Psychological Distress after a Diagnosis of Malignant Mesothelioma in a Group of Patients and Caregivers at the National Priority Contaminated Site of Casale Monferrato

Our plain-English summary of Psychological Distress after a Diagnosis of Malignant Mesothelioma in a Group of Patients and Caregivers at the National Priority Contaminated Site of Casale Monferrato, by M. Bonafede, A. Granieri, A. Binazzi, et al (International Journal of Environmental Research and Public Health, 2020).

The study

• Authors: M. Bonafede, A. Granieri, A. Binazzi, C. Mensi, F. Grosso, G. Santoro, I.G. Franzoi, A. Marinaccio, F. Guglielmucci
• Journal: International Journal of Environmental Research and Public Health
• Published: 2020;17(12)
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Patients of malignant mesothelioma (MM) and their caregivers face significant physical and psychological challenges. The purpose of the present study is to examine the emotional impact after the diagnosis of MM in a group of patients and familial caregivers in a National Priority Contaminated Site (NPCS).

Methods: A sample of 108 patients and 94 caregivers received a sociodemographic/clinical questionnaire, the Beck Depression Inventory II, the Davidson Trauma Scale, the Coping Orientation to the Problems Experienced-New Italian Version, and the Defense style questionnaire. The risk of depressive and post-traumatic stress disorder (PTSD) symptoms in relation to the strategies of coping and defense mechanisms was estimated in patients and caregivers separately by logistic regression models.

Results: For patients, a high risk of depression was associated with high usage of Defense Style Questionnaire (DSQ) Isolation (OR: 53.33; 95% CI: 3.22-882.30; p = 0.01) and DSQ Somatization (OR: 16.97; 95% CI: 1.04-275.90; p = 0.05). Other significant risks emerged for some coping strategies and some defenses regarding both depression and trauma in patients and caregivers.

Conclusions: This research suggests that for both patients and caregivers unconscious adaptive processes have a central role in dealing with overwhelming feelings related to the disease.

