Coping Strategies Modify the Risk of Depression Associated with Chronic Graft-Versus-Host Disease Severity

BACKGROUND: Previous research suggests that chronic graft-versus-host disease (cGVHD) is a risk factor for depressive symptomatology among allogeneic hematopoietic cell transplant (HCT) survivors. The extent to which coping modifies this risk is unknown, however.

OBJECTIVE: The goal of the current study was to determine whether coping strategies modify risk of depression among patients with cGHVD.

METHODOLOGY: As part of a larger study of quality of life in allogeneic HCT recipients, participants were assessed 90 days post-transplant. Participants completed the Center for Epidemiological Studies–Depression Scale, the Coping Responses Inventory focusing on coping with the disease and its treatment, and the Lee Chronic Graft-Versus-Host Disease Specific Symptom Scale. Descriptive, correlation and moderation analysis were performed.

RESULTS: The sample consisted of 105 participants (mean age 52, range 20-76, 42% female).  A total of 28% of the sample met criteria for clinically significant depressive symptomatology.  Univariate Spearman correlations indicated that depression was associated with greater cGVHD severity as well as the coping strategies of avoidance, acceptance and resignation, emotional discharge (p values <.01).  Problem solving coping was associated with less depression (p=.03).  Moderator analyses indicated that coping strategies significantly modified the risk of depression associated with cGVHD.  Specifically, cGVHD was significantly associated with depression among patients who frequently used maladaptive coping strategies (i.e., avoidance, emotional discharge) and rarely used adaptive coping strategies (i.e., positive reappraisal, problem solving).  In contrast, cGVHD severity was not associated with depression in patients who frequently used problem solving and infrequently used avoidance and emotional discharge. 

DISCUSSION: Results from the current study suggest that adaptive coping mitigates cGVHD as a risk factor for depression.  These results highlight the importance of psychological interventions to improve coping as a means to prevent or reduce depressive symptomatology associated with cGVHD.

FUNDING: NCI K07 CA138499