Factores de riesgo y de protección en la adopción internacional

L’adopció internacional, tot i no ser un fenomen nou, ha assolit una magnitud i una visibilitat molt important en les darreres dècades. Espanya és a l’actualitat, un dels principals països receptors de nens adoptats a l’estranger. D’acord amb aquesta realitat, l’estudi del creixement i l’adaptació d’aquest menors ha esdevingut un tema de gran importància per la investigació. La present tesi doctoral té com a objectiu analitzar el desenvolupament (en termes de capacitat d’aprenentatge i ajust emocional) de nens adoptats a l’estranger i identificar diferents factors de protecció relacionats amb l’entorn familiar que influeixen en la seva evolució. Amb això volem aportar, per un banda, dades que contribueixin a un millor coneixement i comprensió de la realitat d’aquests infants i per altra, aportar eines que facilitin vies d’intervenció orientades a promoure i prevenir un millor desenvolupament i benestar dels menors adoptats en el nostre país. Aquesta tesi es configura a partir de tres estudis. El primer, tracta d’explorar les capacitats d’aprenentatge i el desenvolupament emocional i del llenguatge dels menors adoptats al poc temps d’iniciar la seva escolaritat. A més, pretén observar si el temps que els pares tenen cura del nen a casa abans de ser escolaritzat influeix en el desenvolupament de les seves capacitats d’aprenentatge. Els resultats mostren que la majoria dels menors adoptats presenten unes capacitats d’aprenentatge adequades a la seva edat. Tot i així, un 35,4% del menors presentava dificultats per aprendre i seguir el ritme escolar. Els menors que mostraven dificultats en el desenvolupament emocional foren el 14,2% i un 44% els que presentaven retard en l’àrea del llenguatge. Un major temps de cura a casa abans d’iniciar l’escolarització es va associar amb majors capacitats d’aprenentatge. El segon estudi se centre en la traducció i la validació de l’escala Adoption Communication Scale (ACS) dissenyada per avaluar el grau en que els nens adoptats senten als seus pares oberts i sensibles en la comunicació de la seva adopció i el grau en el que ells (els menors) se senten confortables parlant i expressant els seus sentiments en torn a l’adopció i els seus orígens. Els resultats obtinguts mostren que la versió espanyola de l’escala ACS és un instrument vàlid per avaluar el grau d’obertura en la comunicació familiar en torn als orígens en adolescents adoptats espanyols. Al tercer estudi s’analitza l’ajust psicològic d’un grup d’adolescents adoptats internacionalment i la seva relació amb alguns factors de risc preadoptius. L’estudi també pretén determinar la influencia del grau d’obertura en la comunicació dels orígens en l’ajust psicològic dels adolescents. Els resultats d’aquest últim treball, mostren que la majoria dels adolescents estudiats presenten un bon ajustament psicològic, tot i que un 74,5% dels adolescents s’han visitat en centres de salut mental. El consum de drogues per part de la mare biològica durant l’embaràs i una història de negligència, abús o maltractament prèvia a l’adopció han resultat estar estretament lligats a la presència de problemes de conducta. Finalment, les nostres dades mostren que un major grau d’obertura en la comunicació dels orígens s’associa a una menor probabilitat de patir trastorns de conducta a l’adolescència. Del conjunt de dades obtingudes a la present tesi doctoral, es poden extreure dues recomanacions dirigides a les famílies adoptives. La primera és evitar un inici massa avançat de l’escolarització (malgrat els menors hagin estat adoptats a major edat) amb la finalitat de potenciar dins del sí de la família les seves capacitats de l’aprenentatge. La segona és mantenir una comunicació oberta en torn als orígens entre pares i fills adoptius també durant l’adolescència per prevenir o minimitzar els riscos de presentar possibles trastorns de conducta.La adopción internacional, a pesar de no ser un fenómeno nuevo, ha adquirido una magnitud y una visibilidad muy importante en las últimas décadas. España es, en la actualidad, uno los principales países receptores de niños adoptados en el extranjero. De acuerdo con esta realidad, el estudio del crecimiento y la adaptación de estos menores se ha convertido en un tema de gran importancia para la investigación. La presente tesis doctoral tiene como objetivo analizar el desarrollo (en términos de capacidad de aprendizaje y ajuste emocional) de niños adoptados en el extranjero e identificar distintos factores de protección relacionados con el entorno familiar que influyen en la evolución de éstos. Con ello pretendemos aportar, por un lado, datos que contribuyan a un mejor conocimiento y comprensión de la realidad de estos menores y por otro, aportar herramientas que faciliten vías de intervención orientadas a promover y prevenir un mejor desarrollo y bienestar de los menores adoptados en nuestro país. Esta tesis se configura a partir de tres estudios. El primero, trata de explorar las capacidades de aprendizaje y el desarrollo emocional y del lenguaje de los menores adoptados al poco tiempo de iniciar su escolarización. Además pretende averiguar si el periodo de tiempo que el menor es cuidado por sus padres en el hogar antes de ser escolarizado influye en el posterior desarrollo de sus capacidades de aprendizaje. Los resultados revelan que la mayoría de los menores adoptados presentan unas capacidades de aprendizaje adecuadas a su edad. Sin embargo, un 35,4% de los menores presentaban dificultades para aprender y seguir el ritmo escolar. Los menores que mostraron dificultades en el desarrollo emocional fueron el 14,2% y un 44% los que presentaron retraso en el área del lenguaje. Un mayor tiempo de cuidado en casa antes de iniciar la escolarización se asoció con mayores capacidades de aprendizaje. El