initiation: a prospective study over 3 years
Am J Public Health
Major depression and stages of smoking. A longitudinal investigation
Arch Gen Psychiatry
Depression and the dynamics of smoking. A national perspective
JAMA
Cited by (0)
- ☆
Funding/Support: This project was supported by funding from the National Institutes of Health [grants F32 HL083687, K23 HL091049], a Postdoctoral Research Fellowship Grant from the Alpha-1 Foundation, and the Flight Attendant Medical Research Institute.