Depression in Parkinson’s disease: etiology, identification, and cognitive behavioral intervention
Embargo Date
2024-06-15
OA Version
Citation
Abstract
It is projected that over 12 million people will be living with Parkinson’s disease (PD) by 2040. Depression is present in 40-50% of persons with PD (PwPD) and associated with debilitating motor and nonmotor symptoms. Despite its prevalence, the identification and treatment of depression can prove challenging, with individuals being unwilling or unable to obtain diagnosis and engage in multi-session treatment due to motor disability, transportation restrictions, caregiver burden, and stigma associated with PD and with mental illness. The high prevalence of depression in PD, its clear impact on functioning, and the challenges related to depression identification and treatment highlight the need for feasible, acceptable, and effective depression screening and intervention.
Study 1 used an online anonymous survey of depression in 165 men and 179 women with PD. Hypotheses were: (1) the gender difference in depression prevalence, well-documented in in-person studies (women more than men) would be mitigated through online, anonymous assessment; (2) the anonymity of online self-report would result in greater depression prevalence compared to in-person studies. The survey also assessed the relation between depressive symptoms and demographic/clinical information to identify potential depression risk factors. Results showed no difference in clinically- significant depression symptoms between men and women, supporting the first hypothesis, and similar prevalence of such symptoms compared to in-person studies, not supporting the second hypothesis. The correlational results indicated risk factors for depression to be younger age at PD onset (men and women) and younger age (women).
Study 2 was a pilot randomized controlled trial examining a telehealth cognitive-behavioral intervention for depression in 12 PwPD. Hypotheses that it would be efficacious, feasible, and acceptable were supported. The intervention also resulted in secondary benefits in domains commonly affected in PD, including anxiety, apathy, quality of life, and cognition. These positive benefits were experienced by the group and were further illustrated by a case study examining change processes through the use of ideographic assessment score comparisons and clinical vignettes (Study 3).
Together, these studies illustrate how online and telehealth approaches to assessment and treatment of depression can meet the unique needs of PwPD and circumvent significant barriers to care.