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Влияние психологического дистресса на эффективность санаторной реабилитации больных с хроническими заболеваниями легких
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Аннотация
Целью исследования явилось изучение влияния выраженности психологического дистресса на эффективность санаторного этапа реабилитации больных с хроническими заболеваниями легких. В исследование были включены 117 больных с хронической патологией легких (105 мужчин и 12 женщин), средний возраст – 59,6±0,9 года. Всем пациентам проводили спирометрию, тест 6-минутной ходьбы (ТШХ), психологическое тестирование (опросники DS-14, самочувствия, активности и настроения – САН, шкала депрессии, Спилбергера–Ханина). Больные прошли курс санаторной пульмональной реабилитации. Согласно опроснику DS-14 выделены группы пациентов с типом личности Д (n=39) и не-Д (n=78). В этих группах сопоставлены результаты ТШХ и опросника САН после лечения. Пациенты с типом личности Д не отличались от больных с типом не-Д по тяжести патологии легких, наличию сопутствующих заболеваний, дистанции ТШХ. При типе Д был выше, чем при типе не-Д, уровень депрессии (р=0,00004), личностной (р=0,01) и ситуационной тревожности (р=0,02). После курса реабилитации при типе Д отмечено существенное улучшение психологического статуса по шкалам опросника САН (на 14,9–18,6%) по сравнению с типом не-Д (на 3,9–5,6%). С приростом толерантности к нагрузке коррелировали показатели функции внешнего дыхания, уровень депрессии и наличие типа личности Д. Улучшение психологического состояния по подшкалам опросника САН зависело от исходного уровня депрессии, тревожности и наличия типа личности Д.
Таким образом, у больных с хроническими заболеваниями легких наличие типа личности Д не зависит от тяжести нарушений функции внешнего дыхания, связано с более высоким уровнем тревожности и депрессии и более низкой самооценкой психологического состояния. Отмеченная связь между наличием типа личности Д и результатами санаторной реабилитации делает целесообразной его оценку в клинической практике для повышения эффективности реабилитационных программ.
Ключевые слова: тип личности Д, эффективность пульмональной реабилитации.
Таким образом, у больных с хроническими заболеваниями легких наличие типа личности Д не зависит от тяжести нарушений функции внешнего дыхания, связано с более высоким уровнем тревожности и депрессии и более низкой самооценкой психологического состояния. Отмеченная связь между наличием типа личности Д и результатами санаторной реабилитации делает целесообразной его оценку в клинической практике для повышения эффективности реабилитационных программ.
Ключевые слова: тип личности Д, эффективность пульмональной реабилитации.
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The investigation was undertaken to study the impact of the magnitude of psychological distress on the efficiency of sanatorium rehabilitation in 117 patients (105 men and 12 women; mean age 59,6±0,9 years) with chronic lung diseases. All the patients underwent spirometry, 6-minute walk test (6’WT), psychological testing (DS14 and heath, activity, mood (HAM) questionnaires, depression inventory, and Spilberger-Khanin scale) and received a course of sanatorium pulmonary rehabilitation. Groups of Type D (n=39) and non-Type D (n=78) patients were identified according to the DS14 questionnaire. The results of 6’WT and HAM questionnaire were compared in these groups after treatment. The Type D patients did not differ from non-Type D patients in lung disease severity, comorbidity, and 6’WT distance. The Type D patients had higher levels of depression (р=0,00004) and personality (р=0,01) and situational (р=0,02) anxiety. After the course of rehabilitation, the Type D patients showed a substantial psychological improvement according the HAM questionnaire (by 14,9–18,6%) compared to the non-Type D patients (by 3,9–5,6%). The parameters of external respiratory function, the level of depression, and Type D personality were correlated with an increase in exercise tolerance. Psychological improvement according to HAM subscales depended on the baseline level of depression, anxiety, and Type D personality. Thus, Type D personality in patients with chronic lung diseases does not depend on the severity of external respiratory dysfunction and is related to the higher level of anxiety and depression and a lower psychological self-evaluation. The mentioned relationship between Type D personality and sanatorium rehabilitation results makes its assessment expedient in clinical practice to enhance the effectiveness of rehabilitation programs.
Key words: Type D personality, effectiveness of pulmonary rehabilitation.
Полный текст
Список литературы
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30. Barone S, Bacon SL, Campbell TS et al. The association between anxiety sensitivity and atopy in adult asthmatics. J Behav Med 2008; 31 (4): 331–9.
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32. Pedersen SS, Herrmann-Lingen C, de Jonge P, Scherer M. Type D personality is a predictor of poor emotional quality of life in primary care heart failure patients independent of depressive symptoms and New York Heart Association functional class. J Behav Med 2010; 33 (1): 72–80.