segundo estudio se centra en la traducción y validación de la escala Adoption Communication Scale (ACS) diseñada para evaluar el grado en que los niños adoptados sienten a sus padres abiertos y sensibles en la comunicación de su adopción y el grado en el que ellos (los menores) se sienten confortables hablando y expresando sus sentimientos acerca de su adopción y sus orígenes. Los resultados muestran que la versión española de la escala ACS resulta un instrumento válido para evaluar el grado de apertura en la comunicación familiar en torno a los orígenes en adolescentes adoptados españoles. En el tercer estudio se analiza el ajuste psicológico de un grupo de adolescentes adoptados internacionalmente y su relación con algunos factores de riesgo preadoptivos. El estudio también pretende determinar la influencia del grado de apertura en la comunicación de los orígenes en el ajuste psicológico de los adolescentes. Los resultados de este último trabajo muestran que la mayoría de los adolescentes estudiados presentan un buen ajuste psicológico, a pesar de que un 74,5% de los adolescentes se ha visitado en centros de salud mental. El consumo de drogas por parte de la madre biológica durante el embarazo y una historia de negligencia, abuso o maltrato previa a la adopción han mostrado estar estrechamente ligados a la presencia de problemas de conducta. Finalmente, nuestros datos muestran que un mayor grado de apertura en la comunicación de los orígenes se asocia a una menor probabilidad de sufrir trastornos de conducta en la adolescencia. Del conjunto de datos obtenidos en la presente tesis doctoral pueden ser extraídas dos recomendaciones dirigidas a las familias adoptivas. La primera, evitar una escolarización demasiado temprana (aun cuando los menores son adoptados a mayor edad) con la finalidad de potenciar en familia las capacidades de aprendizaje del menor adoptado. Y la segunda, mantener una comunicación abierta en torno a los orígenes entre padres e hijos adoptivos también durante la adolescencia, para prevenir o mitigar posibles trastornos de conducta.International adoption, despite not being a new phenomenon, has expanded considerably and has received remarkable exposure in the last decades. Spain is currently one of the primary countries that are recipient of children adopted abroad. Coinciding with this reality, the study of the growth and adaptation of these minors has become a topic of great importance in the research field. The present doctoral thesis seeks to analyse the development in terms of learning abilities and emotional adjustment of children adopted abroad. Furthermore, to identify the various protective factors associated with the family surrounding that influence the children’s evolution. We aim to provide, on the one hand, data that will contribute to an elevated knowledge and understanding of the reality of these minors, and, on the other, tools that will facilitate intervention strategies oriented towards promoting a better development and wellbeing of minors adopted in our country. This thesis is structured around three studies. The first study explores, shortly after the start of the adoptees’ academic education, their learning abilities and their emotional and language development. In addition, it aims to assess whether the period of time that the minor is cared by the parents at home before attending school influences the development of learning abilities. The results show that the majority of adopted minors present learning abilities that are adequate for their age. However, 35.4% of the minors presented difficulties to learn and to keep up with the school syllabus. The minors that displayed difficulties in emotional development were 14.2% and 44% showed hindrance in the language area. A longer care at home before beginning the school was associated with greater learning abilities. The second study focuses on the translation and validation of the scale Adoption Communication Scale (ACS) designed to evaluate the degree to which adopted children feel that their parents are open and sensitive to discuss their adoption, and the extent to which the minors feel comfortable to talk about and express their feelings regarding their adoption and origins. The results show that the Spanish version of the ACS scale is a valid instrument to evaluate the degree of openness to family communication regarding the origins of Spanish adopted adolescents. In the third study, the psychological adjustment of a group of adolescents adopted internationally is analysed, as well as its association with certain risk factors present prior to the adoption. The study also aims to determine the influence of the degree of openness to discuss the adolescents’ origins on their psychological adjustment. The results of this last study show that the majority of the studied adolescents presented a good psychological adjustment despite that 74.5% had attended mental health centres. The consumption of drugs by the biological mother during pregnancy and a history of negligence, abuse or maltreatment prior to the adoption were found to be tightly linked to the presence of behaviour problems. Finally, our data demonstrate that a greater degree of openness to discuss the origins is associated with an increased likelihood of suffering behaviour disorders. From the data obtained in the current doctoral thesis it is possible to make two recommendations to adoptive families. First, starting school shortly after the adoption should be avoided (including when the minors are adopted at a later age) in order to potentiate, as a family, the learning abilities of the adopted minor. Secondly, open discussions in relation to the origins should be maintained between the parents and adoptive children, including in adolescence, to prevent or manage possible behavioural disorders

