Coping with Multiple Sclerosis: Development of a measure

Investigation of the Relationship Between Coping With the Disease and Affecting Cognitive, Physical, and Psychosocial Factors in People with Multiple Sclerosis

OBJECTIVE

To investigate the relationship between coping mechanisms in people with multiple sclerosis (MS, pwMS) and cognitive, physical, and psychosocial factors such as socio-demographic characteristics, disability, personality, stigma, quality of life, depression, and anxiety.

METHOD

One hundred and two pwMS were enrolled in this cross-sectional study. Demographics and clinical characteristics were recorded. Coping with the MS Scale (CMSS), including seven subscales, which are problem-solving, physical assistance, acceptance, avoidance, personal health control, energy conservation, and emotional release, was used to measure coping. Anxiety and depression levels, stigma, neuropsychological symptoms, and personality were measured by the Hospital Anxiety and Depression Scale (HAD), EuroQol-5D Quality of Life Scale (EQ-5D), Quality of Life in Neurological Diseases (NeuroQoL) -Stigma Scale, Multiple Sclerosis Neuropsychological Questionnaire (MSNQ), and Revised Eysenck Personality Questionnaire-Abbreviated Form (EKA-GGK), respectively.

RESULTS

There was a weak statistically significant positive correlation between the physical support subscale and age and the disease duration and a strong positive correlation with EDSS (r = .214, p = .035; r = .213, p = .036; r = .582, p ≤ .0001, respectively). There was a moderate negative relationship between the physical support subscale and the EQ-5D mobility, self-care, pain, and health subscales (r = -.434, p = .000; r = -.482, p = .000; r = -.526, p ≤ .001, respectively), a weak negative correlation with anxiety, and a strong negative relationship with usual activities (r = -.379, p ≤ .001; r = -.243, p = .017; r = -.384, p ≤ .001, respectively).

CONCLUSION

It has been shown that coping with MS can be affected by cognitive, physical, and psychosocial factors.

Striving to Limit the Impact: Parenting an Adult Child Who Has Multiple Sclerosis-A Grounded Theory Study

BACKGROUND

Multiple sclerosis (MS) is a chronic, progressive autoimmune inflammatory disorder. Its impact is felt not only by individuals but also by their families; however, little is known about the effect on their parents. This study of a cohort from the United Kingdom aimed to develop a conceptual understanding of the parental role and how it changes over time when an adult son or daughter has MS via firsthand accounts.

METHODS

Twelve parents of adults with MS were recruited from a UK hospital providing outpatient services to people with MS and a branch of a national MS charity. A social constructivist grounded theory approach informed audio-recorded semistructured interviews and subsequent data analysis.

RESULTS

In this sample, parents of adults with MS strove to limit the impact of MS on their son or daughter by undertaking practical caring activities and providing emotional support. The developed theoretical model illustrates how, in their efforts to meet this aim, parents experienced competing demands between prioritizing their child's needs and managing the effects on their life, between managing the emotional experience and protecting their child from the burden of their experience, and between an intensified instinct/desire to help while maintaining their child's independence.

CONCLUSIONS

Findings indicate that parents may be uniquely affected by their adult son or daughter having MS, advocating for their inclusion in research and clinical interventions addressing family adjustment to MS. Further research is needed to ascertain the generalizability of these findings in comparable samples and to determine the impact of sociodemographic and cultural variables on the observed phenomena.

Anticipatory coping: how women deal with the hassles of living with multiple sclerosis

Background: People living with MS confront a variety of changes and challenges that need to cope with. The aim of this study was to explore the coping patterns related to the impact of MS on people's lives including; daily, family, and social functions.Methods: A constructivist grounded theory approach was taken. A purposive sample of 16 women living with MS were recruited from a MS clinic at a teaching hospital in the north of Iran. Participants completed 22 semi-structured interviews. The interviews were digitally recorded, transcribed and analyzed using initial, focused and theoretical coding.Results: Participants described coping with a certain pattern that reflected direction and orientation of coping. Anticipating outcomes related to disease, self or others led the participants to plan ahead to deal with the challenges of living with MS. Indeed, they develop and employed anticipatory coping in disease-directed, self-directed and other-directed. Then they focused on the orientation of coping patterns, which involved actions, reactions, and interactions in order to manage anticipated outcomes.Conclusion: The majority of participants used coping pattern that were anticipatory rather than a reactionary to past or present challenges. The results highlight the value of engaging with people with MS in order to identify ways that they cope with the impact of this condition. This is an important distinction and one that health professionals not only need to be aware of but highlights the value of engaging with people with MS in this frame to develop informed and positive approaches to anticipated outcomes and in responding to anticipated changes and challenges.IMPLICATIONS FOR REHABILITATIONPeople develop the pattern of anticipatory coping in order to deal with issues related to the disease, self and others that they anticipate will happen in order to manage potential dysfunctions related to living with multiple sclerosis.People living with MS employ anticipatory coping based on existing and anticipated abilities and disabilities in order to maintain normality for as long as possible in daily, family and social activities.Proactive approaches to dealing with MS can be promoted in a number of ways, for example through support groups, social media or the development of networks with the aim of providing peer support and education.Developing rehabilitation programmes that reflect individual responses to living with MS would improve the ability of healthcare systems to meet clients' needs related to adjusting to living with a chronic condition.

The use of generic avoidant coping scales for psychosocial adaptation to chronic illness and disability: A systematic review

This systematic review examined the validity of generic coping-with-stress measures in the relationships between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Major data bases were searched for studies on the association between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Findings indicated that reliance upon avoidance-type coping is linked to reports of poorer psychosocial adaptation. The veracity of these findings must be treated cautiously owing to conceptual, structural, psychometric, and other issues. Users of generic coping measures should consider these concerns prior to empirically investigating the link between generic avoidance-type coping measures and psychosocial adaptation among people with chronic illness and disability.