33. Mols F, Denollet J. Type D personality among noncardiovascular patient populations: a systematic review. Gen Hosp Psychiatry 2010; 32 (1): 66–72.
34. Sogaro E, Schinina F, Burgisser C et al. Type D personality impairs quality of life, coping and short-term psychological outcome in patients attending an outpatient intensive program of cardiac rehabilitation. Monaldi Arch Chest Dis 2010; 74 (4): 181–91.
35. Fuchs AR, Meneghelo RS, Stefanini E et al. Exercise may cause myocardial ischemia at the anaerobic threshold in cardiac rehabilitation programs. Braz J Med Biol Res 2009; 42 (3): 272–8.
36. Enfield K, Gammon S, Floyd J et al. Six-minute walk distance in patients with severe end-stage COPD: association with survival after inpatient pulmonary rehabilitation. J Cardiopulm Rehabil Prev 2010; 30 (3): 195–202.
37. Parissis JT, Nikolaou M, Farmakis D et al. Self-assessment of health status is associated with inflammatory activation and predicts long-term outcomes in chronic heart failure. Eur J Heart Fail 2009; 11 (2): 163–9.
2. Wakabayashi K, Gonzalez MA, Delhaye C et al. Impact of chronic obstructive pulmonary disease on acute-phase outcome of myocardial infarction. Am J Cardiol 2010; 106 (3): 305–9.
3. Leavitt BJ, Ross CS, Spence B et al. Northern New England Cardiovascular Disease Study Group. Long-term survival of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass surgery. Circulation 2006; 114 (Suppl. 1): I430–4.
4. Mascarenhas J, Azevedo A, Bettencourt P. Coexisting chronic obstructive pulmonary disease and heart failure: implications for treatment, course and mortality. Curr Opin Pulm Med 2010; 16 (2): 106–11.
5. Schneider C, Bothner U, Jick SS, Meier CR. Chronic obstructive pulmonary disease and the risk of cardiovascular diseases. Eur J Epidemiol 2010; 25 (4): 253–60.
6. Finkelstein J, Cha E, Scharf SM. Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity. Int J Chron Obstruct Pulmon Dis 2009; 4: 337–49.
7. Сумин А.Н., Береснева В.Л., Енина Т.Н. и др. Факторы, влияющие на эффективность физической реабилитации у больных, перенесших инфаркт миокарда. Клин. медицина. 2007; 85 (5): 24–9.
8. Khawaja IS, Westermeyer JJ, Gajwani P, Feinstein RE. Depression and coronary artery disease: the association, mechanisms, and therapeutic implications. Psychiatry (Edgmont) 2009; 6 (1): 38–51.
9. Jennings JH, Digiovine B, Obeid D, Frank C. The association between depressive symptoms and acute exacerbations of COPD. Lung 2009; 187 (2): 128–35.
10. De Voogd JN, Wempe JB, Koëter GH et al. Depressive symptoms as predictors of mortality in patients with COPD. Chest 2009; 135 (3): 619–25.
11. Denollet J. DS14: standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosom Med 2005; 67: 89–97.
12. Сумин А.Н. Поведенческий тип личности Д («дистрессорный») при сердечно-сосудистых заболеваниях. Кардиология. 2010; 10: 66–73.
13. Медведев В.Э. Личность пациента как фактор заболеваемости ишемической болезни сердца. Кардиология и сердечно-сосудистая хирургия. 2010; 5: 18–23.
14. Denollet J, Schiffer AA, Spek V. A general propensity to psychological distress affects cardiovascular outcomes: evidence from research on the type D (distressed) personality profile. Circ Cardiovasc Qual Outcomes 2010; 3 (5): 546–57.
15. Pelle AJ, Erdman RA, van Domburg RT et al. Type D patients report poorer health status prior to and after cardiac rehabilitation compared to non-type D patients. Ann Behav Med 2008; 36 (2): 167–75.
16. McCathie HC, Spence SH, Tate RL. Adjustment to chronic obstructive pulmonary disease: the importance of psychological factors. Eur Respir J 2002; 19 (1): 47–53.
17. Kaplan RM, Ries AL, Reilly J. Measurement of Health-Related Quality of Life in the National Emphysema Treatment Trial. CHEST 2004; 126: 781–9.
18. Чучалин А.Г., Белевский А.С., Овчаренко С.И. Качество жизни пациентов с хронической обструктивной болезнью легких: можем ли мы ожидать большего? (Результаты национального исследования ИКАР–ХОБЛ). Пульмонология. 2006; 5: 19–24.
19. Giardino ND, Curtis JL, Andrei AC et al. NETT Research Group. Anxiety is associated with diminished exercise performance and quality of life in severe emphysema: a cross-sectional study. Respir Res 2010; 11: 29.
