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Originalarbeit

Tabakabhängigkeit, Rauchverhalten und Depressivität bei COPD- Patienten: Teilergebnisse einer naturalistischen Studie zur krankheitsspezifischen Tabak- entwöhnung in pneumologischen Facharztpraxen (ATEMM-Studie)

Published Online:March 06, 2019https://doi.org/10.1024/0939-5911/a000577

Abstract

Zusammenfassung.Zielsetzung: Die chronisch-obstruktive Lungenerkrankung COPD wird hauptsächlich durch Tabakrauchen verursacht. Die Quote aktiver Raucher liegt in dieser Patientengruppe bei 33–50 %. Zugleich weisen COPD-Patienten eine im Bevölkerungsvergleich überdurchschnittliche psychische Komorbidität auf. Mögliche Zusammenhänge zwischen Depressivität, Tabakrauchen und Abstinenzerfolg werden im prospektiven Kohortendesign nach einer komplexen Tabakentwöhnungsintervention bei COPD untersucht. Methode: Anhand einer Teilstichprobe (N = 209) der ATEMM-Studie (AOK PLUS-Studie zur strukturierten Tabakentwöhnung durch pneumologische Facharztpraxen und Psychotherapeuten in Sachsen und Thüringen mit Minimalintervention vs. Maximalintervention) wurde überprüft, inwieweit Patienten mit depressiver Komorbidität zu ausgeprägterem Tabakkonsum und Rauchverhalten sowie einer höheren Tabakabhängigkeit und Misserfolgsquote neigen als psychisch unauffällige Patienten. Ergebnisse: Patienten mit Verdacht auf ein depressives Syndrom (PHQ-D) weisen eine hohe Rauchchronizität auf (96 % ≥ 20 Packungsjahre), bei psychisch unauffälligen Personen ist der Anteil signifikant niedriger (74 %, p = .045). Depressivität ist assoziiert mit höherer Tabakabhängigkeit. Zwischen depressiver Symptomatik und 12-Monatstabakabstinenz besteht kein signifikanter Zusammenhang. Diskussion: Der hypothetische Zusammenhang zwischen depressiver Komorbidität, Tabakabhängigkeit und Rauchintensität bzw. Entwöhnungserfolg wird im Wesentlichen gestützt. Depressiv komorbide Patienten rauchen besonders stark und mit hoher Abhängigkeit. Die Misserfolgsquote (Rückfälligkeit bzw. keine anhaltende Abstinenz) ist nur bei schwerer Depressionsausprägung überdurchschnittlich. Eine konsequente psychologische Begleitbehandlung könnte den Entwöhnungserfolg erhöhen.


Tobacco dependence, smoking behavior and depressiveness among COPD patients: Partial results of a naturalistic study on a disease-specific smoking cessation in pulmonary practices (ATEMM-Study)

Abstract.Aims: The chronic obstructive pulmonary disease (COPD) is mainly caused by smoking tobacco. About 33–50 % of COPD patients are active smokers and show a considerably higher than average psychological comorbidity compared to the general population. Possible links between depression, tobacco smoking and cessation success amongst COPD patients are examined employing a prospective cohort design following a complex smoking cessation intervention. Method: Using a partial sample (N = 209) of the ATEMM-study (AOK PLUS-study for structured smoking cessation by pulmonary practices and psychotherapists in Saxony and Thuringia with minimal vs. maximal intervention), analysis examined whether patients with depressive comorbidity display more pronounced tobacco smoking behaviors as well as higher tobacco dependence and failure rate than mentally healthy patients. Results: Among patients with a suspected depressive syndrome (PHQ-D) was a significant larger proportion of a long cumulative smoke exposure (96 % ≥ 20 Pack-Years) than among those without comorbidity (74 %, p = 0.045). Depressiveness is associated with a higher tobacco dependence. There was no significant link between depressive symptomatology and 12-month abstinence. Conclusions: The hypothesized link between depressive comorbidity, tobacco dependence and smoking intensity as well as cessation success could largely be supported. Patients with depressive comorbidity were heavier smokers with higher rates of dependence. Higher-than average failure rates (relapse or no sustained abstinence) were only found in patients with a higher severity of depression. A continuous psychological treatment could enhance the success of cessation efforts.

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