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Chou PC, Lee Y, Chang YY, Hung CF, Chen YF, Lin TK, Shih FY, Chen WF, Lin PY, Chong MY, Wang LJ. The Interrelationship of Benefit Finding, Demoralization, and Stigma among Patients with Parkinson's Disease and Their Caregivers. Healthcare (Basel) 2024; 12:878. [PMID: 38727435 PMCID: PMC11083473 DOI: 10.3390/healthcare12090878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 05/13/2024] Open
Abstract
Parkinson's disease (PD) is a debilitating neurodegenerative disease with a relentlessly progressive course of illness. This study aimed to assess the dyadic dynamics of benefit finding (BF), demoralization, and stigma on the depression severity of PD patients and their caregivers. This study used a cross-sectional design with purposive sampling. In total, 120 PD patients and 120 caregivers were recruited from the neurological ward or neurological outpatient clinic of a medical center in Taiwan from October 2021 to September 2022. PD patients and their caregivers were enrolled and assessed using the Mini International Neuropsychiatric Interview, the Benefit Finding scale, Demoralization Scale, Stigma Subscale of the Explanatory Model Interview Catalogue, and Taiwanese Depression Questionnaire. Among the 120 patients and 120 caregivers that successfully completed the study, 41.7% (N = 50) and 60% (N = 72) were female, respectively. The most common psychiatric diagnoses of both the PD patients (17.5%) and their caregivers (13.3%) were depressive disorders. Using structural equation modeling, we found that the stigma, BF, and demoralization of PD patients might contribute to their depression severity. Demoralization and stigma of PD patients' caregivers might also contribute to the depression severity of PD patients. Caregivers' BF and demoralization were significantly linked with their depression severity. PD patients' BF degree and their caregivers' BF degree had significant interactive effects. Both patients' and their caregivers' stigma levels had significant interactive effects. Clinicians should be aware of and manage these contributing factors between PD patients and their caregivers in order to prevent them from exacerbating each other's depression.
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Affiliation(s)
- Pei-Chien Chou
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-C.C.); (Y.L.); (C.-F.H.); (P.-Y.L.)
| | - Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-C.C.); (Y.L.); (C.-F.H.); (P.-Y.L.)
| | - Yung-Yee Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-Y.C.); (Y.-F.C.); (T.-K.L.)
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-C.C.); (Y.L.); (C.-F.H.); (P.-Y.L.)
| | - Ying-Fa Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-Y.C.); (Y.-F.C.); (T.-K.L.)
| | - Tsu-Kung Lin
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-Y.C.); (Y.-F.C.); (T.-K.L.)
| | - Fu-Yuan Shih
- Center for Parkinson’s Disease, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (F.-Y.S.); (W.-F.C.)
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Wu-Fu Chen
- Center for Parkinson’s Disease, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (F.-Y.S.); (W.-F.C.)
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-C.C.); (Y.L.); (C.-F.H.); (P.-Y.L.)
| | - Mian-Yoon Chong
- Health Management International, Singapore 218108, Singapore;
- Regency Specialist Hospital, Johor 81750, Malaysia
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
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Kaplan RI, McDowell CP, Wall J, Kinger SB, Salazar RD, Neargarder S, Cronin‐Golomb A. Discordance between Reports of Internalized Symptoms in Persons with Parkinson's Disease and Informants: Results from an Online Survey. Mov Disord Clin Pract 2024; 11:391-397. [PMID: 38269854 PMCID: PMC10982598 DOI: 10.1002/mdc3.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/19/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Self-report of motor and non-motor symptoms is integral to understanding daily challenges of persons with Parkinson's disease (PwPD). Care partners are often asked to serve as informants regarding symptom severity, raising the question of concordance with PwPD self-reports, especially regarding internalized (not outwardly visible) symptoms. OBJECTIVES Concordance between PwPD and informant ratings of motor and non-motor symptoms was evaluated across multiple domains. METHODS In 60 PwPD-informant pairs, we compared ratings on 11 online self-report measures comprising 33 total scores, 2/3 of which represented purely internalized symptoms. For discordant scores, multiple regression analyses were used to examine demographic/clinical predictors. RESULTS Though concordant on 85% of measures, PwPD endorsed more non-motor symptoms, bodily discomfort, stigma, and motor symptoms than informants. For PwPD, younger age, greater disease severity, and female gender predicted discordance. CONCLUSIONS Discordance between PwPD and informants on measures assessing symptoms that cannot be outwardly observed may require targeted education.
