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Psychological-Symptom Mismatch Phenotypes and Their Clinical Implications in Patients with Chronic Obstructive
Yingying Cai1, Xiaohe Ren2, Kefang Wang3
1Gynecology, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, People's Republic of China.
Purpose:
Psychological distress in Chronic obstructive pulmonary disease (COPD) patients often does not correspond to symptom severity. The clinical significance of psychological-symptom mismatch phenotypes is unclear. To identify psychological-symptom mismatch phenotypes in COPD and examine their associations with clinical outcomes.
Patients And Methods:
A cross-sectional study was conducted in 306 COPD patients from a tertiary hospital in Shandong, China. Latent profile analysis was applied to standardized measures of anxiety, depression, lung function, symptom severity, and dyspnea to identify phenotypes. Multivariable linear and negative binomial regressions assessed associations with clinical outcomes.
Results:
Four phenotypes were identified: psychological-dominant mismatch (22%), low (47%), moderate (26%), and high psychological-symptom burden (5%). The mismatch phenotype was characterized by disproportionately elevated psychological burden relative to symptom burden and was associated with the poorest quality of life. In adjusted analyses, patients in the low, moderate, and high burden phenotypes had better quality of life than those in the mismatch phenotype (all P <0.001). Patients in the low and moderate burden phenotypes had fewer hospitalizations in the preceding year (incidence rate ratios, 0.592 [95% CI, 0.355-0.989] and 0.233 [95% CI, 0.141-0.386], respectively), whereas no significant difference was observed for the high burden phenotype. Differences in self-management and coping were limited, while patterns of health locus of control varied across phenotypes.
Conclusion:
Psychological-symptom mismatch appears to be a common and clinically relevant pattern in COPD. Patients with a psychological-dominant mismatch phenotype exhibited poorer quality of life and a higher likelihood of hospitalization. These findings highlight the potential importance of incorporating psychological assessment into routine COPD care and suggest that phenotype-informed approaches may help identify patients with differing clinical needs.
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