University of Manchester, Academic Division of Clinical Psychology, Manchester
University of Manchester, Academic Division of Clinical Psychology, Manchester
University of Manchester, Division of Psychology, Manchester
Department of Elderly Medicine, Northumbria Healthcare NHS Trust, Northumbria, UK
Correspondence: Rory Allott, Clinical Psychologist, Academic Division of Clinical Psychology, University of Manchester, 2nd Floor ERC, Wythenshaw Hospital, Southmoor Road, Manchester, UK. Tel: +44 (0)161 291 5883; Fax: +44 (0)161 291 5882; e-mail: rallott{at}fsl.with.man.ac.uk.
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ABSTRACT |
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INTRODUCTION |
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METHOD |
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Measures
Distress, the dependent variable, was measured using the Hospital Anxiety
and Depression Scale (HAD; Zigmond &
Snaith, 1983). Metacognitive style was measured using the
Metacognitions Questionnaire - 30 (MCQ-30;
Wells & Cartwright-Hatton,
2004). This contains five sub-scales: positive beliefs about
worry; negative beliefs about worry, focusing on its uncontrollability and
danger; negative beliefs about thoughts, concerning the need for control; low
cognitive confidence; and cognitive self-consciousness. A higher total score
on the MCQ-30 indicated a more maladaptive metacognitive style.
Disease-related factors identified by previous research as associated with distress in Parkinson's disease were also measured. These included medication regimen (daily L-dopa equivalent dose; Fenelon et al, 2000; Fung et al, 2001; Chen, 2002), stage of illness (Hoehn and Yahr Scale; MacCarthy & Brown, 1989), cognitive functioning (Mini-Mental Parkinson's; Mahieux et al, 1995) and presence of hallucinations (Revised Hallucinations Scale; Morrison et al, 2000). Participants were interviewed at home, where the questionnaires and cognitive testing were completed.
Statistical methods
Hierarchical regression was used to test whether a more maladaptive
metacognitive style would predict heightened distress, independent of disease
factors. Successive disease variables were entered into the equation followed
by metacognitive style. With a sample size of 44 and five variables entered
into the regression, the study had 80% power to identify an
R2 of 0.25 at the P <0.05 significance level.
A logarithmic transformation was computed for the dependent variable (HAD) to
satisfy assumptions of normality. Collinearity statistics showed that
tolerance values of individual variables were acceptably high for all multiple
regression equations.
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RESULTS |
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The mean age of the remaining 44 (33 males) participants was 68.52 years (s.d.=9.61, range 25-81) and mean duration of illness was 7.19 years (s.d.=5.53, range 6 months to 23 years). The five stages of illness were represented: I (2, 5%), II (6, 14%), III (15, 34%), IV (13, 30%) and V (8, 18%); 17 (39%) and 19 (43%) of participants reached possible caseness on the HAD for depression and anxiety, respectively. All except one were receiving anti-parkinsonian medication and six were receiving antidepressants.
Metacognitive style and distress
With metacognitive style and the disease variables entered into the
equation, the multiple R was 0.641 and significant
(F(5,38)=5.290, P <0.001). These variables accounted for
33% of the variance in distress. Metacognitive style showed a significant and
independent association with distress, contributing 8% to the variance
(F(1,38)=5.271, P <0.05).
To determine which of the MCQ sub-scales best predicted distress, a second multiple regression was conducted. A combination of direct entry (disease variables) and forward selection methods (MCQ sub-scales; selection criteria P <0.05) was used. Negative beliefs about worry was the sub-scale explaining most variance in distress, contributing 11.6% (F(1,38)=7.924, P <0.01). Alongside the disease factors, these variables showed a multiple R of 0.667 (F(5,38)=6.080, P <0.001) and accounted for 37% of the variance in distress. Of the disease factors, only stage of illness (beta=0.292, P <0.05) and propensity for hallucinations (beta=0.392, P=0.011) were significant predictors of distress.
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DISCUSSION |
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Two methodological limitations should be highlighted. The sample was recruited as part of another study investigating visual hallucinations in Parkinson's disease and was drawn from both community self-help groups and out-patient populations. This may have led to a bias towards recruiting people with hallucinations or less severe disease. Although some bias towards male participation was evident, the age, disease severity, duration of illness, and rates of anxiety, depression and hallucinations were comparable with those reported elsewhere (Gotham et al, 1986; Di Rocco et al, 1996).
Like previous studies, this research found increased anxiety and depression in the later stages of illness and when hallucinations were reported (Tandberg et al, 1997; Fenelon et al, 2000). Nevertheless, when these and other important disease factors were included in the multivariate analyses, metacognition remained a significant and independent predictor of distress. This is the first time that metacognitive beliefs have been investigated in chronic illness. The similarity between the distress observed in Parkinson's disease and other non-neurological movement disorders (e.g. arthritis; Gotham et al, 1986) suggests that these same results might be found in other chronic illnesses. Future research could investigate this possibility.
Worry is a normal phenomenon commonly reported in the general population and by people experiencing a range of chronic illnesses (Wells & Morrison, 1994; Fortune et al, 2000). Metacognitive beliefs may transform the meaning of mental events such that worry is itself appraised as uncontrollable and harmful. In this situation, individuals are likely to worry about Parkinson's disease and worry about their worry, thereby amplifying distress. This explanation resembles cognitive conceptualisations of generalised anxiety disorder, for which specific cognitive-behavioural techniques have been devised (Wells, 2000). Future research should investigate whether these same techniques might ameliorate distress in Parkinson's disease.
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ACKNOWLEDGMENTS |
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REFERENCES |
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Received for publication July 13, 2004. Revision received November 25, 2004. Accepted for publication November 30, 2004.
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