Psychological Factors in Chronic Edema: A Case–Control Study

Christine J. Moffatt, Aimee Aubeeluck, Peter J. Franks, Debra C. Doherty, Peter Mortimer and Isabelle Quere. Lymphatic Research and Biology Volume 15, Number 3, 2017

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Psychological Factors in Chronic Edema: A Case–Control Study

Christine J. Moffatt, Aimee Aubeeluck, Peter J. Franks, Debra C. Doherty, Peter Mortimer and Isabelle Quere. LYMPHATIC RESEARCH AND BIOLOGY Volume 15, Number 3, 2017

Background: To examine psychological health and perceived social support in patients with chronic edema (CE).

Methods and Results: A random sample of 107 patients with CE was group matched for age and gender with 102 community controls. The cases had swelling of the arm (38%) and leg (61%) and midline swelling (14%). Cases were more likely to be single or divorced/separated (p=0.041) and have reduced mobility (p<0.001). They had significantly poorer overall health related quality of life (HRQoL), in particular physical functioning (p=0.003); role physical (p<0.001); general health (p=0.026); vitality (p=0.015); social function (p=0.007); and role emotional (p=0.041). EQ5-D health index scores were significantly reduced in cases by 13 points (p=<0.001, 95% confidence interval 5.8, 21.6). Cases had similar sized social networks to the control group (5.8 vs. 6.6 p=0.49), but had lower total perceived social support scores (67.8 vs. 76.1 p=0.018). CE patients used significantly fewer coping strategies (COPE scale) than controls with regard to the following: active coping (p=0.024); planning (p<0.001); and use of instrumental support (p=0.006). Significantly higher levels of coping were used in restraint (p=0.031), positive reinterpretation and growth (p<0.001); acceptance (<0.001); denial (p<0.001); mental disengagement (p<0.001); behavioral disengagement (<0.001); substance abuse (p=0.010); and humor (p<0.001).

Conclusions: Patients with CE have poorer health and greater impact on many aspects of HRQoL. Perceived social support is reduced. Deficits in social function combined with perceived reduction in support, and reduced mental health and emotional scores indicate the risk of psychological issues. Systems of care should offer an environment to address these issues.

Main findings

  • Chronic oedema is associated with significant psychosocial morbidity.
  • Predominantly it was an elderly population who had been suffering with chronic oedema for a long period with less than half having chronic oedema as a consequence of cancer or its treatment.
  • There was evidence of significant impact on mobility. General health status was poor.
  • The results would suggest that the patients are socially isolated.
  • The sample size, although reflective of the larger population, is relatively small.
  • The low levels of perceived support and increased levels of social isolation support the concept of services that allow for an integrated approach, which includes psychological support and offers patient interaction, a relief from isolation, and an opportunity to share common experiences.