# The effect of clinical and psychosocial factors on quality of life in COPD: a cross-sectional assessment using a mediation analysis approach

## TL;DR

This study shows that psychosocial factors like stress and social support significantly affect quality of life in COPD patients, alongside clinical indicators.

## Contribution

The study introduces an integrated model using mediation analysis to show how psychosocial factors influence COPD patients' quality of life.

## Key findings

- Emotion regulation difficulties indirectly lower physical quality of life through clinical severity measures like CAT.
- Perceived social support improves physical quality of life by reducing depressive symptoms.
- Stress negatively affects psychological quality of life via reduced social support.

## Abstract

This study aimed to examine the relative contributions of clinical severity indicators and psychosocial factors—including depression, anxiety, stress, emotion regulation difficulties, and perceived social support—on quality of life in patients with Chronic Obstructive Pulmonary Disease (COPD), and to test their mediating mechanisms within an integrated model.

A total of 120 patients with COPD were assessed using spirometry, dyspnea, and symptom severity measures (mMRC, CAT), psychological assessments (DASS-21, DERS-16, MSPSS), and the WHOQOL-BREF. Mediation models using the PROCESS macro (Model 4) for SPSS were applied to evaluate the pathways linking clinical severity and psychosocial factors to quality-of-life domains.

Among 120 participants diagnosed with COPD, disease stages were found to be GOLD A: 25.8%, GOLD B: 35.8%, and GOLD E: 38.3%. Clinical severity measures (CAT, mMRC) were moderately correlated with both psychological symptoms and emotion-regulation difficulties (p < 0.05). CAT had a significant indirect adverse effect on physical quality of life via emotion regulation difficulties [b = –0.174, 95% CI (–0.303, –0.069)]. Perceived social support positively predicted physical quality of life via lower depressive symptoms (b = 0.52, 95% CI (0.06, 1.10)). Stress was indirectly associated with poorer psychological quality of life through reduced social support [b = –0.191, 95% CI (–0.363, –0.042)].

Psychosocial mechanisms substantially contribute to quality-of-life impairment in COPD and operate alongside traditional clinical indicators. Emotion-regulation difficulties and social support emerge as key psychological pathways linking symptom severity and quality-of-life outcomes, suggesting that comprehensive COPD management should integrate psychosocial intervention strategies.