Relationship between dyspnea, fear, anxiety and depression in patients with mild acute respiratory distress syndrome

Abstract

BACKGROUND

Acute respiratory distress syndrome (ARDS) is a severe clinical syndrome caused by multiple factors within or outside the lungs and is mainly characterized by progressive hypoxemia and respiratory distress. With the continuous advancement in critical care medicine, diagnosis, and treatment techniques, the survival rate of patients with ARDS has significantly improved. However, the focus of clinical attention has shifted from simple mortality to long-term functional recovery and improved quality of life. Patients with mild ARDS, as a large group, have relatively mild pathophysiological damage. However, the physical and mental distress they experience should not be ignored. Shortness of breath, one of the core and most painful symptoms of ARDS, is not only a physiological sensation, but also triggers a strong psychological stress response. However, in China, research on the current fear of dyspnea among patients with ARDS, especially those with mild symptoms, and its psychological driving factors is still insufficient.

AIM

To explore the relationship between fear of dyspnea, anxiety, and depression in patients with mild ARDS and to construct a structural equation model (SEM) to analyze the pathways of action and provide a basis for clinical psychological intervention.

METHODS

This study used a cross-sectional design. A total of 276 patients with mild ARDS who were admitted to the Department of Intensive Care, Guannan First People’s Hospital and the Department of Critical Care Medicine of the Affiliated Hospital of Yangzhou University between January 2023 and June 2025 were selected as research subjects. General information questionnaires, the Fear of Breathlessness Questionnaire, and Hospital Anxiety and Depression Scale were used for assessment. Pearson’s correlation analysis was conducted to explore the relationships between variables. In addition, a SEM was constructed to verify the mediating effect.

RESULTS

The fear-of-breathlessness score of the 276 patients was 21.5 points ± 4.2 points, and the positive rates of anxiety and depression symptoms were 42.8% and 36.2%, respectively. Correlation analysis showed that fear-of-breathlessness was significantly and positively correlated with anxiety (r = 0.532, P < 0.01) and depression (r = 0.487, P < 0.01). The SEM fit well (χ²/df = 1.423, root mean squared error of approximation = 0.039, comparative fit index = 0.982, Tucker-Lewis index = 0.975). Path analysis indicated that the direct effect of anxiety on fear-of-breathlessness was 0.412 (P < 0.01), and the direct effect of depression was 0.298 (P < 0.01). Simultaneously, anxiety had an indirect effect on fear-of-breathlessness through depression (β = 0.156, P < 0.05).

CONCLUSION

Fear-of-breathlessness in patients with mild ARDS is closely related to anxiety and depression. Anxiety not only directly affects fear-of-breathlessness levels, but also indirectly affects depression. Clinically, attention should be paid to the psychological state of patients. Targeted interventions should be implemented to alleviate fear-of-breathlessness.

Keywords: Acute respiratory distress syndrome; Fear of dyspnea; Anxiety; Depression; Correlation; Psychological assessment; Structural equation modeling

Core Tip: This study reveals the interrelations between fear of dyspnea, anxiety, and depression in patients with mild acute respiratory distress syndrome through a structural equation model. Findings highlight that anxiety has both direct and indirect effects on dyspnea fear via depression, suggesting anxiety acts as a key mediator. Early identification and intervention for anxiety could reduce dyspnea-related psychological burden and improve recovery outcomes.