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

Table 1 Hospital Anxiety and Depression Scale scoring criteria

Category	Anxiety total score (A)	Depression total score (D)	Explanation and recommendations
No symptoms	0 point to 7 points	0 point to 7 points	Within the normal range, indicative of typical mood fluctuations
Suspicious or mild	8 points to 10 points	8 points to 10 points	May indicate mild anxiety/depressive symptoms; recommended to monitor and re-evaluate periodically
Moderate	11 points to 14 points	11 points to 14 points	Indicates moderate anxiety/depressive symptoms; strongly recommended to seek help from a professional (e.g., psychiatrist or psychologist)
Severe	15 points to 21 points	15 points to 21 points	Indicates severe anxiety/depressive symptoms; immediate professional assessment and treatment are strongly advised

Table 2 Univariate analysis of fear of dyspnea in patients with mild acute respiratory distress syndrome

Influencing factors	Groups	n/(%)	Dyspnea fear score, M (P25, P75)	Statistic	P value
Oxygenation index	≤ 250 mmHg	142	24.0 (20.0, 27.0)	Z = 3.89	< 0.001
	> 250 mmHg	134	20.0 (16.0, 23.0)
APACHE II score	≤ 10	158	20.0 (16.0, 23.0)	χ2 = 8.76	0.003
	11-15	118	23.0 (19.0, 26.0)
Complications	No	102	19.0 (15.0, 22.0)	Z = 4.12	< 0.001
	Have	174	23.0 (19.0, 26.0)
Gender	Male		21.0 (17.0, 24.0)	Z = 1.32	0.187
	Female		23.0 (19.0, 26.0)
Age	< 40 years old		20.0 (16.0, 23.0)	χ2 = 5.67	0.059
	40 years old to 60 years old		22.0 (18.0, 25.0)
	60 years old		23.0 (19.0, 26.0)
Anxiety state	Positive		25.0 (22.0, 28.0)	Z = 5.23	< 0.001
	Negative		20.0 (16.0, 23.0)
Depression state	Positive		24.0 (20.0, 27.0)	Z = 3.45	0.001
	Negative		21.0 (17.0, 24.0)

APACHE II: Acute Physiology and Chronic Health Evaluation II.

Table 3 Spearman correlation coefficient matrix between fear of dyspnea in patients with mild acute respiratory distress syndrome and each study variable

Variables	Dyspnea fear	Degree of dyspnea	Catastrophizing cognition	Self-efficacy	Anxiety symptoms
Difficulty in breathing and fear	1.000
Degree of breathing difficulty	0.632a	1.000
Catastrophizing cognition	0.781a	0.654a	1.000
Self-efficacy	-0.723a	-0.687a	-0.802a	1.000
Anxiety state	0.698a	0.592a	0.712a	-0.745a	1.000
Depressive state	0.657a	0.603a	0.683a	-0.728a	0.835a

^aP < 0.01 (bilateral test); all correlation coefficients remained statistically significant after Bonferroni correction.

Table 4 Results of multivariate regression analysis of fear of dyspnea in patients with mild acute respiratory distress syndrome

Variable	β (95%CI)	Standardize β’	T value	P value	VIF
Constant	18.72 (16.85-20.59)	-	20.37	< 0.001	-
Catastrophizing cognition	0.41 (0.35-0.47)	0.382	13.65	< 0.001	2.12
Oxygenation index	-0.03 (-0.05 to -0.01)	-0.158	3.12	0.002	1.89
Anxiety symptoms	0.29 (0.21-0.37)	0.241	7.33	< 0.001	2.45
Self-efficacy	-0.19 (-0.25 to -0.13)	-0.175	6.08	< 0.001	2.67
Exercise habit	-1.85 (-2.97 to -0.73)	-0.092	3.28	0.001	1.34

VIF: Variance inflation factor; CI: Confidence interval.

Table 5 Path effect analysis (bootstrap 5000 times)

Path	Standardized β’	95%CI	P value
Oxygenation index, catastrophizing cognition	-0.287	-0.38 to -0.19	< 0.001
Catastrophizing cognition, anxiety	0.513	0.42-0.61	< 0.001
Anxiety, difficulty in breathing and fear	0.324	0.25-0.40	< 0.001
Self-efficacy, fear	-0.298	-0.37 to -0.22	< 0.001
Catastrophizing cognition, fear	0.401	0.32-0.48	< 0.001

CI: Confidence interval.