Abstract
ObjectiveParkinson's disease is associated with high rates of depression. There is growing interest in non-pharmacological management including psychological approaches such as Cognitive Behaviour Therapy. To date, little research has investigated whether processes that underpin cognitive models of depression, on which such treatment is based, apply in patients with Parkinson's disease. The study aimed to investigate the contribution of core psychological factors to the presence and degree of depressive symptoms. Methods104 participants completed questionnaires measuring mood, motor disability and core psychological variables, including maladaptive assumptions, rumination, cognitive-behavioural avoidance, illness representations and cognitive-behavioural responses to symptoms. ResultsRegression analyses revealed that a small number of psychological factors accounted for the majority of depression variance, over and above that explained by overall disability. Participants reporting high levels of rumination, avoidance and symptom focusing experienced more severe depressive symptoms. In contrast, pervasive negative dysfunctional beliefs did not independently contribute to depression variance. ConclusionSpecific cognitive (rumination and symptom focusing) and behavioural (avoidance) processes may be key psychological markers of depression in Parkinson's disease and therefore offer important targets for tailored psychological interventions.
Highlights
Depression is common in Parkinson's disease, with over one third having a depressive disorder, subsyndromal depressive symptomatology or significant psychological distress [1]
There has been a welcome advance in the number and quality of randomised controlled trials (RCTs) of antidepressants, a recent meta-analysis identified only small to moderate effect sizes [2], and the non- and partialresponse rates to antidepressant medication are typically high in older adults and those with chronic physical health problems [3]
Cognitive and behavioural avoidance as a coping response to illness related stressors, and negative illness representations are associated with depression, while active task-oriented coping tends to be associated with greater psychological well-being [11,12,13,14]
Summary
Parkinson's disease is associated with high rates of depression. Little research has investigated whether processes that underpin cognitive models of depression, on which such treatment is based, apply in patients with Parkinson's disease. The study aimed to investigate the contribution of core psychological factors to the presence and degree of depressive symptoms. Methods: 104 participants completed questionnaires measuring mood, motor disability and core psychological variables, including maladaptive assumptions, rumination, cognitive-behavioural avoidance, illness representations and cognitive-behavioural responses to symptoms. Participants reporting high levels of rumination, avoidance and symptom focusing experienced more severe depressive symptoms. Conclusion: Specific cognitive (rumination and symptom focusing) and behavioural (avoidance) processes may be key psychological markers of depression in Parkinson's disease and offer important targets for tailored psychological interventions
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