Depressive symptoms in Fabry disease: the importance of coping, subjective health perception and pain

Abstract

Background: Despite the high prevalence of depressive symptoms in Fabry disease (FD), it is unclear which patient characteristics are important in relation to these symptoms. Additionally, the impact of coping styles in relation to depressive symptoms in FD has been unexplored. Determining the impact of different factors relating to depressive symptoms in FD can guide both prevention and treatment of these symptoms. Methods: Depressive symptoms (Center for Epidemiologic Studies Depression scale (CESD)) and coping styles (Utrecht Coping List) were assessed in a Dutch FD cohort. Other potentially important variables were identified from FD literature and assessed in this cohort. Relations were evaluated using multiple linear models. Results: Potentially important variables in FD literature were: pain, unemployment, health perception, being single, comorbidities and stroke. Employed coping styles were "avoidance and brooding", "positivity and problem solving" and "seeking social support". Thirty-one of the 81 FD patients (38%) had depressive symptoms. CESD-scores were lower in patients with better health perception and more "positivity and problem solving" and higher in patients with more pain and "avoidance and brooding". The best model explained 70% (95%CI: 54-76%) of observed variance of the CESD. Conclusions: Depressive symptoms in FD are related to pain, negative health perception and use of specific coping styles. Psychological interventions could be employed to alter coping behavior and alleviate depressive symptoms.

Cognitive functioning and depressive symptoms in Fabry disease: A follow‐up study

“…Considering the indication bias in cohort studies (more severely affected patients will generally receive more and earlier treatment), we expected no verifiable effect of these treatments and regarded the analyses as unreliable and therefore did not include these in this study. Nevertheless, despite treatment with both enzyme replacement therapy and antidepressants, cognitive impairment was clearly present and depressive symptoms were widespread and persistent 3,4,7 . Fourth, since time of day was not standardized and seasonal affective disorder was not controlled for, we cannot rule out their effects on the neuropsychological test results 45,46 .…”

“…Since power was limited due to the sample size, we used an exploratory factor analysis to reduce the number of subscales to three. The three coping styles mainly employed in our FD population were: ‘avoidance and brooding’, ‘positivity and problem solving’ and ‘seeking social support and comfort’ (for more information on the exploratory factor analysis see Reference 7). Scores per coping style were calculated for both baseline and follow‐up using the Anderson‐Rubin method 20 .…”

“…Patients with FD are at risk for cognitive impairment 3‐5 and depressive symptoms are present in a large proportion of patients 3,6,7 . People diagnosed with a major depressive disorder show more cognitive impairment compared to controls from the general population 8 .…”

“…Previous work on depressive symptoms in FD has shown a relation to pain and social factors such as economic status 3,6 . Conversely, the relation of depressive symptoms to renal, cardiac or cerebral involvement is less prominent and patients' subjective health perception is probably more important 3,6,7 . Differences in coping, the process of cognitive and behavioural efforts to manage daily hassles and stressors, 10 might influence the impact of subjective health perception on the psychological well‐being of FD patients.…”

“…In a recent study, we found that patients' use of an avoiding and brooding coping style was related to more depressive symptoms while positivity and problem solving was related to less depressive symptoms. 7 Since most studies on depressive symptoms and cognitive functioning in FD have been cross sectional, little is known about their course over time. Follow-up data on depressive symptoms and cognitive functioning provide insight in the course of FD and offer an opportunity to AMC FD patient cohort n = 154 Excluded patients n = 10: autism n = 2; blindness n = 1; intellectual/developmental disabilities n = 3; aphasia n = 1; insuffic ient knowledge Dutch language n = 3…”