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Cognitive Appraisal and Depression in Patients with Coeliac Disease

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Cognitive Appraisal and Depression in Patients with Coeliac Disease Cognitive Appraisal and Depression in Patients with Coeliac Disease Thesis by Michaela Konigova Submitted in Partial Fulfillment of the Requirements for the Degree of Bachelor of Arts in Psychology State University of New York Empire State College 2016 Reader: Ronnie Mather, Ph.D. Acknowledgements I would like to thank my mentor Ronnie Mather, Ph.D. for his guidance and continuous support and help during my research. Also, I would like to thank Mrs. Jitka Dlabalova, director of Spolecnost pro bezlepkovou dietu (Association for gluten-free diet), for her guidance, consultation, as well as support with participants’ outreach. Furthermore, I would like to thank my family, especially to my life partner Milan, who always supported me in my studies, and our beloved son David. Special thanks belong to my parents, Zdenek and Libuse, who were there for me whenever I need them most, and without their help and babysitting, I would not be able to complete it. Table of Contents 1 Introduction 6 2 Literature Review 9 2.1 Coeliac Disease 9 2.1.1 Impacts of the Coeliac Disease on Psychological Problems 11 2.1.2 Biological Explanations for Psychological Disturbances in Patients with Coeliac Disease 12 2.2 Cognitive Appraisal 14 2.2.1 Types of Cognitive Appraisal 15 2.2.2 Measures of Cognitive Appraisal 16 2.2.3 The Cognitive Appraisal of Health Scale 17 2.3 Depression 18 2.3.1 Types of Depression 19 2.3.2 Factors of Depression 21 2.3.3 Measures of Depression 22 2.3.4 The Beck Depression Inventory II 23 2.4 Cognitive Appraisals and Depression 24 2.4.1 Cognitive Appraisals and Depression in Patients with Coeliac Disease 24 2.5 Model Used in the Current Research 26 2.6 Hypotheses 27 2.7 Theoretical Assumptions 28 3. Method 29 3.1 Introduction 29 3.2 Research Design 29 3.3 Participants 30 3.4 Ethics 30 3.5 Measures 31 3.6 Procedure 32 3.7 Analysis 32 4. Findings 34 4.1. Introduction 34 4.2. Results of the Application of the Method 34 4.3. Descriptive Statistics of Main Variables 34 4.3.1. Overall Descriptive Statistics of Main Variables 34 4.3.2. Descriptive Statistics of Depression Scores by Gender 37 4.3.3. Descriptive Statistics of Depression Scores by Diagnosis 39 4.4. Test of Hypotheses 41 5. Discussion 44 5.1. Discussion of Descriptive Statistics 44 5.2. Discussion of Test of Hypotheses 48 6. Conclusions 50 6.1. Main Conclusions 50 6.2. Implications 51 6.3. Limitations 51 6.4. Suggestions for Future Research 52 Work Cited 53 Appendix 58 Abstract Higher prevalence of depressive disorders among patients with coeliac disease compared to the general population is attracting scientists to study this phenomenon. Based on the current state of research, combination of biological and cognitive reasons is at the center of the presumed association. The research was designed to analyze the impact of cognitive appraisal on depression. To examine if gender, diagnosis of coeliac disease, and the cognitive appraisal predicts clinical depression multiple regression analysis was carried out. The participants were selected based on the random sampling principle. They were advised to participate in the research with the help of the Association for Gluten-Free Diet in the Czech Republic. The total sample size was 215 participants, out of which 141 confirmed the diagnosis of coeliac disease and 74 not. The participants completed two standardized tests: Cognitive Appraisal of Health Scale and Beck Depression Inventory – II. The independent variables, i.e. gender, diagnosis of coeliac disease and cognitive appraisal statistically significantly predicted depression, F (6, 130) = 5.885, p < 0.0005, adj. R2 = 0.177, p < 0.05. This possible association between gender, diagnosis of coeliac disease, cognitive appraisal and depression should be taken into consideration by psychotherapists and counsellors, particularly if the depressed patients do not respond well to psychological treatment or psychopharmacological therapy. Also, the psychotherapists and counsellors should be aware that threat type of cognitive appraisal related to the coeliac disease and gluten- free diet might elevate the clinical symptoms of depression. Further research on this topic should bring more clarity on this interesting association. COGNITIVE APPRAISAL, COELIAC DISEASE, DEPPRESSION 6 Introduction From time to time, everyone feels a little bit blue, lazy, or let’s call it depressed. But when this particular state of mind persists or occur more often, people start to think about it, and they might consider seeking a professional help. Quite often, those who have been looking for the professional help of psychologist because of feeling depressed are not responding well to the treatment. When the professional tries to find out the reasons behind it, they detect intestinal problems leading their patients to seek the help of gastroenterologists and the diagnoses of a coeliac disease. Coeliac disease is a gastrointestinal disorder with many diverse symptoms. The typical disease’s features are represented