Gender differences in the relationship between illness perception, social support and depression among Parkinson's disease patients

Data on Parkinson’s Disease indicate gender based differences with regard to prevalence and with regard to age of onset.  The disease is 1.5-2 times more frequent among men than women, and the symptoms appear later among women (Pavon, Whitson, Okun, 2010; Haaxma et. al., 2007). However, the findings are inconsistent with regard to severity of symptoms, the course of the illness and complications. The literature is still sparse and additional evidence is required to understand how gender might influence the outcome of Parkinson’s disease (Solimeo, 2008). The current study examines this in reference to factors associated with depression among patients.

The prevalence of depressive disorders among Parkinson’s disease patients is high and reaches 30%-40%, but little is known about its mechanism (Barone, 2011). It has been suggested that in addition to neurochemical changes, personal and social factors play a role in the onset of depression (Schrag , Jahanshai & Quinn, 2001). One of the most common theoretical models explaining emotional response to stressful situations, such as physical illness, is the Stress and Coping Model (Lazarus & Folkman, 1984), which assumes that the perception of the stressor and coping resources are associated to emotional reaction to the physical illness. This study focused on understanding the gender differences in the associations between perception of the illness and social support and emotional distress (depression) among Parkinson’s disease patients.

Study questions: a. Do gender differences exist in perception of the illness, social support and level of depression among Parkinson’s disease patients? b. Are there gender differences in the association between perception of the illness, social support and depression among Parkinson’s disease patients? c. Are there gender differences in the association between social support and perception of the illness among Parkinson’s disease patients? d. Do gender differences act as a moderating variable in place of social support in the association between perception of the illness and depression?

Method: The study population was comprised of 125 male and female Parkinson patients aged 50 – 75 years, who were drawn from the Parkinson and Movement Disorders Clinic at the Chaim Sheba Medical Center in Tel Hashomer. Gender distribution was 68 men and 57 women.  Procedure:  After approval of the study by the Ethics Committee of Sheba medical center, patients were asked to fill out questionnaires, while their visit at the clinic.  Research Instruments: Demographic background questionnaire (gender, age, family status, origin and education) and disease variables (as control variables):  disease severity (UPDRS, Hoehn & Yahr) and illness duration. Questionnaires on social support (Zimet, Dahlem, Zimet & Farley,1988), on illness perception (Broadbent, Petrie, Main & Weinman, 2006),  and depression (Beck & Steer, 1987).

Study findings: Significant differences were not found between men and women with regard to perception of the illness, social support and depression. Gender differences in the associations between the variables were only partially supported:  on the one hand, a positive association was found between perception of the illness and depression was found among both men and women, so that the more severe the perception of the illness so was the depression. On the other hand, a negative significant association between social support and depression was found among men only, whereby the greater the social support, the less the depression while it was non-significant among women. Additional gender differences were found in the associations between social support and perception of the illness, so that the association was statistically significant only among men: the greater the social support, the less severe the perception of the illness. Additionally, social support was not identified as a moderator between perception of the illness and depression, and with no gender differences.

Limitations of the study: The main limitations of the study derived from the little number of the variables that were examined, so that coping strategies or personal resources which could potentially be associated to depression, were not included. Additionally, social desirability may have affected the response of the patients because the doctors or other team members requested to fill out the questionnaires.

Importance and implications of the study: The findings of the study contribute to broadening the understanding of gender differences in perception of the illness, social support and depression, which were not investigated enough among Parkinson’s disease patients (Pavon, 2010; Martinez-Martin et. al., 2012).  The findings about gender differences in the associations of these variables with depressions are preliminary and more studies are needed.  The findings about the gender differences in the associations between social support and illness perception and between social support and depression have several implications to psychosocial interventions, and indicate that modes of intervention specifically adapted to men and women.