Medea, la actualidad de un mito : Madres filicidas: su tratamiento en los medios de comunicación

El presente artículo aborda un caso de filicidio por venganza, conocido en la psiquiatría y psicología forenses como “Complejo de Medea”. Dicho caso, de público conocimiento, tuvo un fuerte impacto mediático y social, lo cual invita a analizar el tratamiento mediático que se hizo de la autora del crimen que, con la colaboración de reconocidos especialistas, fue descripta en términos de una mujer aberrante, monstruosa, anormal y peligrosa. Una vez más un homicidio era interpretado de un modo reduccionista como un acto singular producto de una patología determinada, dejando por fuera toda lectura del contexto socio-cultural del acto en sí y de lo que implica el ejercicio de la función materna para cada mujer. Asimismo, se articula este caso con el mito de Medea desde una perspectiva de género, dado que nos acerca las coordenadas para pensar qué se pone en juego en el acto filicida. Medea, al igual que la protagonista de esta historia, quedó “al borde” provocada por la traición y el abandono. Ambas mujeres al borde de un abismo al que arrojaron a sus hijos. Y a sí mismas. Odio y venganza que condujeron a la destrucción de otros y a la propia.This article addresses a case or revenge filicide, known in forensic psychiatry and psychology as the “Medea Complex”. This case became public and had a strong impact in society and the media, which leads to the vision of the crime’s author presented to the public: through the intervention of prestigious specialists, she was described as abnormal, monstrous, anomalous and dangerous. Once more, a homicide is interpreted in a reductionist manner as a unique happening, product of a certain pathology, disregarding all socio-cultural context for the happening and what the motherly role represents for each woman. Likewise, this case connects to the Medea myth from a gender perspective, considering what is at play in cases of filicide. Medea, like the protagonist of this story, is “on the brink” after betrayal and abandonment. Both women placed on the brink of the abyss activated by their children. And themselves. Hatred and violence which led to the destruction of others, and their own.Facultad de Psicologí

Predictors of clinically significant quality of life impairment in Parkinson's disease.

