Specific psychiatric morbidity among patients with chronic obstructive pulmonary disease in a Nigerian general hospital

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Abstract

Objective: The goal of this study was to explore specific psychiatric morbidity among chronic obstructive pulmonary disease (COPD) patients in Nigeria. Method: The mental status of 30 COPD patients was compared with those of 30 uncomplicated hypertensive patients and 30 apparently healthy controls using the 30-item General Health Questionnaire (GHQ-30) and Present State Examination (PSE). The sociodemographic characteristics of the three groups were also compared. Results: The COPD population was significantly least educated and predominantly subsistent farmers. Thirty percent of the COPD population, 13.3% of the hypertensive patients and 3.3% of apparently healthy controls had psychiatric morbidity (P<.05). The COPD population, with psychiatric diagnoses consisted of 16.7% depressive episode, 10% generalized anxiety disorder and 3.3% delirium. This pattern is similar to data from industrialized countries. No sociodemographic factors were significantly associated with psychiatric morbidity. Conclusion: Improving the psychiatric knowledge of the primary physician will result in better management of the COPD patient.

Introduction

Chronic obstructive pulmonary disease (COPD) is an important cause of mortality and morbidity worldwide, and its exacerbations commonly lead to hospital admissions [1]. As the world population ages [2], the significance of COPD for the health care system is growing [3]. Although, COPD is a chronic physical illness, it has profound psychological and social impact on its victims [4]. Among the psychiatric disorders identified in COPD population in western societies are generalized anxiety disorder, panic disorder and depressive episode [5], [6], [7].

The risk factors of developing COPD are cigarette smoking, history of respiratory disease, low socioeconomic status, rural dwelling and the use of biofuel [8], [9], [10], [11], [12], [13]. These factors are prevalent in Nigeria [14], [15]. Unfortunately, studies are lacking on the psychosocial aspects of COPD from this country, which is the most populous African nation. One cannot extrapolate research findings from western societies to developing countries with completely different socioeconomic and sociocultural characteristics. It is therefore necessary to explore the psychiatric aspect of COPD and the sociodemographic factors influencing it in a West African setting.

Section snippets

Method

This study was conducted between September 1997 and August 1998 at the Respiratory Unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

Thirty consecutive patients with COPD, comprising of 25 males and 5 females, seen at the unit, were recruited for the study. Diagnosis of COPD was based on the following criteria: (1) an unequivocal history of chronic exertional dyspnoea, chronic cough and sputum production on most days for at least 3 months for 2 consecutive

The sociodemographic characteristics of the studied populations

Comparing the three groups showed no significant differences with regards to marital status, religion and income (Table 1). However, with regards to education and occupation, there were significant differences when the three groups were compared (χ2=15.79, df=2, P<.001 and χ2=14.85, df=2, P<.001, respectively). Specifically, the educational attainments of the hypertensive and healthy control groups were not significantly different but that of the COPD patients was significantly lower than that

Discussion

In this study, a majority of the COPD patients were uneducated and functioned as subsistent farmers. This group of people is often rural dwellers, in marginal living conditions, cook with firewood and lack access to basic health care facilities. These findings clearly indicate that preventive strategies against COPD should be directed at the rural population.

The psychiatric morbidity complicating COPD in this index population (30%) was significantly higher than those of the comparison groups.

Acknowledgements

The authors are grateful to Prof. Jude U. Ohaeri, the medical superintendent of St. Giles Hospital Suva Fiji Islands, for his useful suggestions.

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