Difficulties in activities of daily living are associated with stigma in patients with Parkinson's disease who are candidates for deep brain stimulation

Antônio G da Silva, Vanessa P Leal, Paulo R da Silva, Fernando C Freitas, Marcelo N Linhares, Roger Walz, Leandro F Malloy-Diniz, Alexandre P Diaz, Antônio P Palha, Antônio G da Silva, Vanessa P Leal, Paulo R da Silva, Fernando C Freitas, Marcelo N Linhares, Roger Walz, Leandro F Malloy-Diniz, Alexandre P Diaz, Antônio P Palha

Abstract

Objective: Parkinson's disease (PD) is often accompanied by stigma, which could contribute to a worse prognosis. The objective of this study is to identify the variables associated with stigma in PD patients who are candidates for deep brain stimulation (DBS).

Methods: We investigated sociodemographic and clinical variables associated with stigma in a sample of 54 PD patients indicated for DBS. The independent variables were motor symptoms assessed by the Movement Disorder Society-sponsored revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS III), depressive symptoms measured by the Hospital Anxiety and Depression Scale, age, disease duration and the presence of a general medical condition. The Mobility, Activities of daily living and Emotional well-being domains of the 39-item Parkinson's Disease Questionnaire (PDQ-39) were also investigated as independent variables, and the Stigma domain of the PDQ-39 scale was considered the outcome variable.

Results: After multiple linear regression analysis, activities of daily living remained associated with the Stigma domain (B = 0.42 [95%CI 0.003-0.83], p = 0.048). The full model accounted for 15% of the variance in the Stigma domain (p = 0.03).

Conclusions: Although causal assumptions are not appropriate for cross-sectional studies, the results suggest that ADL difficulties could contribute to greater stigma in PD patients with refractory motor symptoms who are candidates for DBS.

Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Beitz JM. Parkinson's disease: a review. Front Biosci (Schol Ed) 2014;6:65–74.
    1. Reijnders JS, Ehrt U, Weber WE, Aarsland D, Leentjens AF. A systematic review of prevalence studies of depression in Parkinson's disease. Mov Disord. 2008;23:183–9.
    1. Oguru M, Tachibana H, Toda K, Okuda B, Oka N. Apathy and depression in Parkinson disease. J Geriatr Psychiatry Neurol. 2010;23:35–41.
    1. Diamond A, Jankovic J. The effect of deep brain stimulation on quality of life in movement disorders. J Neurol Neurosurg Psychiatry. 2005;76:1188–93.
    1. Pahwa R, Factor SA, Lyons KE, Ondo WG, Gronseth G, Bronte-Stewart H, et al. Practice parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;66:983–95.
    1. Goffman E. Stigma: notes on the management of spoiled identity. New York: Simon & Schuster Inc; 1963.
    1. Shimotsu S, Horikawa N. Self-stigma in depressive patients: association of cognitive schemata, depression, and self-esteem. Asian J Psychiatr. 2016;24:125–9.
    1. Tickle-Degnen L, Zebrowitz LA, Ma HI. Culture, gender and health care stigma: practitioners' response to facial masking experienced by people with Parkinson's disease. Soc Sci Med. 2011;73:95–102.
    1. Moore SM, Knowles Sr. Beliefs and knowledge about Parkinson's disease. E J Appl Psychol. 2006;2:15–21.
    1. Hermanns M. The invisible and visible stigmatization of Parkinson's disease. J Am Assoc Nurse Pract. 2013;25:563–6.
    1. Alonso J, Buron A, Rojas-Farreras S, de Graaf R, Haro JM, de Girolamo G, et al. Perceived stigma among individuals with common mental disorders. J Affect Disord. 2009;118:180–6.
    1. Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ. Stigmatisation of people with mental illnesses. Br J Psychiatry. 2000;177:4–7.
    1. Sirey JA, Bruce ML, Alexopoulos GS, Perlick DA, Raue P, Friedman SJ, et al. Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression. Am J Psychiatry. 2001;158:479–81.
    1. Corrigan P. How stigma interferes with mental health care. Am Psychol. 2004;59:614–25.
    1. Schomerus G, Evans-Lacko S, Rusch N, Mojtabai R, Angermeyer MC, Thornicroft G. Collective levels of stigma and national suicide rates in 25 European countries. Epidemiol Psychiatr Sci. 2015;24:166–71.
    1. Leaffer EB, Hesdorffer DC, Begley C. Psychosocial and sociodemographic associates of felt stigma in epilepsy. Epilepsy Behav. 2014;37:104–9.
    1. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992;55:181–4.
    1. Carod-Artal FJ, Martinez-Martin P, Vargas AP. Independent validation of SCOPA-psychosocial and metric properties of the PDQ-39 Brazilian version. Mov Disord. 2007;22:91–8.
    1. Peto V, Jenkinson C, Fitzpatrick R, Greenhall R. The development and validation of a short measure of functioning and well being for individuals with Parkinson's disease. Qual Life Res. 1995;4:241–8.
    1. Jacoby A. Felt versus enacted stigma: a concept revisited. Evidence from a study of people with epilepsy in remission. Soc Sci Med. 1994;38:269–74.
    1. Fahn S, Elton RL, Members of the UPDRS Committee . Unified Parkinson's Disease Rating Scale. In: Fahn S, Marsden CD, Goldstein M, Calne DB, editors. Recent developments in Parkinson's disease. Florham Park: MacMillan Health Care; 1987. pp. p. 153–63.
    1. Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967;17:427–42.
    1. First M, Spitzer R, Gibbon M, Williams J. Washington: Americam Psychiatric Press Inc; 1996. Structured clinical interview for DSM-IV Axis I disorders, Clinical Version (SCID-CV)
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.
    1. Salazar RD, Weizenbaum E, Ellis TD, Earhart GM, Ford MP, Dibble LE, et al. Predictors of self-perceived stigma in Parkinson's disease. Parkinsonism Relat Disord. 2019;60:76–80.
    1. Ablon J. The nature of stigma and medical conditions. Epilepsy Behav. 2002;3:2–9.
    1. Maffoni M, Giardini A, Pierobon A, Ferrazzoli D, Frazzitta G. Stigma experienced by Parkinson's disease patients: a descriptive review of qualitative studies. Parkinsons Dis. 2017;2017:7203259. doi: .
    1. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–4.
    1. Belsley DA. Statistics WSiPa, editor. New York: Wiley-Interscience; 1991. Conditioning diagnostics, collinearity and weak data in regression first ed.
    1. Norman GP, Streiner DL. Multiple regression. In: Streiner N, editor. Biostatistics the bare essentials. 3th ed. Beijing: People's Medical Publishing House; 2008.
    1. Schrag A, Jahanshahi M, Quinn NP. What contributes to depression in Parkinson's disease? Psychol Med. 2001;31:65–73.
    1. Ma HI, Saint-Hilaire M, Thomas CA, Tickle-Degnen L. Stigma as a key determinant of health-related quality of life in Parkinson's disease. Qual Life Res. 2016;25:3037–45.
    1. Torbey E, Pachana NA, Dissanayaka NN. Depression rating scales in Parkinson's disease: a critical review updating recent literature. J Affect Disord. 2015;184:216–24.
    1. Nascimento CM, Ayan C, Cancela JM, Gobbi LT, Gobbi S, Stella F. Effect of a multimodal exercise program on sleep disturbances and instrumental activities of daily living performance on Parkinson's and Alzheimer's disease patients. Geriatr Gerontol Int. 2014;14:259–66.
    1. McNeely ME, Duncan RP, Earhart GM. Impacts of dance on non-motor symptoms, participation, and quality of life in Parkinson disease and healthy older adults. Maturitas. 2015;82:336–41.
    1. Choi HJ. Effects of therapeutic Tai chi on functional fitness and activities of daily living in patients with Parkinson disease. J Exerc Rehabil. 2016;12:499–503.
    1. Wykes T, Haro JM, Belli SR, Obradors-Tarrago C, Arango C, Ayuso-Mateos JL, et al. Mental health research priorities for Europe. Lancet Psychiatry. 2015;2:1036–42.

Source: PubMed

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