Objective: Addressing unmet mental health needs in Parkinson’s disease (PD) requires delineating their scope and impact. This study evaluated (1) depressive symptom prevalence and treatment rates and (2) depression’s clinical consequences in the Fox Insight (FI) cohort, a large, global cross-section of the PD community.

Background: Depression is among PD’s most prevalent and detrimental symptoms, often going undiagnosed or undertreated. Yet, its rates and symptom burden remain partially understood, as study settings often exclude key PD subgroups. FI’s online data collection eliminates barriers to participation, providing a wider lens through which to examine depression’s toll on PD management, and mental health care utilization patterns.

Method: Cross-sectional analyses of FI data from PD respondents (baseline as of 2/7/2020), included demographics, medical history, and self-reported physical and mental health and quality of life. A positive depression screen was defined as a Geriatric Depression Scale-15 (GDS) score ≥5. Depression treatment included antidepressant use or any depression treatment noted on the Your Medications and Current Health forms. Analyses included respondents with complete data on variables of interest (N=16,992).

Results: This PD cohort was largely (78%) new to research. Of the 42% to screen positive for depression, only 40% reported any depression care, leaving 60% untreated. Younger age, male gender, more severe depression, and higher motor and non-motor symptom scores predicted mental health care utilization (p<.001). Yet, 43% of the most severely depressed (GDS ≥12)  remained untreated. This is noteworthy, as even mild depression negatively impacted motor disability, cognition, and quality of life (p<.001). U.S. veterans and nonveterans reported comparable rates of depression treatment despite access to different care settings, as did those diagnosed with PD by movement disorder specialists (50%) vs. generalists.

Conclusion: FI drew a novel sample in which depression was observed at higher rates compared to prior well-defined PD cohorts, detrimental across domains, and often unaddressed even in its most severe form. This pattern held regardless of veteran status or specialist care. This more inclusive, precise picture of the shortfalls in PD depression care can inform multidisciplinary assessment and treatment models to improve PD management.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/prevalence-impact-and-suboptimal-treatment-of-depression-in-the-fox-insight-cohort/