Chest
Volume 120, Issue 4, October 2001, Pages 1246-1252
Journal home page for Chest

Clinical Investigations
COPD
The Psychological Impact of End-Stage Lung Disease

https://doi.org/10.1378/chest.120.4.1246Get rights and content

Study objectives

End-stage lung disease is associated with poor quality of life and increased risk for psychological distress. Despite the significant number of individuals with end-stage lung diseases, the emotional health of these patients, as compared with those with other chronic organ diseases, is not well-known. The purpose of this article is to elucidate personality styles and the presence of psychopathology in a clinical sample of patients with end-stage lung disease presenting for possible lung transplantation.

Design

Cross-sectional survey.

Setting

Two academic medical center transplant programs.

Participants

Two hundred forty-three consecutively referred transplant candidates.

Results

Cluster analysis of the Minnesota Multiphasic Personality Inventory (MMPI)-2 indicated five different personality styles. The majority of patients evidenced mild somatic and depressive symptoms. Approximately one fourth of the sample exhibited marked anxiety and mood disturbances. A small cluster also evidenced features consistent with an antisocial personality style.

Conclusions

Separate and distinct personality styles that could affect quality of life, the need for adjunct treatments, and medical compliance emerged from this sample of individuals with end-stage lung disease. Results are discussed in light of prior research on other end-stage organ conditions and in relation to personality and coping theories.

Section snippets

Subjects

Subjects consisted of 243 consecutively referred patients (of 259 potential patients) with a diagnosis of end-stage pulmonary disease who received a psychological assessment (including the MMPI-2) at one of two urban organ transplant centers as part of a pretransplant evaluation between 1993 and 1999. Demographic information is listed in Table 1. The specific medical diagnoses for the sample are presented in Table 2. One hundred sixty-nine patients were evaluated at Temple University Hospital,

Results

The mean MMPI-2 T scores for the entire sample are presented in Table 4. Consistent with prior research, mild mean elevations for the group as a whole were present on MMPI-2 scale 1 (hypochondriasis) and scale 3 (hysteria). Scale 1, scale 2 (depression), and scale 3 had the highest number of individuals scoring above the cutoff of 65T.

Profile clusters were examined for each contributing transplant center and as an aggregate with similar results: a five-group solution best characterized the

Discussion

Five distinct personality profiles, each with the potential to impact treatment decisions and quality of life, were elucidated via cluster analysis of a standardized personality test given to a large sample of transplant candidates suffering from end-stage lung disease. As with prior research, nearly one third of the patients produced profiles indicating clinically significant psychopathology as indicated by prominent elevations of single or multiple MMPI-2 scales. One-half of the patients with

Conclusion

The present study elucidated five different psychological styles of coping with end-stage lung disease that may affect quality of life, interactions with the pulmonary treatment team, and the need for ancillary psychiatric interventions. How these individuals express physical and psychological distress, along with the necessity of mental health intervention, needs to be considered during the evaluation of patients with end-stage lung disease. Further research is suggested to replicate these

References (34)

  • J Craven

    Psychiatric aspects of lung transplantation: the Toronto Lung Transplant Group

    Can J Psychiatry

    (1990)
  • P Meehl et al.

    Antecedent probability and the efficiency of psychometric signs, patterns or cutting scores

    Psychol Bull

    (1955)
  • SR Hathaway et al.

    Minnesota Multiphasic Personality Inventory-2

    (1989)
  • RA Ruchinskas et al.

    A neuropsychologic normative database for lung transplant candidates

    J Clin Psych Med Settings

    (2000)
  • SF Sears et al.

    Predicting quality of life with pretransplant assessment battery: a prospective study of cardiac recipients

    J Clin Psych Med Settings

    (1995)
  • ME Robinson et al.

    Specificity of MMPI cluster types to chronic illness

    Psychol Health

    (1993)
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