Social Determinants of Parkinson’s Disease: Associations Between Education, Mental Health, and Exercise Among Patients with PD Open Access

John, Samuel (Spring 2022)

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Importance: There is an elevated burden of depression and anxiety among PD patients when compared to the non-PD population. Exercise is a known treatment to slow the progression of PD. Social determinants of health have been linked with PD and studies support that SDOH are crucial to health outcomes. It is unclear how one social determinant, education, is associated with mental health and exercise among PD patients.


Aims & Research Questions: To determine, in an exclusively PD sample:

1.    What is the relationship between education and mental health related symptoms?

2.    What is the relationship between education and physical activity?

3.    What is the association of physical activity and mental health symptoms?


Design/Setting, Participants: Observational study, secondary data analysis from Emory clinical research at Parkinsonism Neuroimaging Laboratory. 89 participants with PD diagnosis verified by Emory movement disorders neurologists.


Main Outcomes and Measures: To assess depression, anxiety, and cognitive function, this study used the Beck Depression Inventory (BDI II), Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), and Montreal Cognitive Assessment (MoCA), respectively. SPSS analysis used linear regression, Pearson correlation, and independent t test. Covariate analysis examined relationships between the three core research variables and disease duration, sex, and age.


Results: Regarding the aims, education and physical activity had a strong trend towards significance, and supports a negative relationship (p=0.058, beta= -0.207, R2=0.04). Covariate analysis strongly supports that male participants are more depressed than females. GDS scores were significantly higher among males (t= 1.60, p=0.012) and BDI-II scores supported a strong trend towards significance (t=1.29, p=0.052). Results also suggest that disease duration and BAI score was positively correlated (beta= 0.245, p=0.05, R2= 0.06).


Conclusion and Relevance: This pilot study generated several important hypotheses. Results suggest that education and SDOH play a vital role in PD outcomes. Literature supported that education is positively associated with physical activity, thus, future longitudinal studies should examine how SDOH evolve over time and influence physical activity. Results also support the importance of sex-based differences in PD outcomes and emphasize targeted research towards PD sub-populations, and the male-specific burden of depression merits further investigation. Studies should include more SDOH, such as ZIP code, or income or poverty level, which can provide more context to the nuanced living situations of PD participants.

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