The effect of clinical and psychosocial factors on quality of life in COPD: a cross-sectional assessment using a mediation analysis approach

Objective: This study aimed to examine the relative contributions of clinical severity indicators and psychosocial factors-including depression, anxiety, stress, emotion regulation difficulties, and perceived social support-on quality of life in patients with Chronic Obstructive Pulmonary Disease (COPD), and to test their mediating mechanisms within an integrated model. Methods: A total of 120 patients with COPD were assessed using spirometry, dyspnea, and symptom severity measures (mMRC, CAT), psychological assessments (DASS-21, DERS-16, MSPSS), and the WHOQOL-BREF. Mediation models using the PROCESS macro (Model 4) for SPSS were applied to evaluate the pathways linking clinical severity and psychosocial factors to quality-of-life domains. Results: Among 120 participants diagnosed with COPD, disease stages were found to be GOLD A: 25.8%, GOLD B: 35.8%, and GOLD E: 38.3%. Clinical severity measures (CAT, mMRC) were moderately correlated with both psychological symptoms and emotion-regulation difficulties (p < 0.05). CAT had a significant indirect adverse effect on physical quality of life via emotion regulation difficulties [b = -0.174, 95% CI (-0.303, -0.069)]. Perceived social support positively predicted physical quality of life via lower depressive symptoms (b = 0.52, 95% CI (0.06, 1.10)). Stress was indirectly associated with poorer psychological quality of life through reduced social support [b = -0.191, 95% CI (-0.363, -0.042)]. Conclusion: Psychosocial mechanisms substantially contribute to quality-of-life impairment in COPD and operate alongside traditional clinical indicators. Emotion-regulation difficulties and social support emerge as key psychological pathways linking symptom severity and quality-of-life outcomes, suggesting that comprehensive COPD management should integrate psychosocial intervention strategies.