Coping, depression and anxiety as predictors of functioning in COPD
Heimlich, Tamara Ellen
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Eighty pulmonary rehabilitation inpatients participated in a study of the predictive roles of instrumental and denial coping and depressed and anxious mood, assessed at admission, in functional outcomes at discharge. Instrumental coping was hypothesized to predict positive outcomes, and denial coping, depression and anxiety were expected to be negatively related to outcome. Mood was hypothesized to mediate between coping and outcomes in a path model. Participants completed the COPE, Beck Depression Inventory, Beck Anxiety Inventory, pulmonary function testing, and the six minute walk test, and the rehabilitation staff rated patients' functional abilities on the Functional Independence Measure (FIM). Admission instrumental coping and Forced Expiratory Volume in one second (FEV1%), and Forced Vital Capacity as a percentage of predicted (FVC%) predicted six minute walking distance at discharge. Denial coping negatively predicted the ADL (activities of daily living) factor of the FIM, and both types of coping predicted the Transfer FIM factor in the expected direction. When FVC% was used, instrumental coping remained a significant predictor, while FVC% and denial coping only marginally predicted the Transfer factor. Only FEV1% predicted the Cognition FIM factor and no independent variables predicted the Communication FIM factor. Depressed and anxious mood were not related to outcome. Denial coping predicted depression and anxiety at admission, and instrumental coping negatively predicted anxiety. Thus the final path model was different than hypothesized. Clinical and research implications, and suggestions for further study are discussed.