Role of detailed psychological evaluation and treatment in pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease

Submitted: November 15, 2023
Accepted: February 12, 2024
Published: February 27, 2024
Abstract Views: 415
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


Psychological co-morbidities are common in chronic obstructive pulmonary disease (COPD) but remain overlooked. Psychosocial interventions are deemed to promote mental health and optimize management. This study aimed to determine the role of detailed psychological evaluation and treatment in the comprehensive management of COPD. COPD patients after screening with the general health questionnaire-12 (GHQ-12) for psychological co-morbidity were divided into three groups (26 patients each): i) group A [GHQ-12 score<3, received pulmonary rehabilitation (PR) and standard medical management]; ii and iii) group B and C (GHQ-12 score>3, in addition, received management by a psychiatrist and counseling by a pulmonologist, respectively). At baseline and 8 weeks of follow-up, all participants were evaluated for respiratory [forced expiratory volume in the first second (FEV1), six-minute walk distance (6-MWD), St. George's respiratory questionnaire (SGRQ), modified medical research council (mMRC) dyspnea scale], and psychological [GHQ-12, patient distress thermometer (PDT), coping strategy checklist (CSCL), World Health Organization-quality of life-brief (WHOQOL-Bref-26), and depression anxiety stress scales (DASS)] parameters. Psychological distress (GHQ-12>3) decreased significantly at follow-up, with 11.5% and 53.8% of patients having psychological distress in groups B and C, respectively, versus baseline (p<0.001). mMRC score, SGRQ score, FEV1 and 6-MWD significantly improved in all three groups. Improvement in mMRC and SGRQ was maximal in group B when compared with the other groups. PDT, CSCL, and WHO-QOL-Bref-26 scores improved significantly at follow-up in all three groups, with maximum improvement in group B, followed by group C, and then group A. The DASS score also improved maximally in group B. Patients should be screened for psychological co-morbidities using simple screening tools. PR plays an important role in improving the psychology of COPD patients. However, results are better with directed psycho-educative sessions by non-experts and best with definitive treatment by psychiatrists.



PlumX Metrics


Download data is not yet available.