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Affiliation(s)
- Rini I. Kaplan
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
| | | | - Juliana Wall
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
| | - Shraddha B. Kinger
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
| | - Robert D. Salazar
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
| | - Sandy Neargarder
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
- Department of PsychologyBridgewater State UniversityBridgewaterMAUSA
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Logan BA, Neargarder S, Kinger SB, Larum AK, Salazar RD, Cronin-Golomb A. Self-perceived stigma in Parkinson's Disease in an online sample: Comparison with in-person sample, role of anxiety, and relative utility of four measures of stigma perception. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-10. [PMID: 38442327 DOI: 10.1080/23279095.2024.2321578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVE Persons with Parkinson's disease (PwPD) experience motor and non-motor symptoms that may elicit stigmatization. We investigated whether online assessment would replicate in-person findings of younger age and depression as predictors of stigma perception. We further assessed the predictive value of anxiety, and compared predictors across four stigma measures. METHODS The online study (n = 347), like the earlier in-person study (n = 362), used the Parkinson's Disease Questionnaire stigma subscale (PDQ-39stigma). It also assessed anxiety and added the Stigma Scale for Chronic Illness (SSCI), Stigmatization Scale, and Mental Health Consumers' Experience of Stigma Scale. We correlated stigma perception scores with demographic/clinical characteristics and conducted hierarchical regression and mediation analyses. RESULTS Online and in-person predictors of stigma perception with the PDQ-39stigma included younger age (men) and depression (men, women). Depression mediated the relation between stigma perception and motor experiences of daily living (EDLs). In the online sample, when anxiety was added, it predicted stigma perception (PDQ-39stigma, SSCI) and mediated the relation between stigma and both motor and non-motor EDLs (PDQ-39stigma). For all four stigma-perception scales, younger age predicted scores. Multiple additional predictors of PDQ-39stigma and SSCI scores suggest their utility relative to the other two scales. Conclusions: Younger age and depression predicted self-perceived stigma in online and in-person samples, indicating the cross-modal utility of the measure, PDQ-39stigma. In the online sample, anxiety also predicted stigma perception per the PDQ-39stigma and SSCI. We recommend both measures and note that treating depression and anxiety may be important especially in younger PwPD to reduce self-perceived stigma.
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Affiliation(s)
- Bridget A Logan
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Sandy Neargarder
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- Department of Psychology, Bridgewater State University, Bridgewater, MA, USA
| | - Shraddha B Kinger
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Amie K Larum
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Robert D Salazar
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Piers RJ, Black KC, Salazar RD, Islam S, Neargarder S, Cronin-Golomb A. Equal Prevalence of Depression in Men and Women with Parkinson's Disease Revealed by Online Assessment. Arch Clin Neuropsychol 2024; 39:92-97. [PMID: 37401380 DOI: 10.1093/arclin/acad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE Identifying persons needing mental health services is hampered by stigma-related underreporting of symptoms, especially by men. Men with Parkinson's disease (PD) consistently report lower rates of depression than women in in-person studies. We predicted that online anonymity would elicit more gender-based parity in depression endorsement. METHOD We administered the Beck Depression Inventory-II (BDI-II) online to 344 participants with PD (52% women). Depression was defined as BDI-II score >13 and/or use of antidepressant medications. RESULTS Overall depression prevalence was consistent with in-person studies, but with no significant difference between men and women. CONCLUSIONS Online methods may circumvent barriers to depression identification in men with PD.
