Philadelphia Geriatric Morale Scale in essential tremor: a population-based study in three Spanish communities

Essential tremor (ET) is associated with both functional disability and depression. Each could contribute to a poor sense of well-being and low morale. We hypothesized that morale would be lower in ET cases than controls. Using a population-based, cross-sectional design, morale was assessed in 187 ET cases and 561 matched controls living in three communities in central Spain using the Philadelphia Geriatric Center Morale Scale (PGCMS) (range = 0 [low morale]-17), which included three-dimensions of psychological well-being: agitation, lonely dissatisfaction, and attitude toward own aging. The PGCMS score was lower in ET cases than controls (9.41 +/- 3.21 vs. 10.39 +/- 2.92, P < 0.001), as were the Agitation subscore (3.17 +/- 1.71 vs. 3.78 +/- 1.67, P< 0.001) and Lonely Dissatisfaction subscore (3.75 +/- 1.34 vs. 4.02 +/- 1.24, P < 0.05). Nearly one-half of the ET cases were classified as having low morale compared with only one-third of controls (P = 0.006). In a linear regression analysis adjusting for demographic factors and multiple comorbid conditions, ET cases had a lower log PGCMS score than controls (P < 0.001). Exclusion of participants on antidepressant medication did not change the results. Our results indicate that morale is significantly lower in community-dwelling ET cases than in matched controls. This lower morale could in part be a proxy for mild, untreated depression. It therefore seems important to detect and then possibly treat this problem to improve the psychological well-being of patients with this disease.