title: Coping strategies have a strong impact on quality of life, depression, and embitterment in patients with Cushing's disease.
abstract: OBJECTIVE
  Quality of life (QoL) and psychosocial well-being are substantially impaired in patients with Cushing's disease (CD), not only at the acute illness stage but also after therapy; however, the reason for these impairments remains unclear.
  
  
  METHODS
  In this cross-sectional, patient-reported outcome study, we conducted a postal survey on psychosocial impairment and coping strategies in patients after surgical treatment of CD in three large tertiary referral centers. In total, 176 patients with CD completed a compilation of self-assessment inventories pertaining to depression (Hospital Anxiety and Depression Scale, HADS), QoL (Short Form SF-36, Tuebingen CD; Tuebingen CD-25), coping style (Freiburg questionnaire on coping with illness, FKV-LIS), and embitterment (Bern Embitterment Inventory), on average 6.8 ± 6.66 years after surgery. Regression analyses were performed to identify predictors of psychosocial impairment.
  
  
  RESULTS
  At the time of the study, 21.8 % of patients suffered from anxiety, 18.7 % experienced an above-average feeling of embitterment, and 13.1 % suffered from depression. Maladaptive coping styles (FKV-LIS subscales depressive coping and minimizing importance) emerged as robust and strong predictors of psychosocial impairment in all inventories; while age, sex, and hydrocortisone intake failed to explain the variance in these measures.
  
  
  CONCLUSIONS
  Similar to several studies in non-pituitary patient cohorts (e.g., patients with multiple sclerosis or lower back pain), our results indicate that psychosocial impairment in CD is significantly influenced by how the patient deals with the illness. Therefore, psychological training of positive coping styles could be a helpful complementary therapy in the overall treatment strategy of CD.
authors: Department of Neurosurgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.|Department of Neurosurgery, University of Erlangen-Nuremberg, Schlossplatz 4, 91054, Erlangen, Germany.
authors: Sonja
authors: S
authors: Siegel
authors: Department of Neurosurgery, University of Tuebingen, Hoppe-Seylerstrasse 3, 72076, Tuebingen, Germany.
authors: Monika
authors: M
authors: Milian
authors: Department of Neurosurgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
authors: Bernadette
authors: B
authors: Kleist
authors: Department of Neurosurgery, University of Tuebingen, Hoppe-Seylerstrasse 3, 72076, Tuebingen, Germany.
authors: Tsambika
authors: T
authors: Psaras
authors: Department of Endocrinology and Metabolic Diseases, University of Duisburg-Essen, Hufelandstraße 55, 45171, Essen, Germany.
authors: Maria
authors: M
authors: Tsiogka
authors: Department of Endocrinology and Metabolic Diseases, University of Duisburg-Essen, Hufelandstraße 55, 45171, Essen, Germany.
authors: Dagmar
authors: D
authors: Führer
authors: Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, SE 751 85, Uppsala, Sweden.
authors: Maria
authors: M
authors: Koltowska-Häggström
authors: Department of Neurosurgery, University of Tuebingen, Hoppe-Seylerstrasse 3, 72076, Tuebingen, Germany.
authors: Jürgen
authors: J
authors: Honegger
authors: Department of Neurosurgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
authors: Oliver
authors: O
authors: Müller
authors: Department of Neurosurgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
authors: Ulrich
authors: U
authors: Sure
authors: Department of Neurosurgery, University of Erlangen-Nuremberg, Schlossplatz 4, 91054, Erlangen, Germany.
authors: Christa
authors: C
authors: Menzel
authors: Department of Neurosurgery, University of Erlangen-Nuremberg, Schlossplatz 4, 91054, Erlangen, Germany.
authors: Michael
authors: M
authors: Buchfelder
authors: Department of Neurosurgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany. ilonka.kreitschmann@uk-essen.de.
authors: Ilonka
authors: http://orcid.org/0000-0002-6389-0261
authors: I
authors: Kreitschmann-Andermahr
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000523:psychology* / Q000601:surgery; D011594:Psychometrics; D011788:Quality of Life
keywords: Coping behavior; Coping skills; Cushing’s disease; Depression; Quality of life