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Affiliation(s)
- Ryan J Piers
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Kelly C Black
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Robert D Salazar
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Samia Islam
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Sandy Neargarder
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- Department of Psychology, Bridgewater State University, Bridgewater, MA, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Xu Y, Wan W, Zeng H, Xiang Z, Li M, Yao Y, Li Y, Bortolanza M, Wu J. Exosomes and their derivatives as biomarkers and therapeutic delivery agents for cardiovascular diseases: Situations and challenges. J Transl Int Med 2023; 11:341-354. [PMID: 38130647 PMCID: PMC10732499 DOI: 10.2478/jtim-2023-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Microvesicles known as exosomes have a diameter of 40 to 160 nm and are derived from small endosomal membranes. Exosomes have attracted increasing attention over the past ten years in part because they are functional vehicles that can deliver a variety of lipids, proteins, and nucleic acids to the target cells they encounter. Because of this function, exosomes may be used for the diagnosis, prognosis and treatment of many diseases. All throughout the world, cardiovascular diseases (CVDs) continue to be a significant cause of death. Because exosomes are mediators of communication between cells, which contribute to many physiological and pathological aspects, they may aid in improving CVD therapies as biomarkers for diagnosing and predicting CVDs. Many studies demonstrated that exosomes are associated with CVDs, such as coronary artery disease, heart failure, cardiomyopathy and atrial fibrillation. Exosomes participate in the progression or inhibition of these diseases mainly through the contents they deliver. However, the application of exosomes in diferent CVDs is not very mature. So further research is needed in this field.
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Affiliation(s)
- Yunyang Xu
- Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Weimin Wan
- Department of Clinical Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou215008, Jiangsu Province, China
| | - Huixuan Zeng
- Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Ze Xiang
- Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Mo Li
- Department of Clinical Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou215008, Jiangsu Province, China
| | - Yiwen Yao
- Department of Internal Medicine V-Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, 66424Homburg, Germany
| | - Yuan Li
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou215008, Jiangsu Province, China
| | - Mariza Bortolanza
- Department of Internal Medicine V-Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, 66424Homburg, Germany
| | - Jian Wu
- Department of Clinical Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou215008, Jiangsu Province, China
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McDaniels B, Pontone GM, Mathur S, Subramanian I. Staying hidden: The burden of stigma in PD. Parkinsonism Relat Disord 2023; 116:105838. [PMID: 37689498 DOI: 10.1016/j.parkreldis.2023.105838] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Despite the myriad motor and non-motor challenges associated with Parkinson's disease (PD) diagnosis, the hidden issue of stigma may be among the most influential factors negatively affecting quality of life. A number of qualitative studies have been published assessing various aspects of stigma in PD, and quantitative studies assert that most people with PD experience stigma during the course of their disease. Stigma is associated with poorer mental and physical health, poorer quality of life, decreased levels of hope, self-esteem and self-efficacy. The resulting stigma can lead to social anxiety and isolation, reluctance to seek medical care, loneliness, depression and anxiety. Therefore, understanding what stigma is, where it comes from, and how it affects people living with PD may offer clinicians and care partners tools to help mitigate the negative effects. FOCUS Over the past few decades, we have seen a move away from simply focusing on the effects of a disease (medical model) toward a holistic biopsychosocial approach that considers the role of environmental factors (stigma) when assessing overall well-being. We review some proactive practical suggestions to help people living with PD effectively combat the negative effects of stigma. CONCLUSION The additional hidden burden of stigma from PD affects quality of life. Having a better understanding of the role of stigma and its impact may allow clinicians to provide proactive care and greater empathy for those living with the challenges of this disease.
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Affiliation(s)
- Bradley McDaniels
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA.
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA; Parkinson's Disease Research, Education and Clinical Center (PADRECC), Veterans Administration Greater Los Angeles Health Care System, Los Angeles, CA, USA
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Changes in Apathy, Depression, and Anxiety in Parkinson's Disease from before to during the COVID-19 Era. Brain Sci 2023; 13:brainsci13020199. [PMID: 36831742 PMCID: PMC9954738 DOI: 10.3390/brainsci13020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Apathy, depression, and anxiety are common non-motor symptoms of Parkinson's disease (PD). Tracking the changes in such symptoms over time would be valuable not only to determine their natural course during the disease, but also to establish the effects of unusual historical events interacting with the natural course. Having collected data on apathy (Apathy Scale), depression (Beck Depression Inventory-II), and anxiety (Parkinson's Anxiety Scale) in a large sample of persons with PD (PwPD) before the beginning of the COVID-19 era, we followed up with these individuals to investigate the changes in their prevalence of apathy, depression, and anxiety across two timepoints (T1 and T2). Of the original 347 participants, 111 responded and provided complete data at T2. The data collection at T1, before COVID-19, occurred between 2017-2018. The data collection at T2 occurred in 2021 and included the same measures, with the addition of the Coronavirus Impact Scale to assess the effects of the pandemic on the individual participants. Over this period, there was a significant increase in apathy, but not in depression or anxiety. Anxiety and depression, but not apathy, were correlated with the impact of COVID-19.