Quality of life (QOL) plays an important role in independent living in Parkinson?s disease (PD) patients, being crucial to know what factors impact QoL throughout the course of the disease. Here we identified predictors of QoL impairment in PD patients from a Spanish cohort. PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016, to November 2017, were followed up during 2 years. Health-related QoL (HRQoL) and global QoL (GQoL) were assessed with the 39-item Parkinson?s disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8), respectively, at baseline (V0) and at 24 months ± 1 month (V2). Clinically significant QoL impairment was defined as presenting an increase (PDQ-39SI) or decrement (EUROHIS-QOL8) at V2 ? 10% of the score at baseline (V0). A comparison with a control group was conducted for GQoL. GQoL did not change significantly in PD patients (N = 507; p = 0.686) or in the control group (N = 119; p = 0.192). The mean PDQ-39SI was significantly increased in PD patients (62.7 ± 8.5 years old; 58.8% males; N = 500) by 21.6% (from 16.7 ± 13 to 20.3 ± 16.4; p < 0.0001) at V2. Ninety-three patients (18.6%) presented a clinically significant HRQoL impairment at V2. To be younger (OR = 0.896; 95% CI 0.829?0.968; p = 0.006), to be a female (OR = 4.181; 95% CI 1.422?12.290; p = 0.009), and to have a greater increase in BDI-II (Beck Depression Inventory-II) (OR = 1.139; 95% CI 1.053?1.231; p = 0.001) and NMSS (Non-Motor Symptoms Scale) (OR = 1.052; 95% CI 1.027?1.113; p < 0.0001) total scores from V0 to V2 were associated with clinically significant HRQoL impairment at the 2-year follow-up (Hosmer?Lemeshow test, p = 0.665; R2 = 0.655). An increase in ?5 and ?10 points of BDI-II and NMSS total score at V2 multiplied the probability of presenting clinically significant HRQoL impairment by 5 (OR = 5.453; 95% CI 1.663?17.876; p = 0.005) and 8 (OR = 8.217; 95% CI, 2.975?22.696; p = 0.002), respectively. In conclusion, age, gender, mood, and non-motor impairment were associated with clinically significant HRQoL impairment after the 2-year follow-up in PD patient

Diplopia Is Frequent and Associated with Motor and Non-Motor Severity in Parkinson’s Disease: Results from the COPPADIS Cohort at 2-Year Follow-Up

[Background and objective] Diplopia is relatively common in Parkinson’s disease (PD) but is still understudied. Our aim was to analyze the frequency of diplopia in PD patients from a multicenter Spanish cohort, to compare the frequency with a control group, and to identify factors associated with it.[Patients and Methods] PD patients who were recruited from January 2016 to November 2017 (baseline visit; V0) and evaluated again at a 2-year ± 30 days follow-up (V2) from 35 centers of Spain from the COPPADIS cohort were included in this longitudinal prospective study. The patients and controls were classified as “with diplopia” or “without diplopia” according to item 15 of the Non-Motor Symptoms Scale (NMSS) at V0, V1 (1-year ± 15 days), and V2 for the patients and at V0 and V2 for the controls.[Results] The frequency of diplopia in the PD patients was 13.6% (94/691) at V0 (1.9% in controls [4/206]; p < 0.0001), 14.2% (86/604) at V1, and 17.1% (86/502) at V2 (0.8% in controls [1/124]; p < 0.0001), with a period prevalence of 24.9% (120/481). Visual hallucinations at any visit from V0 to V2 (OR = 2.264; 95%CI, 1.269–4.039; p = 0.006), a higher score on the NMSS at V0 (OR = 1.009; 95%CI, 1.012–1.024; p = 0.015), and a greater increase from V0 to V2 on the Unified Parkinson’s Disease Rating Scale–III (OR = 1.039; 95%CI, 1.023–1.083; p < 0.0001) and Neuropsychiatric Inventory (OR = 1.028; 95%CI, 1.001–1.057; p = 0.049) scores were independent factors associated with diplopia (R2 = 0.25; Hosmer and Lemeshow test, p = 0.716).[Conclusions] Diplopia represents a frequent symptom in PD patients and is associated with motor and non-motor severity.Martínez-Martin P. has received honoraria from National School of Public Health (ISCIII), Editori-al Viguera and Takeda Pharmaceuticals for lecturing in courses, and from the International Parkinson and Movement Disorder Society (MDS) for management of the Program on Rating Scales. Mir P. has received honoraria from AbbVie, Abbott, Allergan, Bial, Merz, UCB, and Zambon and have received grants from the Spanish Ministry of Economy and Competitiveness [PI16/01575], co-founded by ISCIII (Subdirección General de Evaluación y Fomento de la Investigación) and by Fondo Europeo de Desarrollo Regional (FEDER), the Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía [CVI-02526, CTS-7685], the Consejería de Salud y Bienestar Social de la Junta de Andalucía [ PI-0437-2012, PI-0471-2013], the Sociedad Andaluza de Neurología, the Jacques and Gloria Gossweiler Foundation, the Fundación Alicia Koplowitz, the Fundación Mutua Madrileña.Peer reviewe

Predictors of Loss of Functional Independence in Parkinson’s Disease: Results from the COPPADIS Cohort at 2-Year Follow-Up and Comparison with a Control Group