by gastrointestinal problems, anemia, vitamins deficiencies and chronic fatigue but in some people the coeliac disease masks itself by completely different symptoms, if any. Along with these medical problems there is an increased rate of depression in patients with coeliac disease compared to the general population. According to several studies, the symptoms of depression in patients with coeliac disease is almost twice as higher than in general population (Ludvigsson, Reutfors, Osby, Ekbom, & Montgomery, 2007)& (Arigo, Anskis, & Smyth, 2012)& (Ciacci, Iavarone, Mazzacca, & De Rosa, 1998), which suggests that there might be a feasible explanation why depressive symptoms co-occur with the coeliac disease. Researchers focus on three main biological possibilities why coeliac disease might trigger or mask psychological problems, i.e. malabsorption of nutrients essential for normal functioning of the brain; immunological reaction and release of antibodies affecting the hypothalamus-pituitary-adrenal axis; and extra-intestinal inflammation of the body (Beaudoin & Zimbardo, 2012). But even after recognition of the coeliac COGNITIVE APPRAISAL, COELIAC DISEASE, DEPPRESSION 7 disease and initiating the gluten-free diet, which by now represents the only effective treatment for coeliac disease, these symptoms of depression do not simply vanish (Hauser, Janke, Klump, Gregor, & Hinz, 2010). And it is precisely the time when people’s cognitive evaluation affects their feelings and behavior. The gluten-free diet could, in some people, lead to the reduction in quality of life. The adherence to gluten- free diet can be frustrating and isolating as the meal plays an important role in social life and these restrictions could lead to disruption of social relationships and individual’s well-being for many reasons. For example, one cause might be represented by concerns about cross-contamination that intensify the fear, another one could be loss of favorite foods that lead to grief and/or anger ant there is also an impact of constant worries that adhering to the gluten-free diet would result in labeling them sick in the eyes of friends, family, partner and/or colleagues. If these cognitions continue they start to interfere with daily life and could cause further disruptions to an individual’s well- being and could even worsen the depressive states of these individuals. Studies suggest that patients with coeliac disease may need psychological support in order to correct psychological alterations and to improve the acceptance of gluten-free diet (Addolorato, et al., 2004) & (Hauser, Janke, Klump, Gregor, & Hinz, 2010). Also, the new trend of popularity of gluten-free diet causes another problem to patients with coeliac disease. Mass-media are misinterpreting the benefits of gluten-free diet and gluten-free diet is becoming popular diet life-style option among general population. This trend affects significantly the food industry profits with the gluten-free segment becoming a multi-billion dollars’ industry (Gaesser & Angadi, 2012) rising annually by 26% in Europe and the United States of America. The producers are COGNITIVE APPRAISAL, COELIAC DISEASE, DEPPRESSION 8 developing newer and tastier eating options putting those who really need to adhere to the diet at risk. Firstly, not only are those options chemically and otherwise processed, but they also contain more sugars, salt and additives which might have negative effects on health. Secondly and more importantly, the coeliac disease, being the mainstream option, is not taken seriously in restaurants, cafeterias and other facilities anymore. It is not rare for a coeliac asking for a gluten-free option at the restaurant to be served a pasta cooked in a boiled water full of gluten and after returning home experiencing subsequent health problems, which in turn influence coeliacs’ cognitive appraisal system. The goal of this research is to examine the impact of cognitive appraisal, the diagnosis of coeliac disease and necessity to adhere to the diet measures on the increased level of depression among patients with coeliac disease. We believe that our research findings will be useful due to following reasons. The first one is that there are tons of research on biological reasons of depression in patients with coeliac disease but there is lack of research on cognitive appraisal of the coeliac disease’ diagnosis and depression and we need to address this topic. The second one is that this might help to understand the impact of cognitive evaluation on the psyche of the individuals living with a coeliac disease which in turn leads to higher awareness of this problem of both, the professionals (i.e. medical doctors, psychologists, and counselors) and the individuals living with coeliac disease. This in turn might help to overcome the obstacles of living with this type of chronic illness and lead to an increase of the quality of life. COGNITIVE APPRAISAL, COELIAC DISEASE, DEPPRESSION 9 Literature Review 2.1 Coeliac Disease The coeliac disease is an autoimmune type of gastrointestinal disorder often referred to as a Chameleon Disease, because it can be manifested by different kinds of symptoms.
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