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

Flinders Medical Center is a 500-bed teaching hospital in Adelaide, South Australia. For the purposes of this study, asthma was defined by a history of variable cough, wheeze, and dyspnea, with measured increased bronchial responsiveness to inhaled histamine, or a 20 percent increase in forced expiratory volume in one second spontaneously or in response to inhaled bronchodilator agents. The Respiratory Unit is following those patients who have suffered a near miss asthma death. The NMAD has been defined as an episode of severe acute asthma with respiratory failure and/or an altered state of consciousness. Patients who survive such a life-threatening episode of asthma are, if they wish, reviewed monthly by a respiratory physician for at least one year. All patients being followed in this way and all other patients who have suffered a NMAD and have been admitted to Flinders Medical Center within the past three years were contacted and asked to take part in this study. Only three patients who were able to be contacted refused to take part. A cohort of 25 patients out of a possible 28 has consequently been obtained. fully

The patients all underwent the same psychiatric and psychological assessment process, and this has been described in detail elsewhere. Each patient underwent about five hours of psychiatric and psychological assessment which included a detailed clinical interview and allocation of a psychiatric diagnosis, if appropriate, using DSM-III criteria, two structured interviews, one of which was developed specifically for this study while the other consisted of the Diagnostic Interview Schedule, as well as the completion of a variety of questionnaires. These questionnaires included the Eysenck Personality Inventory, the General Health Questionnaire, the Middlesex Hospital Questionnaire, the Asthma Symptom Checklist, the Illness Behaviour Questionnaire, and the Quality of Life Index. The questionnaires were specifically chosen to help delineate further the presence and type of psychiatric disorders seen in this physically ill population, as well as to look at their coping and adaptive styles in relation to their illness. All the questionnaires have been validated and been found to be reliable in clinical use. Statistical analyses were performed on a personal computer.