Exploring the psychological profile: a cross-sectional study of 1,185 patients with pulmonary nodules in an outpatient clinic

Weitao Zhuang; Junhan Wu; Haijie Xu; Cheng Deng; Shaopeng Li; Dan Tian; Xiaosong Ben; Wei Xu; Yong Tang; Guibin Qiao

doi:10.21037/jtd-22-847

Exploring the psychological profile: a cross-sectional study of 1,185 patients with pulmonary nodules in an outpatient clinic

J Thorac Dis. 2022 Dec;14(12):4699-4712. doi: 10.21037/jtd-22-847.

Authors

Weitao Zhuang^#¹, Junhan Wu^#^{1

2}, Haijie Xu^#^{2

3}, Cheng Deng¹, Shaopeng Li^{4

5}, Dan Tian¹, Xiaosong Ben¹, Wei Xu⁶, Yong Tang¹, Guibin Qiao^{1

2}

Affiliations

¹ Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² Shantou University Medical College, Shantou, China.
³ Department of Thoracic Surgery, First Afﬁliated Hospital of Shantou University Medical College, Shantou, China.
⁴ Department of Cardiothoracic Surgery, Longgang Central Hospital of Shenzhen, Shenzhen, China.
⁵ Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
⁶ School of Public Health and Management, Chongqing Medical University, Chongqing, China.

^# Contributed equally.

Abstract

Background: The purpose of this study was to identify the potential risk and protective factors of psychological burden in patients with pulmonary nodules (PNs) and to explore how the psychological status of the patients affects their treatment preferences.

Methods: In this questionnaire-based study, 1,185 outpatients were evaluated using the Hospital Anxiety and Depression Scale (HADS), and the correlations between psychological burden and patients' sociodemographic and clinical characteristics were assessed.

Results: Prevalence of anxiety and depression was 42.1% and 27.0%, respectively, among patients with PNs. Binary logistic regression analysis revealed that age over 60 years old [odds ratio (OR) =0.57; 95% confidence interval (CI): 0.36-0.89], computed tomography (CT) scan due to physical discomfort (OR =1.58; 95% CI: 1.11-2.24), multiple PNs (OR =1.52; 95% CI: 1.20-1.94), family history of malignancy (OR =1.28; 95% CI: 1.01-1.64), and subjective symptoms (OR =1.70; 95% CI: 1.32-2.19) were independently associated with anxiety, while multiple PNs (OR =1.51; 95% CI: 1.15-1.98), subjective symptoms (OR =1.65; 95% CI: 1.23-2.20), and indeterminate nodules (OR =1.91; 95% CI: 1.08-3.40) were independently associated with depression. There was a tendency for patients with anxiety and depression to choose more aggressive management strategies (P<0.001 and P=0.001, respectively). Univariate analysis showed that symptomatic patients (χ²=9.696; P=0.021) and those with progressive nodules (χ²=18.198, P=0.033) chose more aggressive treatment strategies.

Conclusions: Anxiety and depression are common in patients with PNs, which might result in nonnegligible overtreatment. Presence of subjective symptoms can significantly exacerbate psychological burden and influence treatment preference. Taking psychological factors into consideration in the outpatient clinic may facilitate patient-centered communication and promote judicious decision-making.

Keywords: Anxiety; depression; pulmonary nodules (PNs); treatment preference.