Table 2 Research Question 1: Drivers or contributors to psychological distress mapped to theoretical domains.
Domains and themes | Quotes |
|---|---|
Knowledge Participants’ knowledge about their lung condition, mental health, experiences of illness and treatment, and the psychological impacts of living with both (or more) conditions | |
Respiratory condition and treatments | “She [respiratory physician] explains a lot to me but I still don’t understand. I know that I’ve got really bad lungs….And how long I will live with my lungs I don’t know.” (Cynthia, P13) |
Mental health issues and treatments | “Well, I’ve been diagnosed with depression….Uh, I’m on, uh, Zoloft for depression….Yeah, I’m on 200 mil of that per day.” (Sam, P7) “I don’t know what anxiety is [laughs]. If something went wrong, I mean, in my day, have another beer. That’s what you did, you had another beer [laughs]. Anxiety? I don’t understand what it is.” (Derrick, P4) |
Link between mental health and COPD | “It can get very frightening. Really frightening. I know when we were in Queensland for a holiday, I was sent to hospital, quite sick with the breathing. And I couldn’t breathe. And I was so frightened that I wasn’t breathing at all, because of it. And yeah, it caused a bit of a trip to hospital.” (Allen, P1) “I’m getting short of breath. Just standing here. Maybe that’s got something to do with the pain as well, but… This is where I get depressed and think I just want to give it up. I just want to stop fighting.” (Irene, P8) |
Comorbidities | ““So partial asbestosis, partial emphysema and then because of the cardiomyopathy… er having the heart muscle damaged… which was unfortunate because by the time I got into hospital with the heart attack… was over an hour… um. I was not supposed to be alive, but I am.” (Neil, P11) |
Misattribution | “Well before that, if I lost my breath, I had to sit down and get the fan to blow on me to be able to breathe. And now I’m taking the mirtazapine, I hardly do that anymore. I don’t have that problem. So that’s a big plus for me….I better tell them to put it up a bit more. ‘Cos it’s the only tablet that helps me breathe.” (Derrick, P4) |
Social/Professional Role & Identity Participants’ personal qualities, self-identity, or role transitions that may have been associated with the development of psychological distress | |
Self-identity type | “I start to cry sometime, you know. I can’t live like that. Because, to live like that, do nothing in the house, for a woman, that’s… I feel like my life is finished.” (Antonella, P6) “I have moments… My, not my own personal thing, but about other people where I get stressed and I worry for them,… And I worry and I know there’s nothing I can do, I just think I love worrying.” (Pauline, P9) “At that time, I… I didn’t understand this depression. I was a very bright girl. I liked to sing, I liked to dance, I liked to read, and I like all of this. Coming to Australia, it’s like cut my leg.” (Antonella, P6). |
Social influences Social interactions that contributed to uptake of substance use, recognised as both a driver and moderator of psychological distress in COPD | |
Uptake, substance use | “I saw everybody else smoking and I thought, well, you know, this must be a cool thing to do.” (Irene, P8) “Oh just the kids I was mucking around with - some of them were a lot older and you know they sort of say oh just have a drag, have a drag, go on have a drag. I’ll give you $10 If you have the drag. Yeah.” (Fiona, P10) “It’d be one of the guys. Um, “have a smoke, that’ll make you feel better”. And, do you know, I took it up, because that was, that was the thing that, you know, obviously associated the pair of them - stress and smoking.” (Kathy, P3) |
Environmental context and influences Circumstances in a person’s life or environment which may have led to or triggered the onset of psychological distress | |
Triggers, mental health | “To be honest with you, I’m gonna get a little bit personal here. Those other drugs were like how I dealt with traumas. Um, I was, um, sexually abused by just about every member, male member of my family. Physically abused by my stepfather and my mother.” (Irene, P8) “When I was in my 40 s and I think it was part of.…Was after I went to a lot of trouble trying to conceive. And after I stopped doing that, when my eggs failed…I was pretty down there and they put me on some antidepressants, I was on that for a couple of years, but that’s a long time ago. Like…30 years ago.” (Pauline, P9) ““I think because I just wasn’t coping with three kids under two and a half. Um and as I said, my husband was never home. And he used to go out drinking after work and you know, get home at 10, 11 o’clock at night.” (Fiona, P10) |
Psychosocial circumstances | “Each one of us has a cross to bear in the house. My health, [husband’s] health, and my son’s health. We’ve all got a cross to bear, and we’ve got to tolerate each other, but when things aren’t going too good for one person - just verbal - but yelling and that, I just can’t cope with that anymore. It gets me down; very down.” (Barbara, P2) |
Emotions Participants’ reactions, feelings, or emotional state experienced as a result of living with their physical condition, mental health condition, or the interaction between both | |
Reactions to illness and illness treatments | “When I try to do something, it gets very frustrating. If I try to do anything and I can’t climb a ladder and I can’t do this and it… [sighs], you know, you just feel useless.” (Sam, P7) “I used to be a bit embarrassed by it. And always I felt a bit embarrassed and a bit ashamed because people would always say to you, oh, did you smoke? [Laughs]. And I used to say, yes I did, and you feel really bad saying that, you know. They must think you’re stupid…That you’d smoked yourself to this point.” (Pauline, P9) “He’s had days where he’s throwing the tubes off just saying, “I can’t take this! I can’t do this” where he’s getting like this now where that was never a thing.” (Rosemary, C1) “Terrible! How would you like it if you couldn’t breathe? I mean it’s frightening – you’re trying to get your breath in and you can’t get it! It’s very hard. And when, of course, it’s not just you can’t breathe - you’re panicking as well. Because you’re wondering what’s happening.” (Barbara, P2) |
Optimism Participants’ optimism or pessimism regarding the state of their lung condition, mental health, and future wellbeing | |
Pessimism – illness and illness treatments | “Well I don’t think there is anything. Because there’s no…. I’ve been told that there’s nothing – it can’t get better. It’s only gonna get worse. So there’s no hope there.” (Fiona, P10) “Because in my life I’ve been through too much. It never works the right way. Uh, I think that’s negative. You know, I feel negative.” (Antonella, P6) |
Optimism – illness and illness treatments | “I accept because,…You gotta start to live with this symptom. It means they can’t do nothing for me. And then, I think to try to live this whatever time I got left, in a way, I still enjoy myself.” (Antonella, P6) “I think to myself, well…I’m still alive. I wake up, you know if I wake up the next day, I say thank you I’m still around.” (Cynthia, P13) |
