Psychological Defenses and Coping Styles in Patients Following a Life-Threatening Attack of Asthma

Psychological Defenses and Coping Styles in Patients Following a Life-Threatening Attack of AsthmaPaterson and Musk have noted the trend of increasing asthma mortality rates in Australia. Of particular concern is the apparent increase in mortality rates in male patients aged less than 34 years, and the evidence that there are higher mortality rates from asthma in Australia and New Zealand compared with other westernized countries, although it has been noted that most of the recent increase in rates in Australia is related to changed death certification practices in elderly patients.
The psychological defenses used in patients with asthma have been well described in the literature. Dirks et al have defined three types of coping style. These consist of, first, an appropriate adaptive response to asthma management; second, the use of “hopeless dependency” on physicians and hospital services; and third, “inappropriate excessive independence.” This third defensive style, which is related to patients high use of denial of their illness, and of the need for compliance with medication, has been noted to lead to excessive hospitalization rates.

There are few papers in the literature that have commented on psychological issues in patients with life-threatening asthma. Strunk et al, in a well-conducted case controlled study of 21 children with severe asthma who died of asthma following discharge from hospital, found that psychological risk factors “were prominent in severely asthmatic children who subsequently died of asthma.” The psychological risk factors that were identified in this study included disregard of asthmatic symptoms, depressive symptoms, conflicts between the patients parents and hospital staff regarding the medical management of the patient and self-care of asthma while in hospital that was not appropriate for age. Rae et al, in a case control study of deaths from asthma in New Zealand adults, identified a variety of factors that delineated patients with asthma who are at high risk of death. Among these factors was noncompliance with medication, which it is reasonable to assume would be increased in patients who deny their illness excessively, as well as the presence of overt psychosocial problems. Yellowlees et al compared the psychiatric status of 13 patients who had suffered a near miss asthma death with 36 patients with asthma who had not experienced such an episode and found few differences between the groups. Both groups did, however, show higher than expected levels of psychiatric morbidity, severe lifestyle and social restrictions, and an unexpectedly high compliance with prescribed medication.
This report is a detailed analysis of the psychiatric disorders seen in, and the coping styles used by, patients who have suffered a life-threatening attack of asthma. It was hypothesized that these patients would have a high rate of psychiatric disorders related to the life-threatening nature of their chronic disease, and also significant levels of anxiety and disturbance within their families. It was also predicted that the levels of denial employed by these patients would not be excessively high because it was assumed that the experience of having had a near miss asthma death, and the consequences of this, would make patients less able to deny their illness and its implications.