{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T20:53:31Z","timestamp":1773953611442,"version":"3.50.1"},"reference-count":30,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T00:00:00Z","timestamp":1625011200000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,6,14]]},"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The COVID-19 pandemic caused a massive shift in the focus of healthcare. Such changes could have affected health status and mental health in vulnerable patient groups. We aimed to investigate whether patients with chronic pulmonary and cardiac diseases had experienced high levels of psychological distress during the COVID-19 pandemic in the Netherlands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>COVID-19 pandemic-related changes in healthcare use, health status and psychological distress were investigated among patients with chronic obstructive pulmonary disease (COPD), pulmonary fibrosis (PF) and congestive heart failure (CHF), using an online nationwide survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>680 patients completed the survey. COPD was the most often reported diagnosis 334 (49%), followed by congestive heart failure 219 (32%) and PF 44 (7%). There were 79 (12%) patients with primary diagnosis \u2018other\u2019 than chronic cardiopulmonary disease, who also completed this survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Psychological distress was assessed via the DASS-21 score (Depression Anxiety Stress Scale). Moreover, specific worries and anxieties regarding COVID-19 were explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The frequency of contact with healthcare professionals changed in 52%. Changes in treatment were reported in 52%. Deterioration in health status was self-reported in 39%. Moderate to extremely severe levels of depression, anxiety and stress was observed in 25.8%, 28.5% and 14%, respectively. Over 70% reported specific worries and anxieties, such as about their own health and fear of being alone. Both the deterioration in health status and increased levels of anxiety were significantly (p&lt;0.001, p&lt;0.006) associated with changes in treatment. Exploratory analyses indicated that lack of social support may further increase anxiety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Healthcare use changed during the COVID-19 pandemic in the Netherlands. It was associated with a decrease in health status, and increased psychological stress among patients with chronic cardiopulmonary disorders. Provision of healthcare should be more sensitive to the mental health needs of these patients during subsequent COVID-19 waves.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-046883","type":"journal-article","created":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T12:37:54Z","timestamp":1625056674000},"page":"e046883","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Healthcare use during COVID-19 and the effect on psychological distress in patients with chronic cardiopulmonary disorders in the Netherlands: a cross-sectional study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3658-2503","authenticated-orcid":false,"given":"Beau D C","family":"Pouwels","sequence":"first","affiliation":[{"name":"Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4296-5076","authenticated-orcid":false,"given":"Sami O","family":"Simons","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurice","family":"Theunissen","sequence":"additional","affiliation":[{"name":"Centre of Expertise for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madelon L","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janna J","family":"Schoenmaekers","sequence":"additional","affiliation":[{"name":"Respiratory Medicine and Centre of Expertise for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastiaan C","family":"Bekkers","sequence":"additional","affiliation":[{"name":"Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2446-2862","authenticated-orcid":false,"given":"Marieke H J","family":"van den Beuken-van Everdingen","sequence":"additional","affiliation":[{"name":"Centre of Expertise for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,6,30]]},"reference":[{"key":"2025121510105304000_11.6.e046883.1","doi-asserted-by":"crossref","unstructured":"Guan WJ , Liang WH , Zhao Y , et al . China medical treatment expert group for C. comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020;55.","DOI":"10.1183\/13993003.01227-2020"},{"key":"2025121510105304000_11.6.e046883.2","article-title":"Prevalence of underlying diseases in hospitalized patients with COVID-19: a systematic review and meta-analysis","volume":"8","author":"Emami","year":"2020","journal-title":"Arch Acad Emerg Med"},{"key":"2025121510105304000_11.6.e046883.3","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s40249-020-00646-x","article-title":"Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review","volume":"9","author":"Adhikari","year":"2020","journal-title":"Infect Dis Poverty"},{"key":"2025121510105304000_11.6.e046883.4","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1016\/S2352-4642(20)30108-5","article-title":"Delayed access or provision of care in Italy resulting from fear of COVID-19","volume":"4","author":"Lazzerini","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"key":"2025121510105304000_11.6.e046883.5","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.puhe.2020.04.046","article-title":"Non-COVID-19 visits to emergency departments during the pandemic: the impact of fear","volume":"183","author":"Mantica","year":"2020","journal-title":"Public Health"},{"key":"2025121510105304000_11.6.e046883.6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0233147"},{"key":"2025121510105304000_11.6.e046883.7","first-page":"450","article-title":"[Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV]","volume":"48","author":"Peng","year":"2020","journal-title":"Zhonghua