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Life event stress and chronic obstructive pulmonary disease (COPD): associations with mental well-being and quality of life in a population-based study
  1. Yanxia Lu1,2,
  2. Ma Shwe Zin Nyunt1,2,
  3. Xinyi Gwee1,2,
  4. Liang Feng1,2,
  5. Lei Feng1,2,
  6. Ee Heok Kua1,2,
  7. Rajeev Kumar3,
  8. Tze Pin Ng1,2
  1. 1Gerontological Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  2. 2Department of Psychological Medicine, National University Hospital System, Singapore, Singapore
  3. 3Academic Unit of Psychological Medicine, Australian National University Medical School, Canberra, Australia
  1. Correspondence to Dr Tze-Pin Ng; pcmngtp{at}


Objectives To investigate whether life event stress was associated with greater psychological distress and poorer quality of life in older individuals with chronic obstructive pulmonary disease (COPD), in comparison with their counterparts without COPD.

Design Cross-sectional study.

Participants A population-based sample (N=497) of individuals aged 65 and above with COPD (postbronchodilatation FEV1/FVC<0.70, N=136) and without COPD (N=277).

Measurements We measured life event stress, depressive symptoms (GDS, Geriatric Depression Scale), cognitive symptoms and function (CFQ, Cognitive Failures Questionnaire and MMSE, Mini-Mental State Examination), and physical and mental health functional status (SF36-PCS, Physical Health Component Summary and SF36-MCS, Mental Health Component Summary) in participants with and without COPD.

Results In two-way analysis of variance controlling for potential confounders, life event stress was associated with significant main effects of worse GDS (p<0.001), SF36-PCS (p=0.008) and SF36-MCS scores (p<0.001), and with significant interaction effects on GDS score (p<0.001), SF36-PCS (p=0.045) and SF36-MCS (p=0.034) in participants with COPD, more than in non-COPD participants. The main effect of COPD was found for postbronchodilator FEV1 (p<0.001) and cognitive symptoms (p=0.02).

Conclusions Our findings indicate that life event stress was associated with more depressive symptoms and worse quality of life in individuals with COPD, much more than in those without COPD. Further studies should explore the role of cognitive appraisal of stress, coping resources and psycho-social support in this relationship.

  • Mental Health
  • Psychiatry
  • Respiratory Medicine (See Thoracic Medicine)

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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