COPPADIS Study Group.[Background and objective] The aim of this study was to compare the progression of independence in activities of daily living (ADL) in Parkinson’s disease (PD) patients versus a control group, as well as to identify predictors of disability progression and functional dependency (FD).[Patients and Methods] PD patients and control subjects, who were recruited from 35 centers of Spain from the COPPADIS cohort between January 2016 and November 2017 (V0), were included. Patients and subjects were then evaluated again at the 2-year follow-up (V2). Disability was assessed with the Schwab & England Activities of Daily Living Scale (S&E-ADLS) at V0 and V2. FD was defined as an S&E-ADLS score less than 80%.[Results] In the PD group, a significant decrease in the S&E-ADLS score from V0 to V2 (N = 507; from 88.58 ± 10.19 to 84.26 ± 13.38; p < 0.0001; Cohen’s effect size = −0.519) was observed but not in controls (N = 124; from 98.87 ± 6.52 to 99.52 ± 2.15; p = 0.238). When only patients considered functional independent at baseline were included, 55 out of 463 (11.9%) converted to functional dependent at V2. To be a female (OR = 2.908; p = 0.009), have longer disease duration (OR = 1.152; p = 0.002), have a non-tremoric motor phenotype at baseline (OR = 3.574; p = 0.004), have a higher score at baseline in FOGQ (OR = 1.244; p < 0.0001) and BDI-II (OR = 1.080; p = 0.008), have a lower score at baseline in PD-CRS (OR = 0.963; p = 0.008), and have a greater increase in the score from V0 to V2 in UPDRS-IV (OR = 1.168; p = 0.0.29), FOGQ (OR = 1.348; p < 0.0001) and VAFS-Mental (OR = 1.177; p = 0.013) (adjusted R-squared 0.52; Hosmer and Lemeshow test = 0.94) were all found to be independent predictors of FD at V2.[Conclusions] In conclusion, autonomy for ADL worsens in PD patients compared to controls. Cognitive impairment, gait problems, fatigue, depressive symptoms, more advanced disease, and a non-tremor phenotype are independent predictors of FD in the short-term.Fundación Curemos el Parkinson (www.curemoselparkinson.org).Peer reviewe

Predictors of Global Non-Motor Symptoms Burden Progression in Parkinson’s Disease. Results from the COPPADIS Cohort at 2-Year Follow-Up

COPPADIS Study Group.[Background and Objective] Non-motor symptoms (NMS) progress in different ways between Parkinson’s disease (PD) patients. The aim of the present study was to (1) analyze the change in global NMS burden in a PD cohort after a 2-year follow-up, (2) to compare the changes with a control group, and (3) to identify predictors of global NMS burden progression in the PD group.[Material and Methods] PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort from January 2016 to November 2017, were followed-up with after 2 years. The Non-Motor Symptoms Scale (NMSS) was administered at baseline (V0) and at 24 months ± 1 month (V2). Linear regression models were used for determining predictive factors of global NMS burden progression (NMSS total score change from V0 to V2 as dependent variable).[Results] After the 2-year follow-up, the mean NMS burden (NMSS total score) significantly increased in PD patients by 18.8% (from 45.08 ± 37.62 to 53.55 ± 42.28; p < 0.0001; N = 501; 60.2% males, mean age 62.59 ± 8.91) compared to no change observed in controls (from 14.74 ± 18.72 to 14.65 ± 21.82; p = 0.428; N = 122; 49.5% males, mean age 60.99 ± 8.32) (p < 0.0001). NMSS total score at baseline (β = −0.52), change from V0 to V2 in PDSS (Parkinson’s Disease Sleep Scale) (β = −0.34), and change from V0 to V2 in NPI (Neuropsychiatric Inventory) (β = 0.25) provided the highest contributions to the model (adjusted R-squared 0.41; Durbin-Watson test = 1.865).[Conclusions] Global NMS burden demonstrates short-term progression in PD patients but not in controls and identifies worsening sleep problems and neuropsychiatric symptoms as significant independent predictors of this NMS progression.This research was funded by Fundación Española de Ayuda a la Investigación en Parkinson y otras Enfermedades Neuro-degenerativas (Curemos el Parkinson; www.curemoselparkinson.org).Peer reviewe

Staging Parkinson’s Disease Combining Motor and Nonmotor Symptoms Correlates with Disability and Quality of Life

