Xu Tian,1,* Lijuan Yi,2,* Xiaoling Liu,3 Fengli Zuo,4 Hongcai Shang,5 Jianping Zhang,6 Yi Ren7 

1Division of Science & Technology and Foreign Affairs, Chongqing Center for Evidence-Based Traditional Chinese Medicine, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400020, People’s Republic of China; 2Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou, 412012, People’s Republic of China; 3Department of Nuclear Medicine, Chongqing University Cancer Hospital, Chongqing, 400030, People’s Republic of China; 4Department of Lung Diseases, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400020, People’s Republic of China; 5Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, People’s Republic of China; 6Department of Nursing, Shapingba District Hospital of Traditional Chinese Medicine, Chongqing, 400030, People’s Republic of China; 7Department of Classic Traditional Chinese Medicine, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400020, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Jianping Zhang, Department of Nursing, Shapingba District Hospital of Traditional Chinese Medicine, No. 167, Xiaoyanggongqiao, Shapingba District, Chongqing, 400030, People’s Republic of China, Email 339009454@qq.com Yi Ren, Department of Classic Traditional Chinese Medicine, Chongqing Traditional Chinese Medicine Hospital, No. 6 of 7th Brach of Panxi Road, Jiangbei District, Chongqing, 400020, People’s Republic of China, Email cqszyyrenyi@163.com

Background: Psychological distress is prevalent in patients with stable chronic obstructive pulmonary disease (COPD) and may contribute to disease progression. However, the interplay among its influencing factors remains unclear. This study aimed to explore how social support, symptom burden, dyspnea, perceived stress, perceived stigma, and coping styles impact psychological distress in stable COPD using a structural equation model (SEM).
Methods: A convenience sample of 386 stable COPD patients was recruited from three tertiary hospitals in Chongqing, China. Data were collected using Distress Thermometer, Perceived Social Support Scale, COPD Assessment Test, the Modified Medical Research Council Dyspnea Score, the Perceived Stress Scale 10-item version, the Stigma Scale for Chronic Illness 8-item version, and the Simplified Coping Style Questionnaire were used for data collection. SEM was used for relationships among variables.
Results: The mean psychological distress score was (3.770 ± 1.525). Positive coping style (β = − 0.329, p < 0.001) and perceived social support (β = − 0.750, p < 0.001) reduced psychological distress directly. In contrast, negative coping style (β = 0.360, p < 0.001), symptom burden (β = 0.317, p < 0.001), dyspnea (β = 0.396, p < 0.001), perceived stress (β = 0.268, p < 0.001), and stigma (β = 0.224, p < 0.001) increased it. Perceived social support exerted extensive indirect effects on psychological distress (total effect = − 1.044) by reducing symptom burden (β = − 0.681), dyspnea (β = − 0.673), and negative coping style (β = − 0.726), and by improving positive coping style (β = 0.781) and perceived stress (β = − 0.688). Similarly, symptom burden indirectly influenced distress via coping styles (indirect effect = 0.290).
Conclusion: Psychological distress in stable COPD patients is influenced by interrelated factors, with perceived social support playing a central role. Healthcare interventions should focus on improving coping strategies, managing symptoms, and strengthening social support to alleviate distress.

Keywords: pulmonary disease, chronic obstructive pulmonary disease, psychological distress, influencing factors, structural equation model