Identity Reconstruction Through Leisure Activities in Parkinson's Disease: A Three-Case Qualitative Report

Depression, a major non-motor manifestation of Parkinson's disease (PD), substantially reduces patients' quality of life. Although leisure activities may protect against the progression of psychiatric symptoms, clinical observations indicate that some patients discontinue such activities and subsequently develop severe depressive symptoms despite preserved physical function. This three-case qualitative report aims to describe and qualitatively analyze the common characteristics, divergent patterns of leisure engagement, and psychological adaptation process in three home-care patients with Hoehn and Yahr Stage III PD. Three home-care patients with PD at Hoehn and Yahr Stage III were included. Qualitative analysis was performed using the Steps for Coding and Theorization method. Physical function was evaluated using the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III, whereas depressive symptoms were assessed using the Japanese version of the 15-item Geriatric Depression Scale (GDS-15-J). Case 3, who demonstrated the most favorable motor function score (MDS-UPDRS Part III: 10), discontinued leisure activities because of excessive risk-avoidance attitudes among family members and subsequently developed depressive symptoms (GDS-15-J: score 10). In contrast, Cases 1 and 2, despite exhibiting more severe motor impairment (29 and 17, respectively), continued their activities by redefining these activities as "practice for maintaining function" or "preservation of social roles." Supported by appropriate family involvement, these patients maintained participation and exhibited no depressive symptoms (GDS-15-J: 1 and 2, respectively). The findings suggest that preservation of mental health in home-care patients with PD is influenced more strongly by subjective reinterpretation of activity value and risk-inclusive family support than by residual physical capacity. In conclusion, this three-case qualitative report describes how home-care patients with Stage III PD adapt to progressive functional decline through leisure activities. Our findings suggest that sustained engagement in meaningful occupations is supported not only by individual cognitive restructuring but also by collaborative family understanding. For multidisciplinary healthcare teams providing home-based care, recognizing the subjective value patients attach to leisure activities may help facilitate psychological well-being and prevent depressive symptoms.