COPPADIS Study Group.[Introduction] In a degenerative disorder such as Parkinson’s disease (PD), it is important to establish clinical stages that allow to know the course of the disease. Our aim was to analyze whether a scale combining Hoehn and Yahr’s motor stage (H&Y) and the nonmotor symptoms burden (NMSB) (assessed by the nonmotor symptoms scale (NMSS)) provides information about the disability and the patient’s quality of life (QoL) with regard to a defined clinical stage.[Materials and Methods] Cross-sectional study in which 603 PD patients from the COPPADIS cohort were classified according to H&Y (1, stage I; 2, stage II; 3, stage III; 4, stage IV/V) and NMSB (A: NMSS = 0–20; B: NMSS = 21–40; C: NMSS = 41–70; D: NMSS ≥ 71) in 16 stages (HY.NMSB, from 1A to 4D). QoL was assessed with the PDQ-39SI, PQ-10, and EUROHIS-QOL8 and disability with the Schwab&England ADL (Activities of Daily Living) scale.[Results] A worse QoL and greater disability were observed at a higher stage of H&Y and NMSB (). Combining both (HY.NMSB), patients in stages 1C and 1D and 2C and 2D had significantly worse QoL and/or less autonomy for ADL than those in stages 2A and 2B and 3A and 3B, respectively (; e.g., PDQ-39SI in 1D [n = 15] vs 2A [n = 101]: 28.6 ± 17.1 vs 7.9 ± 5.8; ).[Conclusion] The HY.NMSB scale is simple and reflects the degree of patient involvement more accurately than the H&Y. Patients with a lower H&Y stage may be more affected if they have a greater NMS burden.Peer reviewe

Predictors of clinically significant quality of life impairment in Parkinson’s disease

COPPADIS Study Group.Quality of life (QOL) plays an important role in independent living in Parkinson’s disease (PD) patients, being crucial to know what factors impact QoL throughout the course of the disease. Here we identified predictors of QoL impairment in PD patients from a Spanish cohort. PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016, to November 2017, were followed up during 2 years. Health-related QoL (HRQoL) and global QoL (GQoL) were assessed with the 39-item Parkinson’s disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8), respectively, at baseline (V0) and at 24 months ± 1 month (V2). Clinically significant QoL impairment was defined as presenting an increase (PDQ-39SI) or decrement (EUROHIS-QOL8) at V2 ≥ 10% of the score at baseline (V0). A comparison with a control group was conducted for GQoL. GQoL did not change significantly in PD patients (N = 507; p = 0.686) or in the control group (N = 119; p = 0.192). The mean PDQ-39SI was significantly increased in PD patients (62.7 ± 8.5 years old; 58.8% males; N = 500) by 21.6% (from 16.7 ± 13 to 20.3 ± 16.4; p < 0.0001) at V2. Ninety-three patients (18.6%) presented a clinically significant HRQoL impairment at V2. To be younger (OR = 0.896; 95% CI 0.829–0.968; p = 0.006), to be a female (OR = 4.181; 95% CI 1.422–12.290; p = 0.009), and to have a greater increase in BDI-II (Beck Depression Inventory-II) (OR = 1.139; 95% CI 1.053–1.231; p = 0.001) and NMSS (Non-Motor Symptoms Scale) (OR = 1.052; 95% CI 1.027–1.113; p < 0.0001) total scores from V0 to V2 were associated with clinically significant HRQoL impairment at the 2-year follow-up (Hosmer–Lemeshow test, p = 0.665; R 2 = 0.655). An increase in ≥5 and ≥10 points of BDI-II and NMSS total score at V2 multiplied the probability of presenting clinically significant HRQoL impairment by 5 (OR = 5.453; 95% CI 1.663–17.876; p = 0.005) and 8 (OR = 8.217; 95% CI, 2.975–22.696; p = 0.002), respectively. In conclusion, age, gender, mood, and non-motor impairment were associated with clinically significant HRQoL impairment after the 2-year follow-up in PD patients.Mir P. has received honoraria from AbbVie, Abbott, Allergan, Bial, Merz, UCB and Zambon and have received grants from the Spanish Ministry of Economy and Competitiveness [PI16/01575] co-founded by ISCIII (Subdirección General de Evaluación y Fomento de la Investigación) and by Fondo Europeo de Desarrollo Regional (FEDER), the Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía [CVI-02526, CTS-7685], the Consejería de Salud y Bienestar Social de la Junta de Andalucía [PI-0437-2012, PI-0471-2013], the Sociedad Andaluza de Neurología, the Jacques and Gloria Gossweiler Foundation, the Fundación Alicia Koplowitz, the Fundación Mutua Madrileña.Peer reviewe