20. Ng TP, Niti M, Tan WC et al. Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Arch Intern Med 2007; 167 (1): 60–7.
21. Omachi TA, Katz PP, Yelin EH et al. Depression and health-related quality of life in chronic obstructive pulmonary disease. Am J Med 2009; 122 (8): 778.e9–15.
22. Lacasse Y, Martin S, Lasserson TJ, Goldstein RS. Metaanalysis of respiratory rehabilitation in chronic obstructive pulmonary disease. A Cochrane systematic review. Eura Medicophys 2007; 43 (4): 475–85.
23. Güell R, Resqueti V, Sangenis M et al. Impact of pulmonary rehabilitation on psychosocial morbidity in patients with severe COPD. Chest 2006; 129 (4): 899–904.
24. Garrod R, Marshall J, Barley E, Jones PW. Predictors of success and failure in pulmonary rehabilitation. Eur Respir J 2006; 27 (4): 788–94.
25. Boueri FM, Bucher-Bartelson BL, Glenn KA, Make BJ. Quality of life measured with a generic instrument (Short Form-36) improves following pulmonary rehabilitation in patients with COPD. Chest 2001; 119 (1): 77–84.
26. Bratås O, Espnes GA, Rannestad T, Walstad R. Characteristics of patients with chronic obstructive pulmonary disease choosing rehabilitation. J Rehabil Med 2010; 42 (4): 362–7.
27. Kagaya H, Takahashi H, Sugawara K et al. Effective home-based pulmonary rehabilitation in patients with restrictive lung diseases. Tohoku J Exp Med 2009; 218 (3): 215–9.
28. Ferreira A, Garvey C, Connors GL et al. Pulmonary rehabilitation in interstitial lung disease: benefits and predictors of response. Chest 2009; 135 (2): 442–7.
29. Salhi B, Troosters T, Behaeqel M et al. Effects of pulmonary rehabilitation in patients with restrictive lung diseases. Chest 2010; 137 (2): 273–9.
30. Barone S, Bacon SL, Campbell TS et al. The association between anxiety sensitivity and atopy in adult asthmatics. J Behav Med 2008; 31 (4): 331–9.
31. De Voogd JN, Wempe JB, Postema K et al. More Evidence that Depressive Symptoms Predict Mortality in COPD Patients: Is Type D Personality an Alternative Explanation? Аnn Behav Med 2009; 38: 86–93.
32. Pedersen SS, Herrmann-Lingen C, de Jonge P, Scherer M. Type D personality is a predictor of poor emotional quality of life in primary care heart failure patients independent of depressive symptoms and New York Heart Association functional class. J Behav Med 2010; 33 (1): 72–80.
33. Mols F, Denollet J. Type D personality among noncardiovascular patient populations: a systematic review. Gen Hosp Psychiatry 2010; 32 (1): 66–72.
34. Sogaro E, Schinina F, Burgisser C et al. Type D personality impairs quality of life, coping and short-term psychological outcome in patients attending an outpatient intensive program of cardiac rehabilitation. Monaldi Arch Chest Dis 2010; 74 (4): 181–91.
35. Fuchs AR, Meneghelo RS, Stefanini E et al. Exercise may cause myocardial ischemia at the anaerobic threshold in cardiac rehabilitation programs. Braz J Med Biol Res 2009; 42 (3): 272–8.
36. Enfield K, Gammon S, Floyd J et al. Six-minute walk distance in patients with severe end-stage COPD: association with survival after inpatient pulmonary rehabilitation. J Cardiopulm Rehabil Prev 2010; 30 (3): 195–202.
37. Parissis JT, Nikolaou M, Farmakis D et al. Self-assessment of health status is associated with inflammatory activation and predicts long-term outcomes in chronic heart failure. Eur J Heart Fail 2009; 11 (2): 163–9.
Авторы
А.Н.Сумин*1, Е.В.Недосейкина2, О.Г.Архипов2
1 УРАМН Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний СО РАМН, Кемерово;
2 ФГУ Центр реабилитации ФСС РФ «Топаз», Мыски
*sumian@cardio.kem.ru
1 УРАМН Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний СО РАМН, Кемерово;
2 ФГУ Центр реабилитации ФСС РФ «Топаз», Мыски
*sumian@cardio.kem.ru
________________________________________________
A.N.Sumin1*, E.V.Nedoseikina2, O.G.Arkhipov2
1 Ural Research Institute for Complex Problems of Cardiovascular Diseases, Siberian Branch of the Russian Academy of Medical Sciences, Kemerovo;
2 «Topaz» Rehabilitation Center, Social Insurance Fund of the Russian Federation, Myski
*sumian@cardio.kem.ru
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