A Cross-Sectional Study of the Psychological Needs of Adults Living with Cystic Fibrosis

<div><p>Background</p><p>Depression and anxiety are prevalent in people with cystic fibrosis (CF), yet psychological services are rarely accessible in CF clinics. This cross-sectional single center study reports on a psychological needs assessment of people with CF.</p><p>Methods</p><p>We asked adults attending a CF clinic, without integrated psychological services, to complete a psychological needs assessment survey that included items on: a) past access to psychological services (via a CF referral service), b) concerns relevant to discuss with a psychologist, and c) their likelihood of accessing psychological services if available at the CF clinic, and standardized measures of depression (CES-D) and anxiety (GAD-7).</p><p>Results</p><p>We enrolled 49 participants and 45 (91.8%) completed the survey. Forty percent reported elevated symptoms of depression and 13% had elevated anxiety. A majority of individuals (72.2% and 83.3%, respectively) indicated they would be likely to use psychological services, if available at the clinic. Concerns considered most relevant to discuss with a psychologist were: 1) worries (51.1%), 2) mood (44.4%), 3) life stress (46.6%), 4) adjustment to CF (42.2%), 5) life transitions (42.2%) and 6) quality of life (42.2%).</p><p>Conclusions</p><p>This study highlights the rationale for screening adults with CF for depression and anxiety, and to facilitate provision of psychological services and preventative mental health interventions as an integral component of multi-disciplinary CF care.</p></div

Past access to psychological services as part of CF care and likelihood of accessing psychological services if made available.

<p><i>Note</i>: n = 45 participants completed the CES-D and n = 44 completed the GAD7).</p><p>*P-values displayed are unadjusted. None of the adjusted (Holm’s) p-values were significant.</p><p>In bold: p-values for which effect sizes (Phi coefficient) were moderate (≥ 0.30).</p><p>^† Responses to this item were collapsed into two groups (‘Never or Rarely’ and ‘Occasionally or Often’) given the distribution of the data.</p><p>^β Responses to this item were collapsed into two groups (‘Likely’/ ‘Unlikely’) given the distribution of the data. Data was missing for one participant on this item.</p><p>Past access to psychological services as part of CF care and likelihood of accessing psychological services if made available.</p

Characteristics of study participants (n = 45)^*.

<p>*Unless indicated otherwise</p><p>Characteristics of study participants (n = 45)^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0127944#t001fn001" target="_blank">*</a>}.</p

Logistic regression analysis of cohort without self-reported diagnosis of ever-asthma, COPD/Chronic bronchitis/Emphysema (n = 3378) showing risk [adjusted Odds ratio & 95% confidence intervals] of Symptoms with increasing post-bronchodilator change in forced vital capacity as % Pre-bronchodilator value (%ΔFVCi).

*<p>Variables for the first Quintile were used as the reference;</p><p>#Slope for trend was statistically different from the horizontal. Odds ratios and 95% CI adjusted for age, BMI, gender, usage of respiratory drugs (any medication for breathing including nasal decongestant), ever-smoking, site, and proportion of Caucasian.</p

Determinants of bronchodilator responsiveness in forced expiratory volume in one second as % pre-bronchodilator value [%ΔFEV1i] –results from univariate and multivariate analyses of the whole cohort.

*<p>Standard estimates allow comparison between variables with different units. It is the expected change in bronchodilator response per 1 SD increase in the variable. After multivariate correction for confounding variables the ‘most powerful’ effect on BDRFEV1 is doctor diagnosis of current-asthma, followed by age, ever-smoking, use of respiratory drugs (any medication for breathing including nasal decongestant), and gender.These values are adjusted for all corivariates including site and for the proportion of Caucasian population in each site.</p

Population demographics and risk factors of individual sites and for whole cohort.

§<p>Doctor Diagnosis of AO = presence of self reported prior diagnosis of either ever-asthma, or asthmatic bronchitis, or allergic bronchitis, or COPD, or emphysema, or chronic bronchitis. Data for Age, BMI, Packyears, and Spirometry results are expressed in mean(SD); All others are expressed as % of group(SE) and are weighted to the local population. BMI = Body-mass index;</p>†<p>% predicted values = maximum values/predicted values(NHANES)*100;</p>*<p>One-Way ANOVA, alpha = 0.05;</p>#<p>Chi-Square Test.</p>&<p>post bronchodilator responses: % change in FEV1 or FVC after bronchodilator relative to pre-bronchodilator value.</p

Logistic regression analysis of cohort without self-reported diagnosis of ever-asthma, COPD/Chronic bronchitis/Emphysema (n = 3508) showing risk [adjusted Odds ratio & 95% confidence intervals] of Symptoms with increasing post-bronchodilator change in forced expiratory volume in 1 sec % pre-bronchodilator value (%ΔFEV1i).

*<p>Variables for the first Quintile were used as the reference;</p><p>#Slope for trend was statistically different from the horizontal. Odds ratios and 95% CI adjusted for age, BMI, gender, usage of respiratory drugs (any medication for breathing including nasal decongestant), ever-smoking, site, and porpotion of Caucasian.</p

Additional file 5: Figure S2. of Serum IgG subclass levels and risk of exacerbations and hospitalizations in patients with COPD

Comparison of IgG subclass levels according to hospitalization status in MACRO – First cohort (left panel) and STATCOPE – Replication cohort (right panel) cohorts. Error bars represent 95% confidence interval. (DOCX 243 kb

Additional file 6: Table S4. of Serum IgG subclass levels and risk of exacerbations and hospitalizations in patients with COPD

Interactions between IgG subclass levels and inhaled steroid use at enrollment and use of systemic steroids in previous 12 months for both outcomes of interest (time to first exacerbation and time to first hospitalization). (DOCX 15 kb

Additional file 3: Table S3. of Serum IgG subclass levels and risk of exacerbations and hospitalizations in patients with COPD

Median and interquartile range related to each IgG subclass according to the presence or absence of corresponding IgG subclass deficiency in the merged dataset (MACRO and STATCOPE cohorts combined). (DOCX 15 kb