Patients' experiences of self-identification, seeking support, and anticipation of potential relapse in multiple sclerosis

Clinical and psychological factors associated with fear of relapse in people with multiple sclerosis: A cross-sectional study

BACKGROUND

Fear of relapse (FoR) is one of the main psychological concerns in people with relapsing-remitting multiple sclerosis (PwRRMS). It has disastrous consequences on treatment adherence, quality of life (QoL), and clinical course. Although the issue is closely linked to psychosocial aspects, it is not widely explored despite its overall impact on managing the condition. The determinants of FoR are vital for the optimization of therapeutic intervention toward ensuring patient welfare.

METHODS

This cross-sectional study, carried out in Isfahan, Iran, from December 2023 to September 2024, investigated demographic, clinical, and psychological characteristics in PwRRMS. The level of FoR was measured by the Fear of Relapse Scale, and for anxiety, depression, and obsessive-compulsive symptoms, the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) were used, respectively. Correlation between these factors were analyzed using linear regression.

RESULTS

A total of 189 PwRRMS were included. Multivariable linear regression analysis identified significant correlation between the higher annualized relapse rate (ARR) (B = 10.18, standardized 0.14, p-value < 0.05), anxiety (B = 0.32, standardized β = 0.19, p-value < 0.05), depression (B = 0.63, standardized β = 0.42, p-value < 0.001) and Expanded Disability Status Scale (EDSS) (B = 2.19, standardized β = 0.11, p-value < 0.05) with the FoR among PwRRMS. On the other hand, other demographic, clinical, and psychological variables, including disease duration, disability, and obsessive behavior, were found to lack a significant correlation with FoR (p-value < 0.05).

CONCLUSION

This study points out that ARR, anxiety, and depression are among the leading independent risk factors of FoR in PwRRMS. Given the great potential for attenuation with focused treatments and psychological consultation, becoming major contributors to the decrease of FoR and, importantly, to improved overall patient well-being, their proper management and clinical follow-up should be considered an important issue in dealing with such patients.

Insights for Healthcare Providers on Shared Decision-Making in Multiple Sclerosis: A Narrative Review

Shared decision-making (SDM) between the patient and their healthcare provider (HCP) in developing treatment plans is increasingly recognized as central to improving treatment adherence and, ultimately, patient outcomes. In multiple sclerosis (MS), SDM is particularly crucial for optimizing treatment in a landscape that has grown more complex with the availability of newer, high-efficacy MS therapies. However, little direct evidence on the effectiveness of SDM is available to guide practice. Multiple factors, including patient age, ethnic background, perceptions, invisible MS symptoms, and psychological comorbidities can influence a patient's willingness and ability to participate in SDM. HCPs need to appreciate these factors and ask the right questions to break down obstacles to SDM. The HCP has a responsibility to help patients feel adequately informed and comfortable in having an active role in their care. This review identifies potential barriers to SDM and provides a strategy for HCPs to overcome these obstacles through patient (and caregiver) discussions to ensure optimal patient satisfaction with treatment and thus the best possible outcomes for their patients.