{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:06:36Z","timestamp":1789430796471,"version":"build-2803163510"},"reference-count":26,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy, Timisoara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by significant physical and psychological burdens. However, the influence of the disease\u2019s severity on psychological factors and functional outcomes remains unclear. This study aimed to investigate the impact of disease severity on psychological factors and functional outcomes in patients with moderate and severe COPD. Methods: This cross-sectional study included 98 patients with moderate (n = 44) or severe (n = 54) COPD. Anxiety and depression, guilt and shame, self-compassion, self-efficacy (PRAISE), and fear of negative evaluation were assessed. Functional capacity was evaluated with the six minute walk test (6MWT), and disease impact was assessed via the COPD assessment test (CAT). Lung function was measured through post-bronchodilator spirometry. Results: Compared with those with moderate COPD, those with severe COPD presented significantly greater levels of guilt (12 vs. 10; p &lt; 0.01), anxiety (10 vs. 6.5; p &lt; 0.01), and depression (7.5 vs. 6; p = 0.06). Self-compassion was significantly lower in the severe group (3.16 vs. 3.41; p &lt; 0.01), whereas shame and fear of negative evaluation scores were similar between the groups. The functional capacity was significantly reduced in patients with severe COPD (217.04 \u00b1 70.16 m vs. 286.46 \u00b1 77.92 m; p &lt; 0.01). Disease impact and dyspnea (CAT, mMRC) were worse in severe cases (p &lt; 0.01). Conclusions: Patients with severe COPD presented significantly greater levels of guilt, anxiety, and depression, alongside lower self-compassion, worse functional outcomes, and poorer health-related quality of life, compared to those with moderate COPD.<\/jats:p>","DOI":"10.3390\/jcm14061865","type":"journal-article","created":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T09:36:24Z","timestamp":1741599384000},"page":"1865","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Impact of Chronic Obstructive Pulmonary Disease Severity on Psychological and Functional Outcomes: A Cross-Sectional Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6020-4593","authenticated-orcid":false,"given":"Alexandru Florian","family":"Crisan","sequence":"first","affiliation":[{"name":"Research Center for Assessment of Human Motion, Functionality, and Disability, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Pulmonary Rehabilitation Center, Clinical Hospital of Infectious Diseases and Pulmonology, \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7573-3714","authenticated-orcid":false,"given":"Camelia Corina","family":"Pescaru","sequence":"additional","affiliation":[{"name":"Pulmonary Rehabilitation Center, Clinical Hospital of Infectious Diseases and Pulmonology, \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"},{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2112-2923","authenticated-orcid":false,"given":"Adelina","family":"Maritescu","sequence":"additional","affiliation":[{"name":"Pulmonary Rehabilitation Center, Clinical Hospital of Infectious Diseases and Pulmonology, \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"},{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4620-3340","authenticated-orcid":false,"given":"Emil Robert","family":"Stoicescu","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Faculty of Mechanics, Field of Applied Engineering Sciences, Specialization Statistical Methods and Techniques in Health and Clinical Research, \u2018Politehnica\u2019 University Timisoara, Mihai Viteazul Boulevard No. 1, 300222 Timisoara, Romania"},{"name":"Research Center for Pharmaco-Toxicological Evaluations, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vlad","family":"Carunta","sequence":"additional","affiliation":[{"name":"Pulmonary Rehabilitation Center, Clinical Hospital of Infectious Diseases and Pulmonology, \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Oancea","sequence":"additional","affiliation":[{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Pulmonology Clinic, Clinical Hospital of Infectious Diseases and Pulmonology, \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/S2213-2600(23)00461-7","article-title":"GOLD COPD report: 2024 update","volume":"12","author":"Venkatesan","year":"2024","journal-title":"Lancet Respir. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e1183","DOI":"10.1016\/S2214-109X(23)00217-6","article-title":"The global economic burden of chronic obstructive pulmonary disease for 204 countries and territories in 2020\u201350: A health-augmented macroeconomic modelling study","volume":"11","author":"Chen","year":"2023","journal-title":"Lancet Glob. Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.2147\/COPD.S188141","article-title":"Activity-related dyspnea in chronic obstructive pulmonary disease: Physical and psychological consequences, unmet needs, and future directions","volume":"14","author":"Hanania","year":"2019","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1906.e1","DOI":"10.1016\/j.jamda.2017.09.007","article-title":"Management of Dyspnea and Anxiety in Chronic Obstructive Pulmonary Disease: A Critical Review","volume":"18","author":"Yohannes","year":"2017","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3397","DOI":"10.2147\/COPD.S338720","article-title":"Self-Efficacy Intervention Programs in Patients with Chronic Obstructive Pulmonary Disease: Narrative Review","volume":"16","author":"Yi","year":"2021","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"123","DOI":"10.3390\/arm91020011","article-title":"The Impact of Anxiety and Depression in Chronic Obstructive Pulmonary Disease","volume":"91","author":"Rahi","year":"2023","journal-title":"Adv. Respir. Med."