The prevalence of PTSD and changes in PTSD symptoms following pulmonary rehabilitation

TitleThe prevalence of PTSD and changes in PTSD symptoms following pulmonary rehabilitation
Publication TypeJournal Article
Year of Publication2009
AuthorsJones, RMC, Harding, S, Chung, M, Campbell, J
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Volume29
Issue1
Start Page49 - 56
Abstract

PURPOSE: Posttraumatic stress disorder (PTSD) is a common serious condition, which, although treatable, is often undetected. We investigated the prevalence of PTSD in patients with chronic obstructive pulmonary disease (COPD) referred to pulmonary rehabilitation and the impact of rehabilitation on PTSD symptoms. METHODS: Patients with COPD attending pulmonary rehabilitation programs in South West England completed cross-sectional and longitudinal surveys. Outcome measures included the Posttraumatic Diagnostic Scale, Impact of Events scale, Incremental Shuttle Walking Test, Medical Outcomes Short Form 12, Hospital Anxiety and Depression scale (HADS), and Chronic Respiratory Questionnaire. Questionnaires were completed at face-to-face interviews with participants 1 week before commencing pulmonary rehabilitation and at the end of the program. RESULTS: Patients (N = 100), mean age 68 years, 65% men, served as subjects. Seventy-four participants reported traumatic experiences (37 related to lung disease) and 70 completed the pulmonary rehabilitation program. Eight of 100 participants met diagnostic criteria for PTSD. Participants with PTSD reported worse health status than those without PTSD. After pulmonary rehabilitation, exercise capacity and quality of life scores improved significantly, but PTSD symptom severity did not change. CONCLUSIONS: PTSD was present in 8% of COPD patients referred for pulmonary rehabilitation. After rehabilitation, participants with PTSD improved more in respect to anxiety and disease-specific health status than those without PTSD. PTSD symptoms did not improve following rehabilitation, despite its positive effects on HADS scores, exercise, and health status in this cohort.

Practical Implications

PTSD has a significant negative impact on the quality of life of patients with COPD.
Pulmonary rehabilitation in the form studied does not affect symptoms of PTSD.
Pulmonary rehabilitation significantly improves the quality of life and physical exercise ability of people suffering from COPD.
 

Lay Summary

Posttraumatic stress disorder (PTSD) is a common condition, which although treatable is often undetected. Sufferers of PTSD experience hyper arousal (when someone is easily startled and feels tense or “on edge” constantly), avoidance (when someone with actively avoids people or situations so they aren’t put in stress and potentially reminded of their traumatic experience), and reexperiencing of the event triggered by reminders of a traumatic experience. Chronic obstructive pulmonary disease (COPD) is common, worsens over time and causes loss of strength and energy. It causes various problems such as cough and shortness of breath as well as potential disability such as  reduced physical activity. People with COPD frequently become socially isolated because they are physically limited so believe they cannot under take much social interactions. Some sufferers of COPD may be blamed for their own disease because they smoked. This study investigates the prevalence of PTSD in patients having chronic obstructive pulmonary rehabilitation and the impact of rehabilitation on PTSD symptoms
Breathlessness is frequently associated with anxiety, panic fear disorder, and depression. If people with COPD develop PTSD triggered by COPD symptoms, hyper arousal has the potential to aggravate breathlessness. In some people with COPD, a vicious circle can develop in which breathlessness can cause high levels of anxiety and panic, which in turn increase breathlessness.
Pulmonary rehabilitation is a broad program which helps to improve the quality of life of people who have breathing problems.  Patients with COPD attending pulmonary rehabilitation programs completed several surveys about if they had PTSD and how severe their COPD was. Questionnaires were completed at face to face interviews with participants one week before starting rehabilitation and at the end of the program.
PTSD was present in 8% of the COPD patients having pulmonary rehabilitation; the participants with PTSD reported worse health status than those without PTSD. After pulmonary rehabilitation, exercise capacity and quality of life scores improved significantly, but PTSD symptom severity did not change. Finally, PTSD symptoms did not improve following pulmonary rehabilitation although the rehabilitation did positively affect the COPD symptoms.

KeywordsPTSD
URLhttps://www.ncbi.nlm.nih.gov/pubmed/19158588
DOI10.1097/HCR.0b013e318192787e