Xin Xue Guan Bing Za Zhi"},{"key":"2025121510105304000_11.6.e046883.8","unstructured":"Ministerie van Volksgezondheid, Welzijn en Sport . Epidemiologische situatie COVID-19 in Nederland: Rijksinstituut voor Volksgezondheid en milieu, 2020. Available: https:\/\/www.rivm.nl\/sites\/default\/files\/2020-05\/COVID-19_WebSite_rapport_20200520_1022.pdf"},{"key":"2025121510105304000_11.6.e046883.9","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1177\/02692163211003778","article-title":"Dying in times of the coronavirus: an online survey among healthcare professionals about end-of-life care for patients dying with and without COVID-19 (the CO-LIVE study)","volume":"35","author":"Onwuteaka-Philipsen","year":"2021","journal-title":"Palliat Med"},{"key":"2025121510105304000_11.6.e046883.10","doi-asserted-by":"publisher","DOI":"10.1348\/014466505X29657"},{"key":"2025121510105304000_11.6.e046883.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2008.01.023"},{"key":"2025121510105304000_11.6.e046883.12","unstructured":"Government of western Australia . DASS-21: Black Dog Institute, 2020. Available: https:\/\/www.workcover.wa.gov.au\/wp-content\/uploads\/sites\/2\/2015\/07\/3.dass21withscoringinfo.pdf"},{"key":"2025121510105304000_11.6.e046883.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-040951"},{"key":"2025121510105304000_11.6.e046883.14","doi-asserted-by":"crossref","DOI":"10.1016\/S1470-2045(20)30397-1","article-title":"Disruption of cancer care in Canada during COVID-19","volume":"21","author":"Chen-See","year":"2020","journal-title":"Lancet Oncol"},{"key":"2025121510105304000_11.6.e046883.15","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.dsx.2020.06.042","article-title":"Impact of COVID-19 on routine care for chronic diseases: a global survey of views from healthcare professionals","volume":"14","author":"Chudasama","year":"2020","journal-title":"Diabetes Metab Syndr"},{"key":"2025121510105304000_11.6.e046883.16","doi-asserted-by":"crossref","first-page":"e2014053","DOI":"10.1001\/jamanetworkopen.2020.14053","article-title":"Prevalence of and risk factors associated with mental health symptoms among the general population in China during the coronavirus disease 2019 pandemic","volume":"3","author":"Shi","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2025121510105304000_11.6.e046883.17","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.rmed.2016.06.006","article-title":"Prevalence of depression in COPD: a systematic review and meta-analysis of controlled studies","volume":"117","author":"Matte","year":"2016","journal-title":"Respir Med"},{"key":"2025121510105304000_11.6.e046883.18","doi-asserted-by":"crossref","first-page":"S199","DOI":"10.1016\/j.ihj.2018.10.410","article-title":"Frequency and predictors of depression in congestive heart failure","volume":"70 Suppl 3","author":"Zahid","year":"2018","journal-title":"Indian Heart J"},{"key":"2025121510105304000_11.6.e046883.19","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(20)30308-4"},{"key":"2025121510105304000_11.6.e046883.20","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp20X713021"},{"key":"2025121510105304000_11.6.e046883.21","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.bbi.2020.05.048","article-title":"COVID-19 pandemic and mental health consequences: systematic review of the current evidence","volume":"89","author":"Vindegaard","year":"2020","journal-title":"Brain Behav Immun"},{"key":"2025121510105304000_11.6.e046883.22","doi-asserted-by":"crossref","DOI":"10.1016\/j.psychres.2020.113462","article-title":"Lockdown, quarantine measures, and social distancing: associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany","volume":"293","author":"Benke","year":"2020","journal-title":"Psychiatry Res"},{"key":"2025121510105304000_11.6.e046883.23","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00023214"},{"key":"2025121510105304000_11.6.e046883.24","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.ijcard.2016.03.180","article-title":"Physical activity, weight status, and mortality among congestive heart failure patients","volume":"214","author":"Loprinzi","year":"2016","journal-title":"Int J Cardiol"},{"key":"2025121510105304000_11.6.e046883.25","article-title":"Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China","volume":"17","author":"Wang","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2025121510105304000_11.6.e046883.26","doi-asserted-by":"crossref","DOI":"10.1186\/s12890-020-1130-1","article-title":"Findings from a pilot randomised trial of a social network self-management intervention in COPD","volume":"20","author":"Welch","year":"2020","journal-title":"BMC Pulm Med"},{"key":"2025121510105304000_11.6.e046883.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2015.12.017"},{"key":"2025121510105304000_11.6.e046883.28","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2020-215095"},{"key":"2025121510105304000_11.6.e046883.29","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2009166"},{"key":"2025121510105304000_11.6.e046883.30","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1007\/s40273-016-0389-9","article-title":"Health, health-related quality of life, and quality of life: what is the difference?","volume":"34","author":"Karimi","year":"2016","journal-title":"Pharmacoeconomics"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-046883","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T18:10:59Z","timestamp":1765822259000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-046883"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6]]},"references-count":30,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,30]]},"published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1136\/bmjopen-2020-046883"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-046883","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6]]}}}