Depression and cardiac symptoms among AL amyloidosis patients: the mediating role of coping strategies

Abstract

Background: Amyloidosis is a rare disease group. AL amyloidosis represents the most common type of systemic amyloidosis and cardiac involvement determines prognosis. Although some studies have revealed that amyloidosis patients present high levels of depression, few data are available about depression-contributing factors. No investigations have been conducted about the coping strategies that AL amyloidosis patients use to face the disease and there is little research on patients with cardiac symptoms that are strongly related to the prognosis. Objectives: to examine coping strategies (avoidance, social support seeking and problem-solving) as potential mediator in the relationship between cardiac symptom severity (independent variable) and depressive symptoms (dependent variable) in AL cardiologic patients. Method: Thirty-four AL patients with cardiac-related symptoms were administered the Coping Strategy Indicator and the Centre for Epidemiological Study–Depression Scale. Clinical variables such as months since cardiac symptom onset and cardiac symptom severity were collected. Results: According to questionnaire normative values, all patients presented clinical depression. Moreover, out of the coping strategies, avoidance and social support seeking mediated the link between cardiac symptom severity and depressive symptoms. No mediational effect was found for problem-solving. Discussion: As cardiac symptoms have low severity, AL patients can avoid the disease. However, as cardiac symptoms proceed and interfere with daily activities, they can no longer ignore their signs thus perceiving the severity of their medical condition. This status makes individuals prone to seek less social support and thus to prefer social isolation. Results suggest the need for early psychological support on coping strategies for AL cardiologic patients.

Keywords:

• AL amyloidosis
• cardiac symptoms severity
• coping strategies
• depression

Notes

1. According to guidelines, cardiac involvement is assumed to mean left ventricular wall thickness above 12mm or N-terminal probrain natriuretic peptide (NT-proBNP) above 332 ng/l (Gertz, Merlini, 2010).