Coping strategies have a strong impact on quality of life, depression, and embitterment in patients with Cushing’s disease
- 348 Downloads
Quality of life (QoL) and psychosocial well-being are substantially impaired in patients with Cushing’s disease (CD), not only at the acute illness stage but also after therapy; however, the reason for these impairments remains unclear.
In this cross-sectional, patient-reported outcome study, we conducted a postal survey on psychosocial impairment and coping strategies in patients after surgical treatment of CD in three large tertiary referral centers. In total, 176 patients with CD completed a compilation of self-assessment inventories pertaining to depression (Hospital Anxiety and Depression Scale, HADS), QoL (Short Form SF-36, Tuebingen CD; Tuebingen CD-25), coping style (Freiburg questionnaire on coping with illness, FKV-LIS), and embitterment (Bern Embitterment Inventory), on average 6.8 ± 6.66 years after surgery. Regression analyses were performed to identify predictors of psychosocial impairment.
At the time of the study, 21.8 % of patients suffered from anxiety, 18.7 % experienced an above-average feeling of embitterment, and 13.1 % suffered from depression. Maladaptive coping styles (FKV-LIS subscales depressive coping and minimizing importance) emerged as robust and strong predictors of psychosocial impairment in all inventories; while age, sex, and hydrocortisone intake failed to explain the variance in these measures.
Similar to several studies in non-pituitary patient cohorts (e.g., patients with multiple sclerosis or lower back pain), our results indicate that psychosocial impairment in CD is significantly influenced by how the patient deals with the illness. Therefore, psychological training of positive coping styles could be a helpful complementary therapy in the overall treatment strategy of CD.
KeywordsCushing’s disease Coping skills Coping behavior Quality of life Depression
Editorial support and linguistic corrections were provided by Anna Bagińska M.Sc. and Julia Archbold, Ph.D. from Proper Medical Writing Sp. z o.o., Poland.
This work was supported by an independent investigator-initiated grant by Novartis Germany (Project Number RSIG-23).
Kreitschmann-Andermahr, T. Psaras, M. Milian, S. Siegel, M. Buchfelder designed the study. S. Siegel, B. Kleist, C. Menzel and I. Kreitschmann-Andermahr performed the study and other authors contributed with the data. I. Kreitschmann-Andermahr, S.Siegel and B. Kleist analysed the data. All co-authors took active part in the interpretation of results. S. Siegel, I. Kreitschmann-Andermahr and M. Kołtowska-Häggström wrote the first version of the manuscript. All co-authors participated in the preparation of the manuscript and revised its each version. All co-authors accepted the final version of the manuscript.
Compliance with ethical standards
Conflict of interest
S. Siegel, M. Milian, T. Psaras, M. Tsiogka, D. Führer-Sakel, J. Honegger, C. Menzel, M. Buchfelder and I. Kreitschmann-Andermahr have received research and/or travel grants and/or speaker honoraria from Novartis Pharma. M. Kołtowska-Häggström is a consultant for Strongbridge Biopharma. The other authors report no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 7.Wagenmakers MA, Netea-Maier RT, Prins JB, Dekkers T, den Heijer M, Hermus AR (2012) Impaired quality of life in patients in long-term remission of Cushing’s syndrome of both adrenal and pituitary origin: a remaining effect of long-standing hypercortisolism? Eur J Endocrinol 167:687–695CrossRefPubMedGoogle Scholar
- 11.Resmini E, Santos A, Gomez-Anson B, Lopez-Mourelo O, Pires P, Vives-Gilabert Y et al (2013) Hippocampal dysfunction in cured Cushing’s syndrome patients, detected by (1) H-MR-spectroscopy. Clin Endocrinol (Oxf) 79:700–707Google Scholar
- 23.Bullinger M (1996) Assessment of health related quality of life with the SF-36 health survey. Rehabilitation (Stuttg) 35:XVII–XXVIIGoogle Scholar
- 25.Milian M, Kreitschmann-Andermahr I, Siegel S, Kleist B, Fuhrer-Sakel D, Honegger J et al (2015) Validation of the Tuebingen CD-25 inventory as a measure of postoperative health-related quality of life in patients treated for Cushing’s disease. Neuroendocrinology 102:60–67CrossRefPubMedGoogle Scholar
- 30.Znoj H (2008) Bern embitterment inventory. Verlag Hans Huber, Hogrefe AG, Bern, pp 1–50Google Scholar
- 33.Muthny FA (1996) References for evaluation scales in quality assurance in rehabilitation–6. Assessment of coping processes with the Freiburg questionnaire of illness coping. Rehabilitation (Stuttg) 35:Ix–xviGoogle Scholar
- 36.Muthny FA (1989) Freiburger Fragebogen zur Krankheitsverarbeitung. Beltz Test GmbH, WeinheimGoogle Scholar