In plain English

This cross-sectional study at the Mesothelioma Unit of Casale Monferrato-Alessandria, Italy, measured depression and post-traumatic stress symptoms after a diagnosis of malignant mesothelioma. Between September 2014 and December 2018, 108 patients and 94 family caregivers living in the Casale Monferrato contaminated site completed questionnaires on depression, trauma symptoms, coping strategies and defense mechanisms. Caregivers scored higher than patients for trauma symptoms. Thirty caregivers and 12 patients were above the cutoff for post-traumatic symptoms, and 31 caregivers and 25 patients were above the cutoff for depression. Across the whole sample, women were more depressed and traumatized than men. In patients, high use of the defenses called isolation (odds ratio 53.33; 95% CI 3.22 to 882.30) and somatization (16.97; 1.04 to 275.90) was associated with depression. Among caregivers, women had higher odds of depression (6.39; 1.16 to 35.38). The authors concluded that unconscious adaptive processes play a major role in how patients and caregivers respond to feelings about the disease. They noted that they used only self-report measures and that the findings cannot be generalized to all mesothelioma patients.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional questionnaire study with logistic regression analysis
• Who was studied: 108 malignant mesothelioma patients (67% men) and 94 primary family caregivers (72% women) living in the National Priority Contaminated Site of Casale Monferrato, Italy, recruited through the local Mesothelioma Unit from September 2014 to December 2018. Patients were recruited within 6 months of diagnosis.
• Exposure: The study measured psychological outcomes (depression, post-traumatic symptoms), coping strategies and defense mechanisms, not asbestos exposure itself. Patients' asbestos exposure was classed as occupational or environmental: among patients, 61% of men had occupational exposure and 56% of women had environmental exposure. Fiber types are not reported.
• Main results:
  • Patients reported more use of suppression than caregivers. Caregivers were more severely traumatized than patients (Davidson Trauma Scale total score 31.8 in caregivers vs 20.6 in patients).
  • Above the depression cutoff: 25 patients and 31 caregivers. Above the post-traumatic symptom cutoff: 12 patients and 30 caregivers.
  • The difference between patients and caregivers in the numbers above the cutoffs was statistically significant only for post-traumatic symptoms (p = 0.042).
  • In the whole sample (98 men, 104 women), women were more depressed and more traumatized than men.
  • In patients, depression was associated with high use of the defense mechanisms isolation (OR 53.33; 95% CI 3.22 to 882.30; p = 0.01) and somatization (OR 16.97; 95% CI 1.04 to 275.90; p = 0.05).
  • In patients, high use of turning to religion (OR 0.003; 95% CI 0.000 to 0.214) and of humor (OR 0.002; 95% CI 0.000 to 0.286) was associated with lower odds of depression. The authors describe this as a protective effect.
  • In patients, post-traumatic symptoms were associated with passive-aggressive behavior (OR 24.88; 95% CI 1.67 to 369.92) and with avoidance coping strategies (OR 165.87; 95% CI 3.37 to 8173.81).
  • In patients, autistic fantasy (OR 0.007; 95% CI 0.000 to 0.414) and positive attitude (OR 0.0001; 95% CI 0.000 to 0.399) were associated with lower odds of post-traumatic symptoms. The authors call this a potentially protective effect.
  • Among caregivers, women had higher odds of depression (OR 6.39; 95% CI 1.16 to 35.38; p = 0.03).
  • Among caregivers, high use of the following was associated with higher odds of depression: avoidance coping (OR 8.93; 95% CI 2.08 to 38.36), acting out (OR 5.81; 95% CI 1.34 to 25.08), devaluation (OR 11.71; 95% CI 2.27 to 60.45) and displacement (OR 9.98; 95% CI 2.17 to 46.00).
  • Among caregivers, lower odds of depression were found in those aged 61 to 69 years (OR 0.10; 95% CI 0.01 to 0.84) and those with high use of sublimation (OR 0.08; 95% CI 0.02 to 0.40).
  • Among caregivers, post-traumatic symptoms were associated with acting out (OR 7.00; 95% CI 1.10 to 44.47; p = 0.04).
• The authors' conclusion: The authors concluded that unconscious adaptive processes play a major role in how mesothelioma patients and caregivers respond to overwhelming feelings related to the disease. They suggested psychological interventions for both groups.
• Limitations the authors state:
  • Only self-report measures were used, and these may have been influenced by social desirability biases.
  • No clinical data were collected, so results could not be analyzed by disease stage or localization.
  • Because participants were specific subgroups from this contaminated site, the results cannot be generalized to the whole mesothelioma population.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Casale Monferrato.

Related studies

• Preliminary validation of a questionnaire assessing psychological distress in caregivers of patients with malignant mesothelioma: Mesothelioma Psychological Distress Tool-Caregivers — M. Bonafede, C. Chiorri, et al. (2022)
• Psychological Distress in Patients With Asbestos-Related Diseases and Their Families: A Systematic Literature Review — I.G. Franzoi, M.D. Sauta, et al. (2025)
• What are the psychological effects of mesothelioma on patients and their carers? A scoping review — V. Sherborne, J. Seymour, et al. (2020)
• The psychological distress and care needs of mesothelioma patients and asbestos-exposed subjects: A systematic review of published studies — M. Bonafede, M. Ghelli, et al. (2018)
• Preliminary validation of a brief PROM assessing psychological distress in patients with malignant mesothelioma: The mesothelioma psychological distress tool-Patients — F. Guglielmucci, M. Bonafede, et al. (2022)
• Environmental Health Education for Asbestos-Contaminated Communities in Italy: The Casale Monferrato Case Study — D. Marsili, A. Canepa, et al. (2019)

Browse more research in International Journal of Environmental Research and Public Health, or return to medical research.