Beyond diagnosis: coping strategies and their influence on Parkinson's patients' well-being

In a recent study published in Nature's Parkinson's Disease Journal, researchers determined the predictors of particular coping methods used by Parkinson's Disease (PD) patients and whether their choices impacted their quality of life (QoL).

Study: Determinants of coping styles of people with Parkinson’s Disease. Image Credit: sruilk/Shutterstock.com

Background

PD, a chronic and progressive neurodegenerative disorder, presents with motor-type symptoms like rigidity, tremor, and bradykinesia, as well as non-motor-type symptoms such as cognitive functional impairments, hallucinations, depression, and fatigue.

Previous studies have reported an increase in PD progression with a concomitant rise in routine life impairments, and therefore, PD patients develop novel ways to cope with the challenges associated with the disease. However, data on the coping strategies used by PD patients are limited.

About the study

In the present study, researchers identified the predictors of coping strategies adopted by PD patients and evaluated their impact on the health-associated QoL.

The study included PD patients who had attended neurology outpatient clinics ≥1.0 times in the previous year to fulfill the prospective and observational PRIME-NL Parkinson Evaluation study.

The Ways of Coping Questionnaire (WCQ) was used to measure coping, whereas the 39-item PD Questionnaire (PDQ-39) was used to assess QoL.

The team performed factor analyses to determine how coping methods resembled or differed from prior findings among PD patients. They examined the WCQ's factor structure to determine the coping techniques used by the Dutch participants.

Linear regression modeling was performed to identify the determinants of coping strategies, followed by multivariate linear regression modeling to investigate how the coping method was related to the QoL domains, conditional on probable confounding factors. Stressful situations that the individuals thought of while filling out the WCQ were examined.

The interaction between employment status and quality of life was tested for individuals above and below 65. In addition, a sensitivity analysis was performed by excluding depression and anxiety from the study models.

In addition, the analysis was repeated without sex adjustments. As data were obtained during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, a questionnaire related to the pandemic's influence on mental well-being and accessibility to healthcare services was also filled out by the participants.

Results

In total, 977 of 988 individuals completed the questionnaires, of whom 935 and 42 were diagnosed with PD and atypical parkinsonism (AP), respectively. The mean participant age was 71 years, and 39.0% were female.

The coping strategies determined in the factor analyses were: "distancing away and fantasizing,"; "taking actions and focusing on the positives,"; "avoidance and acceptance", "planful and goal-oriented problem-solving," and "seeking social assistance."

Age, sex, anxiety, and education were related to the choice of coping technique. E.g., individuals with higher educational attainment preferred active coping.

Depending on other confounding factors, most strategies used for dealing with PD had limited effects on the quality of life. Personal traits and psychological status affected the PD patients' coping strategies.

However, only modest impacts of coping behaviors on the quality of life were observed. The most frequent reason for stress was associated with the family: 45% (n=419) of the participants developed pressure linked to family problems.

The interaction tests yielded non-significant differences by age. In the sensitivity analysis, "distancing" was negatively correlated with communication, cognition, bodily discomfort, and mobility, and "avoidance and acceptance" were strongly associated with better emotional health. Repeating the analysis without adjusting for sex yielded no significant differences.

Of 822 COVID-19-related questionnaire respondents, 33% (n=274) stated an enormous impact of COVID-19 on healthcare service accessibility, whereas 73% (n=600) indicated that the pandemic considerably impacted their social lives.

Four assumptions showed linear relationships and multivariable normality without multicollinearity or autocorrelations. Only the seeking social support' strategy was associated with the quadratic term for participant age.

Conclusions

Overall, the study findings highlighted the determinants of coping methods for PD patients and the association between the coping techniques and their quality of life.

However, further research is required to determine whether discouragement or enhancement of the coping methods is practical and whether the practices could impact QoL. Future studies may also investigate the coping strategies adopted by caregivers of PD patients.

Age, sex, anxiety, and educational attainment were related to various coping techniques. However, in comparison with disease-associated and demographic variables, only "social support,"; "distancing,"; and "goal orientation" were linked to worse quality of life domains, although more modestly.

Unexpectedly, employment status and partnership did not impact coping, likely due to participant age, the relatively limited number of employed individuals, and those devoid of partners.

Participant sex influenced the coping styles of PD patients. Young individuals were more goal-oriented and sought social assistance. In contrast, older individuals preferred to avoid and accept the situation at hand, probably because the older patients had suffered from PD for a longer duration, were fragile, and had multiple comorbidities.

Social assistance and distancing considerably impacted the QoL of the participants. Actively seeking social aid has been linked to better overall health, whereas passive distancing has been associated with worse QoL.

The "avoidance and acceptance" strategy was linked to lower anxiety levels, probably because of reverse causation or since individuals who readily accepted daily life impairments were less anxious about developing more impairments in later years.

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.