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Muacevic A, Adler JR, Albishi A, Al-Onazi A, Aseeri S, Alotaibi F, Almazroua Y, Albloushi M. Quality of Life in Patients With Parkinson's Disease: A Cross-Sectional Study. Cureus 2023; 15:e33989. [PMID: 36824559 PMCID: PMC9941031 DOI: 10.7759/cureus.33989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 01/21/2023] Open
Abstract
Patients with Parkinson's disease (PD) suffer from a range of physical, psychological, and social problems. The disease affects the quality of life (QOL) of the affected person. Several factors contribute to QOL, and these factors should be examined to develop appropriate strategies. This study aimed to determine the factors related to QOL in patients with PD. A cross-sectional, descriptive study was conducted using a tool with strong validity and reliability (39-Item Parkinson's Disease Questionnaire (PDQ-39)) to assess the quality of life. Descriptive statistics were used to analyze the data, and non-parametric chi-square tests were applied to evaluate the relationship between QOL and the variables. Frequent hospital admissions, level of education, and marital status were among the factors that affected QOL. The ability to perform Ramadan fasting correlated with the degree of QOL. The coronavirus disease 2019 (COVID-19) pandemic has adversely affected the quality of life due to changes in access to medical care and medications. To improve QOL in patients with PD, a comprehensive approach is required in many healthcare domains that includes physiotherapy together with the conventional pharmacotherapy, other treatments, and psychological support.
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Karacan AV, Kibrit SN, Yekedüz MK, Doğulu N, Kayis G, Unutmaz EY, Abali T, Eminoğlu FT, Akbostancı MC, Yilmaz R. Cross-Cultural Differences in Stigma Associated with Parkinson's Disease: A Systematic Review. JOURNAL OF PARKINSON'S DISEASE 2023; 13:699-715. [PMID: 37355913 PMCID: PMC10473089 DOI: 10.3233/jpd-230050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Stigma is an important social attitude affecting the quality of life (QoL) of people with Parkinson's disease (PwP, PD) as individuals within society. OBJECTIVE This systematic review aimed to 1) identify the factors associated with stigma in PD and 2) demonstrate culture-based diversity in the stigmatization of PwP. We also reported data from the Turkish PwP, which is an underrepresented population. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a literature search of the PubMed/Medline electronic database was performed covering the last 26 years. Articles on self-perceived stigma in PD with a sample size > 20 and quantitative results were included. Data were extracted by independent reviewers. RESULTS After screening 163 articles, 57 were eligible for review, most of which were from Europe or Asia. Only two studies have been conducted in South America. No study from Africa was found. Among the 61 factors associated with stigma, disease duration, sex, and age were most frequently studied. A comparison of the investigated factors across the world showed that, while the effect of motor impairment or treatment on stigma seems to be culture-free, the impact of sex, education, marriage, employment, cognitive impairment, and anxiety on stigma may depend on culture. CONCLUSION The majority of the world's PD population is underrepresented or unrepresented, and culture may influence the perception of stigma in PwP. More diverse data are urgently needed to understand and relieve the challenges of PwP within their society.
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Affiliation(s)
| | | | - Merve Koç Yekedüz
- Department of Pediatric Metabolism, Ankara University School of Medicine, Ankara, Turkey
| | - Neslihan Doğulu
- Department of Pediatric Metabolism, Ankara University School of Medicine, Ankara, Turkey
| | - Gorkem Kayis
- Ankara University School of Medicine, Ankara, Turkey
| | - Elif Yüsra Unutmaz
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Talha Abali
- Ankara University School of Medicine, Ankara, Turkey
| | - F. Tuba Eminoğlu
- Department of Pediatric Metabolism, Ankara University School of Medicine, Ankara, Turkey
- Ankara University Rare Diseases Application and Research Center, Ankara, Turkey
| | - M. Cenk Akbostancı
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
- Ankara University Brain Research Center, Ankara, Turkey
| | - Rezzak Yilmaz
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
- Ankara University Brain Research Center, Ankara, Turkey
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