Coping Behavior in Patients with Parkinson's Disease Prior to Subthalamic Deep Brain Stimulation and Association with Psychiatric Symptoms, Quality of Life and Neuropsychological Status

BACKGROUND: Coping behavior of Parkinson's disease (PD) patients undergoing subthalamic Deep Brain Stimulation (STN-DBS) is poorly understood. Identifying patients with ineffective coping could help prepare them better for surgery. OBJECTIVES: To clarify coping of PD patients preoperatively and the relation with psychiatric symptoms, quality of life (QoL), and cognition. METHODS: Scores of 158 STN-DBS candidates were retrospectively reviewed, including the Utrecht coping list (UCL), Symptom Checklist (SCL90-R), Beck Depression Inventory (BDI2NL), PD Questionnaire 39 Summary Index (PDQ39-SI) and the neuropsychological assessment. One-sample and independent-samples t-tests, and correlation coefficients were calculated. RESULTS: We found significant positive correlations between emotion-focused coping (palliative/passive reactions, avoidance, expression of emotions, reassuring thoughts and seeking social support) and anxiety, depressive symptoms, and general psychosomatic symptoms. Patients reporting more palliative and passive reactions reported lower QoL. Patients with executive function deficits/impairment reported less active problem-focused coping (-1.89, 95% CI -3.60; -0.17); those with deficits/impairments in memory and executive functions reported less problem-focused coping (-1.96, 95% CI -3.81; -0.10), palliative reactions (-2.12, 95% CI -3.72; 0.51), seeking social support (-2.68, 95% CI -4.07; -1.28) and reassuring thoughts (-1.41, 95% CI -2.52; -0.30) compared to cognitively unimpaired patients. CONCLUSIONS: Our data affirm the association of specific coping strategies with depression, anxiety, general physical and mental symptoms, and QoL in STN-DBS candidates. Patients with impaired cognition, especially poor executive functioning, used ineffective coping strategies more often. Characterizing coping is simple and helps identify patients who may benefit from additional support to reinforce effective strategies, possibly leading to a less burdensome pre-surgical trajectory.