Impact of coping strategies on quality of life of adolescents and young women with endometriosis.

Adolescents and young adult women with endometriosis report experiencing anxiety and depression, impacting their quality of life. The adoption of adaptive instead of maladaptive coping strategies may improve quality of life in these patients.

Key Points

Highlights

• Adolescents and young adult women diagnosed with endometriosis experienced high levels of depression and anxiety, which appeared to directly affect their QoL, as shown previously in adult patient populations.
• The use of maladaptive coping strategies was correlated with poor quality of life (QoL) scores.

Importance

• Research exploring the relationship between coping strategies and QoL is lacking in the adolescent and young adult women population. The current study aims to narrow this gap in the literature.  

What’s Done Here

• Adolescents and young women between the ages of 13 and 25 with a surgical diagnosis who participated in the ‘EndoTeens’ initiative were invited to participate in this study.
• 24 participants completed questionnaires.
• Questionnaires included questions on sociodemographic and clinical history, as well as five scales: Beck Anxiety Inventory; Coping Strategies Inventory; Endometriosis Health Patient-5 to measure domains of endometriosis-related QoL; and Visual Analogue Scale to measure the intensity of pain felt by patients.
• The questionnaires were analyzed using statistics.

 Key Results

• The majority of patients reported some level of anxiety and/or depression.
• QoL scores were positively correlated with anxiety, depression, but not with pain levels.
• Low QoL scores were correlated with coping strategies including auto-criticism (positive correlation), emotion expression (negative correlation), social support (negative correlation), cognitive restructuring (negative correlation), and social withdrawal (negative correlation).
• Maladaptive coping skills such as auto-criticism and social withdrawal were especially correlated with QoL factors such as mood and physical changes and feelings of being misunderstood.

 Limitations of the Study

• The study included a relatively small sample size.
• The correlations observed may not be specific to endometriosis but rather to any severe chronic pain condition experienced by adolescents and young adult women.

Lay Summary

González-Echevarría et al. report in J Psychosom Obstet Gynaecol. that symptoms caused by endometriosis have been found to be associated with negative quality of life (QoL) in women with endometriosis and the type of coping strategies adopted by patients have been shown to impact QoL. Coping strategies are categorized as either ineffective (maladaptive) or effective (adaptive) in managing stressful life events. The authors revealed that when dealing with symptoms of a chronic and painful disease, it has been shown that the adaptive coping strategy can be correlated with QoL and symptom presentation.

Research exploring the relationship between coping strategies and QoL is lacking in the adolescent and young adult women population. Therefore, Dr. Flores group from Ponce, PR, USA, investigated the relationship between coping strategies and quality of life (QoL) through a quantitative, cross-sectional study. Cognitive strategies studied included auto-criticism, expression of emotions, social support, cognitive restructuring, and social withdrawal, whereas QoL measures included activity impairments, mood and appearance changes, perception that others do not understand, and feelings that pain controls one’s life.

The majority of patients reported that they feel that endometriosis controls their lives, negatively impacting areas such as work and school, and reported experiencing some level (mild, moderate, or severe) of anxiety and/or depression. QoL scores were positively correlated with anxiety and depression, but not with pain levels. Low QoL scores were correlated with specific coping strategies. “Auto-criticism was the coping strategy more strongly associated with a substantial and negative impact on most of the QoL domains assessed. In addition, social withdrawal scores correlated with impact on work/school performance, mood and physical changes and feelings of being misunderstood. The cognitive restructuring was correlated with work/study impact, physical deficiencies, activity impairment, and mood changes. Significant negative correlations were observed also between express emotion and work/study impairments”.

The authors report that their results are consistent with findings in adult women with endometriosis, where symptoms are reported to reduce QoL and findings show higher rates of depression and anxiety compared to healthy controls. They encourage further studies to explore the correlation between the diagnosis of endometriosis and psychopathological comorbidities in order to better inform patient care and suggest that there is a distinction made between disease staging, symptoms experienced (pain, infertility), use of hormone therapy, and other variables.

The authors conclude that since “patients with a chronic illness are at a significantly greater risk than healthy peers to develop behavioral and emotional problems, it is imperative that patients are coached on the use of adaptive coping strategies to limit the impact on their emotional distress and mental health status promptly after symptom onset”.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29648907