From Perceived Stress to Demoralization in Parkinson Disease: A Path Analysis

John M. de Figueiredo, Boheng Zhu, Amar Patel, Robert Kohn, Brian B. Koo, Elan D. Louis

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objectives: The objective of this study was to determine whether depression and anxiety are mediators between perceived stress and demoralization via a loss of the cognitive map to get out of the predicament manifesting as subjective incompetence. Methods: Ninety-five consecutive outpatients with Parkinson's disease were evaluated for perceived stress, depression, anxiety, subjective incompetence, and demoralization using reliable and valid scales. Inclusion criteria were ages 40–90, intact cognition, and no current history of substance use. The setting was a Movement Disorders Clinic at a university-affiliated hospital. The outcome variable was demoralization, selected a priori. Mediators between perceived stress and demoralization were examined using path analysis. Results: Depression, anxiety, and subjective incompetence were mediators between perceived stress and demoralization. Among all variables, subjective incompetence was the largest contributor to demoralization. Depression connected to demoralization indirectly via subjective incompetence (β = 0.25, p < 0.001), whereas anxiety bypassed subjective incompetence (β = −0.01, p = 0.882), connecting directly to demoralization (β = 0.37, p = 0.008). Conclusion: Early treatment and reversal of subjective incompetence and anxiety could potentially prevent the escalation of demoralization and the associated disruption in health-related quality of life and eventual suicide.

Original languageEnglish (US)
Article number876445
JournalFrontiers in Psychiatry
StatePublished - May 10 2022


  • Parkinson's disease
  • anxiety
  • demoralization
  • depression
  • stress
  • subjective incompetence
  • suicide/suicidal ideation/suicidal behavior

ASJC Scopus subject areas

  • Psychiatry and Mental health


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