Mental health and COPD: why we need more research

Over 1 in 3 people with COPD report symptoms of anxiety and depression. Yet, challenges with mental health are often under-recognised and under-treated in people living with chronic lung disease. Dr Lisa Brighton tells us about her important research into ways to support people with COPD and their mental health.

An unrecognised struggle

We know that many people with COPD struggle with their mental health, and that poor mental health can relate to a worse course of disease. However, it’s often unrecognised and untreated. I recently worked with a team to understand what non-drug approaches can be used to best support the mental health of people with chronic obstructive pulmonary disease (COPD). We found that psychological therapies and pulmonary rehabilitation can both reduce anxiety and depression symptoms in people with COPD. However, there are still lots of questions about the best way to ensure people with COPD receive the psychological support they need in practice.

The relationship between mental and physical health

Reflecting on these findings, I spoke with Debs, a person living with COPD, about the relationship between psychological and physical health when living with a lung condition: 

“With a lung condition, it can be more difficult to do things physically, and can make you more dependent on people, which can make you feel worse about yourself sometimes. Or you might be monitoring every little thing and worrying about possible side effects you might get from medication.

Obviously, physical health and mental health are linked. So, if you were very low mentally, then it will make it more difficult to do the things that you need to do to try and keep yourself well and to be motivated. You might not be taking the medication that you need to or going to the appointments that you need to.”

The need for combined support

Deb described the challenges experienced in both lung services and mental health care:

“I guess [respiratory clinicians] ask you generally how you are, but it doesn't appear as though they’re that concerned about knowing about your mental health. People say that often, they can say to their consultant they feel a bit low, and then consultant starts talking about the last set of blood tests and doesn't acknowledge them feeling low at all.

I also have had support for mental health issues separately, and they haven't really understood my respiratory condition.

I think possibly clinicians’ understanding of people is getting better, but services aren't combined together. It feels as though physical health, and mental health, they are still kept quite separate. It's still not as holistic as you would like.”

The importance of shared experience

When I asked what she finds most helpful for her own mental health, Debs highlighted the importance of meeting and talking with other people with similar conditions:

“I guess getting to know other people with similar conditions is helpful. To be able to share experiences, and hear how other people manage. That’s the most helpful thing I find in terms of mental health. Understanding that you're not alone with it, and what you're going through isn't just you. It's other people and the similarities and sharing coping strategies.”

Improving access to support

Moving forwards, she raised the need for more access to supportive services, and how upskilling professionals may play a role in this:

“Having greater access, I think, to things that people enjoy which would be positive, things that would help their mental health. If there was greater understanding of the connection between the two, then some of these things might be easier to access.

I think upskilling respiratory clinicians more in mental health could help when people are first struggling. So you know, if they're struggling with their mental health and they can get access to some help with their mental health from the respiratory clinicians that are already seeing them, that would help. But if it gets that they need more specialised help from a mental health specialist, then those staff understanding respiratory conditions more would be helpful. It would give them more understanding. On both sides it would help.”

Identifying challenges early

Having a lung condition can affect mental health in lots of different ways: it can range from short-term worries about symptoms or feeling sad about the impacts of a lung condition, to being diagnosed with a mental health condition like anxiety or depression. Despite this being a common challenge for people with lung conditions, more research is needed to understand the best ways to identify these challenges early and provide the right support.

If you have concerns about your mental health and well-being, there are some helpful resources from Asthma + Lung UK for managing your mental health.

To find out more about this research, read the full review or get in touch with Lisa Brighton at Lisa.Brighton@kcl.ac.uk.

Lisa Brighton is funded by an Economic & Social Research Council Post-Doctoral Fellowship.