| Author/ Date | Study Sample | Study design/ sampling | Study Purpose | Data Collection period | The instrument used to measure HRQoL | Main study results |
| (Ivziku, Clari, Piredda, De Marinis, & Matarese, 2019) | 80 dyads | A cross- sectional descriptive design | To assess the influence of anxiety and depression on the physical and mental QoL in a patient with COPD and caregiver dyads | 11 months from November 2016 to October 2017 | GAD-7 Health Survey (SF-12) | This study found that psychological distress affects the QoL of COPD patients and caregivers consistently with prior research that used individual level of analysis and these results confirm the negative impact of anxiety and depression on the caregivers’ mental QoL. |
| (Jarab, Alefishat, Mukattash, Alzoubi, & Pinto, 2018) | 28 patients | Qualitative focused group | To explore patients’ views and perceptions regarding COPD and its impact on their quality of life | NA | A qualitative study by the focused group and four themes emerged | In this qualitative study about patients’ perspectives regarding COPD and its impacts on HRQoL, the evidence was COPD had a negative physical and psychological impact like anxiety on COPD patients. |
| (Brien et al., 2018) | 735 patients | a cross-sectional analysis of cohort study | To investigate factors associated with poor QoL, focusing on psychological measures potentially amenable to intervention | during the period of May 2012-June 2014 | EQ-5D CAT GAD-7 scores | The study was evident that psychological factors like anxiety significantly contribute to disease-specific QoL impairment in COPD |
| (Quaderi & Hurst, 2018) | 18 patients and 18 doctors | A qualitative method focused group/ convenience sampling | To explore the unmet needs of patients from both patients and doctors managing COPD | In 2012 | A qualitative study by the focused group and four themes emerged | This study aimed to explore the psychological impacts as an unmet need of patients that could potentially improve their quality of life from both patients’ and doctors’ perspectives whose managing patients with COPD. The study results showed most patients with COPD experienced difficulties in their psychosocial and physical functions such as breathlessness, fear, and helplessness that affect QoL and lead to social isolation. |
| (Kouijzer, Brusse-Keizer, & Bode, 2018) | 20 form inpatient and outpatient | Qualitative semi- structured interview/ purposive sampling | To explore the patient’s perspective on the impact of fatigue on their daily lives and on treatment opportunities to tackle the burden of fatigue | NA | A qualitative study by the focused group and four themes emerged | The study findings indicate that patients with COPD perceive the impact of fatigue on their daily lives to be a key factor in decreasing their quality of life |
| (Stridsman et al., 2018) | 795 patients | Population- based study | To evaluate the association between fatigue and health-related quality of life HRQoL both among subjects with and without COPD | In 2014 | FACIT-Fatigue EQ-5D CAT | In this population-based study, clinically relevant fatigue was associated with worse HRQoL among subjects with and without COPD when using the clinically useful generic instrument EQ-5D-VAS. Also, among subjects with COPD, clinically relevant fatigue was independently associated with anxiety |
| (Chen et al., 2018) | 91 patients | a cross- sectional study/a survey method | To assess the impact of fatigue and dyspnea symptoms on quality of life in individuals with COPD | January 2014 to May 2015 | DI BFI CCQ | The symptoms of fatigue, Dyspnea, and anxiety were moderate to highly correlate with each other, and with HRQoL. Thus, all individuals have an impact on their health-related quality of life. |
| (Lim, Kim, Kim, & Kim, 2017) | 130 patients | A descriptive cross- sectional design/ convenient sampling | To identify symptom clusters and the effects on quality of life (QOL) in patients with COPD | Between November and December 2014 | Korean version of the CAT | Symptom cluster 1 consisted of dyspnea, physical functional status, and dry mouth; symptom cluster 2 consisted of anxiety and depression, and symptom cluster 3 consisted of sleep disturbance and fatigue. Subgroup cluster analysis showed that COPD subjects with higher-scoring symptoms in symptom clusters 1, 2, and 3 had significantly poorer QOL. |
| (Pascal, Trofor, Lotrean, Filipeanu, & Trofor, 2017) | 60 patients | an observational study | To assess anxiety, depression and panic disorders among patients diagnosed with COPD and to investigate their correlation with disease severity, QoL as well as tobacco use | Between January and September 2014 | HADS CAT | The results indicated associations between anxiety, depression, panic attacks, and disease severity, as well as poor quality of life of patients with COPD, regardless of their current tobacco use status. |
| (Mewes, Rief, Kenn, Ried, & Stenzel, 2016) | 502 patients | a cross-sectional online survey | To investigate the influence of psychological factors on HRQL and disability in COPD individuals recruited from the general population. | Between May and September 2012 | Health Survey (SF-12) PHQ | High depression and anxiety were the main predictors of low mental HRQoL. an association was found between strong emotional reactions to COPD and low mental HRQoL |
| (Martinez et al., 2016) | 4097 patients | a cross-sectional analysis of data from participants with COPD in two cohorts | To explore factors associated with age-related differences in HRQL in COPD. | NA | SGRQ | Anxiety was associated with change and predicting HRQoL |
