The roles of resilience and nonmotor symptoms in adjustment to Parkinson’s disease
by: Andrea M. Shamaskin-Garroway, M.S.
Doctoral Candidate in Clinical Psychology
Virginia Commonwealth University
Clinical Health Psychology Intern
VA Connecticut Healthcare System—West Haven, CT
VCU Parkinson’s & Movement Disorders Center (VCU PMDC) is committed to sharing results of our research projects with the community. Ms. Shamaskin-Garroway recently defended her doctoral dissertation and finished reviewing the data from the 2013 “Living well with Parkinson’s disease” project. A summary of the results is written below. The project was a survey administered starting in April 2013 and concluded in October 2013. You may have been asked to complete the survey during a visit to our facility, online, at a support group or education event. A full copy of the manuscript with more detail about the project will be published in an upcoming issue of ‘Journal of Health Psychology’. For more information please contact us at firstname.lastname@example.org or 804-662-5300.
Nonmotor symptoms (NMS) are increasingly a new clinical focus within PD due to their high prevalence and link to poorer PD-related quality of life (QOL). Some NMS are mood symptoms, such as depression and apathy, which are also common in PD and are associated with functional impairment – meaning that these conditions negatively impact a person’s daily functioning. Many individuals function well with PD despite the high prevalence of mood symptoms, and the reasons for this possibility remain unclear. By studying factors that help individuals cope well despite mood symptoms, we hope to learn ways to help people with PD live better lives. One such factor is resilience. The concept of resilience is a burgeoning area of study in the chronic disease literature. Little empirical research has explored the role of resilience in adjustment to PD. The purpose of the current project was to explore how resilience and NMS affect adjustment to PD in terms of mood symptoms and QOL.
Patient characteristics are listed below:
138 individuals with PD completed the survey. The average age was 64.15 years (SD = 10.09, range 34-89 years), with 54% female, 52.9% retired, 95% Caucasian, 65.9% with a Bachelor’s degree or higher, and 40.1% reporting annual income $65,001 – $105,000. Participants received a PD diagnosis 6.42 years ago (SD = 5.02, range 1-32 years), and 57.9% reported no comorbid diagnoses other than PD. Participants reported themselves as highly resilience; over 94% of the sample rated themselves on average at the midpoint or higher on the resilience scale.
We found that 35% of the patient sample had clinically significant depressive levels, and almost half (46%) had clinically significant apathy symptoms. Importantly, participants also reported themselves as highly resilience; over 94% of the sample rated themselves on average at the midpoint or higher on the resilience scale.
In this sample using hierarchical regression analyses, we found that after controlling for demographic variables, day-to-day functional status, and NMS, greater resilience was associated with less depression, less apathy, better QOL, and greater life satisfaction. We also found that increased number of NMS was associated with more depression and worse QOL.
What we learned:
As has been seen in other literature, we confirmed that resilience is an “ordinary magic” process, meaning that the majority of people view themselves as resilient in the face of adversity. At the same time, however, a significant portion of our sample reported depression and apathy symptoms, which speaks to the pathophysiological nature of these symptoms in PD.
We also learned that one’s sense of one’s own resilience has a very important impact on how well a person adjusts to PD. Having a higher sense of resilience seems to protect people from experiencing depression and apathy, and it can improve their QOL and life satisfaction.
Finally, this project contributed to the literature regarding the role of NMS in adjustment to PD. Historically, NMS have received less attention from researchers and even treating clinicians than the cardinal motor features of PD. Our results demonstrated that NMS, which can include gastrointestinal, sensory, urinary, and sexual dysfunction, also negatively affect people’s emotional functioning and QOL. These findings highlight the importance of continued research in this area of NMS in PD.
In summary, we hope that this research supports efforts toward capitalizing on psychological strengths and enhancing the quality of people’s lives as they live with chronic disease. We thank all individuals who volunteered to be a part of this project.
A full copy of the manuscript with more detail about the project will be published in an upcoming issue of “Journal of Health Psychology”. For more information, please contact us at email@example.com or (804) 662-5300.