Impact of Ruminative Thinking on Breathlessness Catastrophizing With Elderly COPD Patients: The Mediating Role of Self‐Efficacy

ABSTRACT Background It is extremely significant to explore the relationship between ruminative thinking and breathlessness catastrophizing among elderly COPD patients. However, the impact of self‐efficacy on this relationship is still unclear. This study attempted to explore the mediating role of self‐efficacy between ruminative thinking and breathlessness catastrophizing. Design A cross‐sectional study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Methods This study was conducted between 10 November 2024 and 25 January 2025, with 225 patients. Data were collected using the valid and reliable instruments, including the Ruminative Response Scale (RRS), the COPD Self‐Efficacy Scale (CSES) and the Breathlessness Catastrophizing Scale (BCS). Additionally, IBM SPSS v28.0 software was used to explore the mediating effect. Results The scores for BCS of most patients were at moderate and high levels. Scores for the RRS and CSES were significantly correlated with the BCS. The analysis of the mediating effect demonstrated that ruminative thinking has a direct predictive effect on breathlessness catastrophizing. Additionally, ruminative thinking can also predict breathlessness catastrophizing indirectly through the mediation of self‐efficacy. The direct effect accounted for 64.4% of the total effect. Conclusion This research revealed that self‐efficacy played a partial mediating role in the relationship between ruminative thinking and breathlessness catastrophizing. Specifically, patients who were trapped in ruminative thinking were more likely to experience heightened breathlessness catastrophizing, but this relationship was mitigated by their level of self‐efficacy. Implications for the Profession and/or Patient Care This finding underscores the significant psychological burden that accompanies the physical symptoms of COPD in this demographic. It is imperative that nurses adopt a holistic approach in the management of elderly COPD patients. Patient or Public Contribution Voluntary patients with elderly COPD hospitalised in the pneumology department were included in the study.