},{"key":"ref_7","first-page":"PA4138","article-title":"Anxiety and depression in Chronic Obstructive Pulmonary Disease: A systematic review and meta-analysis","volume":"62","author":"Miah","year":"2023","journal-title":"Eur. Respir. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.physio.2018.07.009","article-title":"The Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE) tool predicts reduction in sedentary time following pulmonary rehabilitation in people with chronic obstructive pulmonary disease (COPD)","volume":"105","author":"Liacos","year":"2019","journal-title":"Physiotherapy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1177\/1479972316654284","article-title":"Exploring self-conscious emotions in individuals with chronic obstructive pulmonary disease: A mixed-methods study","volume":"14","author":"Harrison","year":"2016","journal-title":"Chron. Respir. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.2147\/COPD.S306874","article-title":"Stigma Experiences in People with Chronic Obstructive Pulmonary Disease: An Integrative Review","volume":"16","author":"Woo","year":"2021","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"335","author":"Altman","year":"2007","journal-title":"BMJ Br. Med. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1164\/rccm.202301-0106PP","article-title":"Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary","volume":"207","author":"Celli","year":"2023","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"E70","DOI":"10.1164\/rccm.201908-1590ST","article-title":"Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement","volume":"200","author":"Graham","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1183\/09031936.00025214","article-title":"The COPD assessment test: A systematic review","volume":"44","author":"Gupta","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/0005-7967(96)00034-4","article-title":"Conceptual and methodological issues in the assessment of shame and guilt","volume":"34","author":"Tangney","year":"1996","journal-title":"Behav. Res. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1177\/0146167283093007","article-title":"A Brief Version of the Fear of Negative Evaluation Scale","volume":"9","author":"Leary","year":"1983","journal-title":"Pers. Soc. Psychol. Bull."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.janxdis.2004.02.003","article-title":"The validity of the brief version of the Fear of Negative Evaluation Scale","volume":"19","author":"Collins","year":"2005","journal-title":"J. Anxiety Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1080\/15298860309032","article-title":"Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself","volume":"2","author":"Neff","year":"2003","journal-title":"Self Identity"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.4187\/respcare.08889","article-title":"Modified Medical Research Council and COPD Assessment Test Cutoff Points","volume":"66","author":"Munari","year":"2021","journal-title":"Respir. Care"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002). ATS statement: Guidelines for the six-minute walk test. Am. J. Respir. Crit. Care Med., 166, 111\u2013117.","DOI":"10.1164\/ajrccm.166.1.at1102"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.rmed.2009.12.007","article-title":"Determinants of poor 6-min walking distance in patients with COPD: The ECLIPSE cohort","volume":"104","author":"Spruit","year":"2010","journal-title":"Respir. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1080\/17476348.2016.1198697","article-title":"Could targeting disease specific fear and anxiety improve COPD outcomes?","volume":"10","author":"Janssens","year":"2016","journal-title":"Expert. Rev. Respir. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1183\/16000617.0170-2022","article-title":"Nonpharmacological management of psychological distress in people with COPD","volume":"32","author":"Volpato","year":"2023","journal-title":"Eur. Respir. Rev."},{"key":"ref_25","first-page":"OA4873","article-title":"Characteristics of people with COPD associated with emotions of shame and guilt","volume":"62","author":"Lundell","year":"2023","journal-title":"Eur. Respir. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.pec.2015.10.031","article-title":"Self-management and quality of life in chronic obstructive pulmonary disease (COPD): The mediating effects of positive affect","volume":"99","author":"Benzo","year":"2016","journal-title":"Patient Educ. Couns."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/6\/1865\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:50:09Z","timestamp":1760028609000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/6\/1865"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,10]]},"references-count":26,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14061865"],"URL":"https:\/\/doi.org\/10.3390\/jcm14061865","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,10]]}}}