Viegi G, Maio S, Fasola S, Baldacci S. Global burden of chronic respiratory diseases. J Aerosol Med Pulm Drug Deliv 2020;33:171-7. DOI:
Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009;33:1165-85. DOI:
Vögele C, von Leupoldt A. Mental disorders in chronic obstructive pulmonary disease (COPD). Respir Med 2008;102:764-73. DOI:
Dar SA, Bhat BA, Shah NN, Imtiyaz SB. The pattern of psychiatric morbidity in chronic obstructive pulmonary disease: a cross-sectional, case-control study from a tertiary care hospital in Kashmir, North India. J Neurosci Rural Pract 2019;10:65-70. DOI:
Zidan M, Daabis R, Essam H. Psychiatric comorbidity in COPD and its determinants. Eur Respiratory Soc 2012;40:1466.
Güell Rous MR, Díez Betoret JL, Sanchis Aldás J. Pulmonary rehabilitation and respiratory physiotherapy: time to push ahead. Arch Bronconeumol 2008;44:35-40. [Article in Spanish]. DOI:
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. 2018. Available from: Accessed: 8/05/2021.
Dajczman E, Wardini R, Kasymjanova G, et al. Six minute walk distance is a predictor of survival in patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation. Can Respir J 2015;22:225-9. DOI:
Ferrer M, Villasante C, Alonso J, et al. Interpretation of quality of life scores from the St George's respiratory questionnaire. Eur Res J 2002;19:405-13. DOI:
Montazeri A, Harirchi AM, Shariati M, et al. The 12-item general health questionnaire (GHQ-12): translation and validation study of the Iranian version. Health Qual Life Outcomes 2003;1:66. DOI:
Mattoo SK, Handa S, Kaur I, et al. Psychiatric morbidity in vitiligo: prevalence and correlates in India. J Eur Acad Dermatol Venereol 2002;16:573-8. DOI:
Goldberg DP, Gater R, Sartorius N, et al. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 1997;27:191‐7. DOI:
Lynch J, Goodheart F, Saunders Y, O Çonnor SJ. Screening for psychological distress in patients with lung cancer. Support Care Cancer 2011;19:193-202. DOI:
Sharma Y, Mattoo KS, Kulhara P, et al. Stress and coping in women with cervical and breast cancer in India. German J Psychiatry 2003;2:40-8.
Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med 1998:28;551-8. DOI:
Margari N, Karapoulios D, Getsios I, et al. Anxiety and depression in lung cancer patients. Int J Caring Sci 2016;9:308-13.
Mahajan V, Sareen H, Kant S, et al. Prevalence of psychiatric co morbidities in bronchial asthma and chronic obstructive pulmonary disease patients in north Indian population cohort. Int J Res Med Sci 2018;7:2143-7. DOI:
Rzadkiewicz M, Nasiłowski J. Psychosocial Interventions for patients with severe copd - an up-to-date literature review. Medicina (Kaunas) 2019;55:597-619. DOI:
Korpova E, Vargova V, Vanova N. Mental co-morbidities and psychosocial support in COPD patients within the pulmonary rehabilitation. J Public Health Policy Plann 2020;4:2-5.
Usmani ZA, Carson KV, Heslop K, et al. Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017;3:CD010673. DOI:
Usmani ZA, Carson KV, Cheng JN, et al. Pharmacological interventions for the treatment of anxiety disorders in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011;CD008483. DOI:
Papassotiropoulos A, Heun R, Maier W. Age and cognitive impairment influence the performance of the general health questionnaire. Compr Psychiatry 1997;38:335-40. DOI:
Pumar MI, Gray CR, Walsh JR, et al. Anxiety and depression - important psychological comorbidities of COPD. J Thorac Dis 2014;6:1615-31.
Li JM, Cheng SZ, Cai W, et al. Transitional care for patients with chronic obstructive pulmonary disease. Int J Nurs Sci 2014;1:157-64. DOI:
Bratås O, Grønning K, Forbod T. A comparison of two versions of the general health questionnaire applied in a COPD population. Health Care Curr Rev 2014;2:1000123.
Liang WM, Chen JJ, Chang CH, et al. An empirical comparison of the WHOQOL-BREF and the SGRQ among patients with COPD. Qual Life Res 2008;17:793-800. DOI:
Stoilkova A, Janssen DJ, Franssen FM, et al. Coping styles in patients with COPD before and after pulmonary rehabilitation. Respir Med 2013;107:825-33. DOI:
Spencer LM, Alison JA, McKeough ZJ. Maintaining benefits following pulmonary rehabilitation: a randomised controlled trial. Eur Respir J 2010;35:571-7. DOI:
Incorvaia C, Riario-Sforza GG, Ridolo E. About the effect of pulmonary rehabilitation on lung function in patients with chronic obstructive pulmonary disease. Respir Med Case Rep 2016;19:53. DOI:
de Godoy DV, de Godoy RF. A randomized controlled trial of the effect of psychotherapy on anxiety and depression in chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2003;84:1154-7. DOI:
Weatherall M, Marsh S, Shirtcliffe P, et al. Quality of life measured by the St George's Respiratory Questionnaire and spirometry. Eur Respir J 2009 May 1;33:1025-30. DOI:
Nonato NL, Díaz O, Nascimento OA, et al. Behavior of quality of life (SGRQ) in COPD patients according to BODE scores. Arch Bronconeumol 2015;51:315-21. DOI:
Jo YS, Park S, Kim DK, et al. The cutoff point of clinical chronic obstructive pulmonary disease questionnaire for more symptomatic patients. BMC Pulm Med 2018;18:38. DOI:
Andenæs R, Moum T, Kalfoss MH, Wahl AK. Changes in health status, psychological distress, and quality of life in COPD patients after hospitalization. Qual Life Res 2006;15:249-57. DOI:
Brien SB, Lewith GT, Thomas M. Patient coping strategies in COPD across disease severity and quality of life: a qualitative study. NPJ Prim Care Respir Med 2016;26:16051. DOI:
Yohannes AM, Dryden S, Hanania NA. Validity and responsiveness of the depression anxiety stress scales-21 (DASS-21) in COPD. Chest 2019;155:1166-77. DOI:
Coventry PA, Bower P, Keyworth C, et al. The effect of complex interventions on depression and anxiety in chronic obstructive pulmonary disease: systematic review and meta-analysis. PLoS One 2013;8:e60532. DOI:
Srivastava K, Chatterjee K, Bhat PS. Mental health awareness: the Indian scenario. Ind Psychiatry J 2016;25:131-4. DOI:
Munisami T, Namasivayam RK, Annamalai A. Mental illness-related stigma in health care in South India: mixed-methods study. Indian J Psychol Med 2021;43:58-64. DOI:
Gaiha SM, Salisbury TT, Koschorke M, et al. Stigma associated with mental health problems among young people in India: a systematic review of magnitude, manifestations and recommendations. BMC Psychiatry 2020;20:538. DOI:
Bhandari NJ, Jain T, Marolda C, ZuWallack RL. Comprehensive pulmonary rehabilitation results in clinically meaningful improvements in anxiety and depression in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev 2013;33:123-7. DOI:

Ethics Approval

The study was approved by the Institute’s Ethics committee vide letter no. GMC/IEC/2018/160 dated 26-12-2018.

How to Cite

Jacob, Anna, Kranti Garg, Kashish Dutta, Varinder Saini, Deepak Aggarwal, and Ajeet Sidana. 2024. “Role of Detailed Psychological Evaluation and Treatment in Pulmonary Rehabilitation Programs for Patients With Chronic Obstructive Pulmonary Disease”. Monaldi Archives for Chest Disease, February.

Similar Articles

You may also start an advanced similarity search for this article.