Some surprisingly good news about Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) — a debilitating chronic lung disease that includes emphysema and chronic bronchitis — has previously been linked to mental health problems, such as depression, anxiety, and substance use disorders. But a new study by University of Toronto researchers found that, even though adults without the disease were mentally flourishing at higher rates, a strong majority of those diagnosed with COPD were in excellent mental health.

The study investigated factors associated with mental flourishing in a nationally representative sample of 703 Canadians aged 50 and older who had been diagnosed with COPD, which is the third leading cause of death in Canada. It found that found that 87% of older Canadians with COPD had no mental illness, while two-thirds (67%) of those with COPD were in a state of excellent mental health.

"This research provides a very hopeful message for individuals struggling with COPD, as well as for their families and health professionals. says co-author Sally Abudiab, a recent graduate of U of T’s Factor-Inwentash Faculty of Social Work. “Our findings suggest the vast majority of individuals with COPD are embracing their lives and thriving. They are in exceptionally good mental health despite the physical, mental and economic challenges of coping with COPD.”

The researchers wanted to investigate factors associated with a high level of mental wellness. To be defined in excellent mental health, respondents had to achieve three things: 1) almost daily happiness or life satisfaction in the past month, 2) high levels of social and psychological well-being in the past month, and 3) freedom from generalized anxiety disorder and depressive disorders, suicidal thoughts and substance dependence for at least the preceding full year.

Individuals with COPD who were socially isolated were particularly vulnerable to poorer mental health. On the other hand, those who had at least one person in their lives with whom they could talk about important decisions were seven times more likely to be free of mental illness and to be in excellent mental health compared to those without a confidant.

“It is clear that social support is a key factor in the well-being of older adults with COPD. Interventions are needed to promote social support and to decrease social isolation and loneliness among the most isolated,” says Abudiab.

The factors associated with lower levels of flourishing included previous major depressive disorders and adverse childhood experiences. Older Canadians with COPD who had experienced a major depressive disorder or generalized anxiety disorder at some point in the past were much less likely to be happy and flourishing than those with COPD without this history.

In addition, adverse childhood experiences, such as physical and sexual abuse, decreased the odds of those with COPD being free of mental illness by 31%. Childhood adversities may impede the development of positive coping strategies and emotional regulation, and exacerbate maladaptive attachment styles, such as smoking and substance abuse, in adulthood, ultimately compromising both physical and mental health.

“Our findings underline the importance of targeted outreach and referrals for those with COPD who are not flourishing,” says the study’s senior author, Esme Fuller-Thomson. “Health care professionals may want to consider mental health interventions such as cognitive-behavioral therapy (CBT) for older adults with COPD who are struggling with their mental health. CBT has been shown to be very effective for reducing symptoms of mental illness in COPD patients who also have depression and anxiety, and it has also been used successfully for those with a history of childhood adversities.” Fuller-Thomson is Director of the U of T’s Institute for Life Course and Aging and Professor at the Factor-Inwentash Faculty of Social Work and the Department of Family & Community Medicine.