A Multidimensional Perspective on COPD: How Coping Styles and Self-Esteem Relate to Psychological Distress and Functional Capacity.

Purpose: Emerging evidence indicates that psychological resources may influence clinical outcomes and disease burden in chronic obstructive pulmonary disease (COPD), but their interactions are still not well understood. This study examined how coping strategies and self-esteem are connected to psychological distress, symptom impact, and functional capacity in moderate and severe COPD. Patients and Methods: A cross-sectional study was conducted between December 2024 and July 2025 at a tertiary pulmonary center. Ninety-three patients with stable COPD were enrolled and classified into moderate (n = 43) and severe (n = 50) groups according to GOLD criteria. Assessments included spirometry, 6-minute walk test (6MWT), COPD Assessment Test (CAT), modified Medical Research Council (mMRC) scale, Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-Esteem Scale (RSES), and the COPE inventory. Statistical analyses comprised group comparisons, correlation analyses with Benjamini-Hochberg correction, and multiple linear regression to identify independent predictors of coping styles. Results: Severe COPD was associated with lower self-esteem (median RSES 18.5 vs 21, p < 0.0001), reduced 6MWT (203 m vs 300 m, p < 0.0001), higher anxiety (HADS-A 9.5 vs 7, p = 0.0001), and greater symptom burden (CAT 25 vs 19, p < 0.0001). These patients relied less on problem- (27 vs 31, p < 0.0001) and emotion-focused coping (23 vs 27, p < 0.0001), but more on avoidant coping (21 vs 19, p < 0.0001). Correlations showed that problem- and emotion-focused coping were linked to higher self-esteem and better 6MWT performance, whereas avoidant coping was related to greater dyspnea, higher CAT, and lower self-esteem. Regression analyses identified dyspnea severity (mMRC, p = 0.018) and lower FEV1% (p = 0.0003) as predictors of avoidant coping, while self-esteem (p = 0.036) and 6MWT % (p = 0.015) predicted adaptive coping. Conclusion: Severe COPD is associated with greater psychological distress, reduced self-esteem, and reliance on avoidant coping. In contrast, higher self-esteem and better functional capacity favor adaptive coping strategies.