| (Paap, Bode, Lenferink, Terwee, & van der Palen, 2015) | 13 Health care professionals | Qualitative study/face to face interview | To identify which domains of HRQoL are most important for patients with COPD from the perspective of healthcare professionals | From July through December 2013 | Seven main themes emerged from the analysis of the open question | The study findings report the most frequently selected Patient-Reported Outcomes Measures (PROMs) domains which are fatigue, physical function, emotional support, anxiety, and depression that showed the most important domains to measure and associated with HRQoL among patients with COPD. |
| (Mehta et al., 2014) | 59 patients | a cross-sectional study | To study the association of psychiatric co-morbidities and QoL with the severity of COPD. | Between September and November 2013 | HADS SGRQ | Patients with depression and anxiety disorders were likely to have a poorer quality of life represented by higher SGRQ scores. Also, patients with severe respiratory symptoms are more likely to suffer from anxiety disorders and depression and have a poorer quality of life. |
| (Miyazaki et al., 2014) | 336 COPD patients and 67 non-COPD subjects | an observational study | To investigate comorbid factors that may contribute to high CAT scores | Between April 2010 and December 2012 | SF-36 version 2 CAT SGRQ HADS | There is a significant-good correlation with the SGRQ total score, all components of the SF-36, and CAT score with anxiety in the COPD patients. |
| (Al-Gamal, 2014) | 67 patients and spouses | a cross- sectional, descriptive, correlational design/ interview | To examine the relationships between anxiety, depression, and QoL of both Jordanian patients with COPD and their spouses | in 2011 | QLI HADS | There was a significant negative correlation between total patient QoL scores and depression subscale score and anxiety sub-scale This indicated that patients with high psychological distress reported poor QoL. |
| (Burgel et al., 2013) | 326 patients | a cross-sectional analysis | To evaluate the independent contribution of comorbidities including mood disorders, metabolic and cardiovascular comorbidities to SGRQ scores | Between January 2005 and August 2009. | HADS SGRQ | The univariate data in this study indicated that COPD subjects with anxiety or depression had worse HRQoL |
| (Hoth et al., 2013) | 407 patients | Survey study/online survey | The primary objective was to determine whether ambiguity or complexity has a stronger impact on depressive symptoms, anxiety, quality of life, and breathlessness. | NA | MUIS HADS SGRQ | Uncertainty about physical symptoms which is ambiguity consistently predicted depression, anxiety, quality of life, and breathlessness over a two-year period among individuals with COPD while uncertainty about treatment and the healthcare system which is complexity did not have an independent effect on any of the previous outcome variables. |
| (Lou et al., 2012) | 1100 patients | A case-controlled study/A cluster- randomized sampling | To assess depression and anxiety in Chinese patients with COPD | Between March and May 2008 | SGRQ HADS | Patients with COPD who had anxiety and/or depression had a poorer health-related quality of life |
| (Jiang & He, 2012) | 96 patients | RCT | To explore the effects of an uncertainty management intervention on uncertainty, anxiety, depression, and QoL of COPD outpatients in China | 10-month study duration | MUIS-A SGRQ STAI | This study suggests that an uncertainty management intervention is effective in improving uncertainty, anxiety, depression, and quality of life in COPD outpatients. It is provided the first evidence that uncertainty management can improve the QoL of COPD patients |
| (Baltzan et al., 2011) | 251 individuals | observational study/a secondary analysis of data collected during a randomized clinical trial | To determine whether patients with high fatigue differed in their response to pulmonary rehabilitation program compared to those with low reported fatigue both immediately after the program and 1 year after entry. |
| SGRQ CRQ 6MWD | In this study patients in both groups are improved similarly in their dyspnea, the 6MWD and endurance time after introducing a pulmonary rehabilitation program. However, high-fatigue patients had greater improvements in both the CRQ fatigue and the SGRQ scores. thus, this study suggests that high levels of fatigue are a common feature in patients with COPD |
| (Balcells et al., 2010) | 337 patients | a cross-sectional analysis/ convenient sampling | To evaluate the association between anxiety and depressive symptoms and health-related quality of life (HRQoL), and to identify the effect modifiers of this relationship in patients with chronic obstructive pulmonary disease | between January 2004 and March 2006. | SGRQ HADS
| This study showed a significant association between anxiety, depression or both and reduced HRQOL. |
| (Borge, Wahl, & Moum, 2010) | 154 patients | a cross-sectional study | To explore the relationships between demographic and clinical variables and the symptoms of breathlessness, depression, anxiety, fatigue, sleeping difficulties and pain for patients with COPD. | from June 2006 to December 2007 | HADS Lee Fatigue Scale (LFS) RQLQ | This study confirms breathlessness is associated with variables of anxiety and fatigue which affect the QoL in patients with COPD. |