# The Unseen Burden: Uncovering Shame and Its Determinants in Parkinson's Disease

## TL;DR

This study explores how shame affects Parkinson's disease patients and finds that psychological traits and health quality strongly influence it.

## Contribution

The study identifies distinct shame profiles and their associations with psychological and clinical factors in Parkinson's disease.

## Key findings

- PD-related shame correlates with trait anxiety, guilt propensity, and health-related quality of life.
- Three distinct shame clusters were identified, each linked to different symptom and psychological profiles.
- Apathy and depression are key factors in the highest-intensity shame cluster.

## Abstract

Shame is frequent in Parkinson's disease (PD) and often overlooked.

The aim was to assess factors associated with PD‐related shame.

PD‐related shame was measured using the Shame and Embarrassment in PD (SPARK) scale in patients without cognitive impairment. Correlation between personal determinants (demographics, psychological traits [shame/guilt propensity, trait anxiety]), PD‐related determinants (PD characteristics; motor, cognitive, and neuropsychiatric symptoms; medication; and health‐related quality of life [QoL]), and SPARK was analyzed using multiple correlation analysis and generalized linear mixed models. To describe the cohort's response to shame, data‐driven clustering based on SPARK was conducted, and clusters' associations with the determinants were analyzed.

Forty‐seven PD patients were included. PD‐related shame correlated with psychological traits (trait anxiety, shame, and guilt propensity), clinical symptoms (dyskinesia, state anxiety, depression, and apathy), and QoL. These determinants explained 79.3% of the total variance in the subsequent linear model analysis, with QoL and anxiety as the strongest covariates of shame. Apathy positively covaried with SPARK self‐esteem subscale. Cluster analysis identified 3 patient groups. Highest‐intensity shame cluster demonstrated elevated scores on both motor and nonmotor symptom–related shame and was associated with higher levels in anxiety, depression, and apathy, and poorer QoL. The remaining clusters showed a dissociation, with motor symptom–related shame predominating in one and nonmotor symptom–related shame in the other.

This study provides an in‐depth understanding of shame, highlighting its multifactorial nature. Due to its impact on QoL, shame should be addressed in clinical practice through pharmacological/nonpharmacological interventions, targeting both shame and its modifiable determinants. Identifying distinct shame profiles underscores the need for tailored interventions.