COVID-19 Stressors Associated With Poorer Mental Health in Parkinson Disease

Data from a recent study presented at the International Parkinson and Movement Disorders Society (MDS) Virtual Congress 2021, September 17-22, suggest that subgroups of patients with Parkinson disease (PD) experienced worsening mental health and a poorer quality of life (QOL) due to a range of stressors associated with the COVID-19 pandemic. 

Investigators led by Lisanne Dommershuijsen, MSc, PhD candidate, department of epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands, further concluded that during the ongoing pandemic, interventions tailored to address COVID-19 stressors may improve mental health in patients with PD. “People with Parkinson disease might be especially vulnerable to distress, for instance, because reduced levels of physical activity have caused worsening of symptoms, or because people with Parkinson disease often have difficulties with flexible adaptations to rapid and drastic changes in daily routines, such as those introduced by the COVID-19 pandemic,” Dommershuijsen said in her presentation.

The cross-sectional study utilized baseline data from the PRIME-NL study, which included total of 883 participants with PD. Patients had an average age of 70.2 years (standard deviation, 7.9), 38.1% of whom were women (n = 317). Investigators included 8 COVID-19 stressors in analyses. Care stressors included problems accessing care, problems accessing medication, and problems accessing nursing. Social stressors included loss of social contacts, cancelled social events, and tension or conflict at home. Other stressors included inability to perform physical activity/relax and symptoms of COVID-19. Scores which were then integrated into stressors sum score. 

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The findings found that a higher stressor sum score was associated with worse depression (Beck Depression Inventory [BDI] ß, 0.04 [95% CI, 0.02-0.05]), greater anxiety (Spielberger State-Trait Anxiety Inventory [STAI] ß, 0.04 [95% CI, 0.02-0.05), as well as poorer QOL (Parkinson’s Disease Quality of Life Questionnaire [PDQ-39] ß, 0.03 [95% CI, 0.02-0.04]). 

When evaluating the associations between BDI and STAI scores and the 8 stressors, all were associated with depressive and anxiety symptoms, the largest effect of which was associated with tension or conflict at home. Subgroup effects also showed that women, patients who were highly educated, and patients with advanced PD had more pronounced association between mental health and COVID-19 stressors. Lower effects, investigators noted, were found with subgroups that had confrontive coping and planful problem solving strategies. 

“Several previous studies indeed concluded that the COVID-19 pandemic worsened depressive and anxiety symptoms and reduced quality of life of people with Parkinson disease. However, there is a lack of data on subgroup differences regarding the effect of the COVID-19 pandemic on mental health and quality of life, and this lack of insight has so far precluded the deployment of targeted interventions,” Dommershuijsen said.

When performing a hypothetic intervention that removed the COVID-19 stressors, investigators saw decreases in BDI from 11.2 (95% CI, 10.7-11.6) to 9.0 (95% CI, 8.2-9.8), STAI from 74.3 (95% CI, 73.1-75.6) to 68.0 (95% CI, 65.4-70.5), and PDQ-39 from 25.1 (95% CI, 24.2-26.0) to 20.9 (95% CI, 19.3-22.6).

A similar intervention also performed for the patient group with advanced PD, defined as an MDS-Unified Parkinson’s Disease Rating Scale II score above the median, where investigators model a 50% reduction in the sum score of all 8 COVID-19 stressors. Discussing the hypothetical reduction in her presentation, Dommershuijsen noted, “Intervening on COVID-19 stressors in people with advanced Parkinson disease could result in clinically important improvements of mental health and quality of life.” 

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REFERENCE

Dommershuijsen L, Heide A, Berg E, et al. Effect of COVID-19 stressors on mental health and quality of life in Parkinson’s disease. Presented at: MDS Congress 2021; September 17-22; Virtual. Poster 1045.