Exploring the psychological profile: A cross-sectional study of 1185 pulmonary nodules patients in the out-patient clinic

Purpose: To identify the potential risk or protective factors for psychological burdens in patients with pulmonary nodules (PNs) and to explore how the patients’ psychological status affect their treatment preferences. Methods This questionnaire-based study evaluated 1185 out-patients using the Hospital Anxiety and Depression Scale (HADS) and explored the correlations between psychological burdens and their sociodemographic and clinical characteristics. Results Prevalence of anxiety and depression was 42.1% and 27.0%, respectively, among patients with PNs. Binary logistic regression analysis revealed that age ≥ 60 years (OR = 0.57, 95% CI = 0.36–0.89), CT scan due to physical discomfort (OR = 1.58, 95% CI = 1.11–2.24), multiple PNs (OR = 1.60, 95% CI = 1.26–2.04), family history of malignancy (OR = 1.29, 95% CI = 1.02–1.64), and subjective symptoms (OR = 1.73, 95% CI = 1.35–2.22) were independent influencing factors of anxiety, while CT scan due to physical discomfort (OR = 1.46, 95% CI = 0.96–2.23), multiple PNs (OR = 1.71, 95% CI = 1.27–2.31), subjective symptoms (OR = 1.71, 95% CI = 1.24–2.34) and indeterminate nodules (OR = 2.02, 95% CI = 1.08–3.77) were independently associated with depression. There was a tendency for patients with anxiety and depression to choose more aggressive management strategies (P༜0.001 and P = 0.001, respectively).Univariate analysis showed that symptomatic patients (χ2 = 9.696, p = 0.021) and those with progressive nodules (χ2 = 18.198, p = 0.033) choose more aggressive treatment strategies. Conclusion Anxiety and depression are common in patients with pulmonary nodules, which might result in nonnegligible overtreatment. The presence of subjective symptoms can significantly exacerbate the psychological burden and influence the treatment preference. Taking psychological issue into consideration in outpatient clinic might facilitate the patient-centered communication and promote judicious decision-making.