The Self-Efficacy in Multiple Sclerosis (SEMS) Scale

Abstract. This research developed a new scale to evaluate Self-Efficacy in Multiple Sclerosis (SEMS). The aim of this study was to investigate dimensionality, item functioning, measurement invariance, and concurrent validity of the SEMS scale. Data were collected from 203 multiple sclerosis (MS) patients (mean age, 39.5 years; 66% women; 95% having a relapsing remitting form of MS). Fifteen items of the SEMS scale were submitted to patients along with measures of psychological well-being, sense of coherence, depression, and coping strategies. Data underwent Rasch analysis and correlation analysis. Rasch analysis indicates the SEMS as a multidimensional construct characterized by two correlated dimensions: goal setting and symptom management, with satisfactory reliability coefficients. Overall, the 15 items reported acceptable fit statistics; the scale demonstrated measurement invariance (with respect to gender and disease duration) and good concurrent validity (positive correlations with psychological well-being, sense of coherence, and coping strategies and negative correlations with depression). Preliminary evidence suggests that SEMS is a psychometrically sound measure to evaluate perceived self-efficacy of MS patients with moderate disability, and it would be a valuable instrument for both research and clinical applications.

Concept analysis of coping with multiple sclerosis

OBJECTIVE

The concept of coping with disease appears frequently in the literature; however, there is no precise definition of coping. The aim of this study is to clarify coping concept, and to identify its attributes, antecedents, and consequences in patients with multiple sclerosis.

METHODS

Rodgers' evolutionary method of concept analysis was used to clarify the concept of coping. A literature review was conducted with key terms 'multiple sclerosis', 'coping', 'adjustment', and 'deal with'. After searching databases, 1370 papers were found for the period 1995-2017. Finally, 55 articles and texts were selected for analysis. Data analysis was carried out using thematic analysis. An independent researcher checked the process to ensure credibility and reduce personal bias.

RESULTS

Coping with multiple sclerosis is a multidimensional concept with three main attributes: maintenance of emotional balance, acceptance of the disease, and self-regulation. Social support, awareness toward the disease, attitude toward the disease, and religious-spiritual beliefs were found as antecedents. Health promotion, adherence to treatment regimen, independence in personal life and social relationships, and improvement of family relationships were found as consequences of these attributes.

CONCLUSION

These findings not only add to the body of knowledge in health science, but also serve as an important motivation for further theory development and research in this context. Nurses and health professions can also benefit from a deeper understanding of coping concept in providing and planning healthcare for these patients.

Using special interest sessions to design and implement a fatigue management group for people with multiple sclerosis

Aims and Method

Special interest sessions are a means of developing additional clinical interests in higher specialist training. We investigated the educational value of developing a group treatment programme for people with multiple sclerosis as well as its benefits for participants.

Results

Feedback from those attending the groups indicated the programme was rated highly or very highly. There was a trend towards improvement in quality of life measures.

Clinical Implications

The group programme provided an excellent opportunity for shared interdisciplinary learning. The use of special interest sessions in psychiatry was important in building relationships with a department without direct psychiatric input and allowed the psychiatric trainee to acquire specific disease knowledge.

Development and validation of the coping with multiple sclerosis questionnaire

BACKGROUND

Development of a self-report measure of coping with multiple sclerosis is required based on cultural factors, which can advance our understanding of the level of coping for care planning and improvement of coping and quality of life. The current study aimed to develop and validate the scale of coping with Multiple Sclerosis.

METHODS

This methodological study was conducted in three phases. In the first phase, the concept of coping with MS was defined by the hybrid model. In the second phase, the item pool was generated from findings of the first phase. In the third phase, psychometric properties of the scale were evaluated including face, content and construct validity as well as reliability.

RESULTS

192 items in primary item pool were finally reduced to 35 items after evaluating the validity (face, content and construct validity) and reliability. Factor analyses revealed five factors: self-efficacy, self-regulation, accepting the current situation, treatment seeking and adherence to it, and emotional balance. Internal consistency and stability of the developed questionnaire confirmed with 0.93 and 0.96 respectively that indicated excellent reliability.

CONCLUSION

The 35-item developed questionnaire is valid and reliable for assessment of levels of coping in Iranian people with MS.

Coping strategies and adjustment to multiple sclerosis among recently diagnosed patients: the mediating role of sense of coherence

Objective:

To examine the relationship between coping strategies (problem solving, emotional release, and avoidance) and adjustment (health-related quality of life, depression, and affective well-being) in a group of recently diagnosed multiple sclerosis patients (up to three years since diagnosis), and to explore the mediating role of sense of coherence between coping strategies and adjustment.

Design:

Cross-sectional.

Setting:

Multiple Sclerosis Clinic Centre.

Subjects:

A total of 102 patients (61.8% women; age (years): M = 35.8, SD = 11.9; 95% with a relapsing–remitting form of multiple sclerosis; Expanded Disability Status Scale score, between 1 and 4).

Interventions:

Not applicable.

Main measures:

Coping with multiple sclerosis (problem solving, emotional release, and avoidance), sense of coherence, health-related quality of life (SF-12), depression (CES-D), and affective well-being (PANAS).

Results:

Problem solving was linked to higher mental health ( β = 0.28) and higher affective well-being ( β = 0.36), emotional release was related to lower depression ( β = −0.22); avoidance was associated to higher mental health ( β = 0.25), higher affective well-being ( β = 0.24), and lower depression ( β = −0.29 ) (all betas were significant at p < 0.05). Sense of coherence mediated the relationship between emotional release and depression (Sobel z-value = −2.00; p < 0.05) and the relationship between avoidance and all the indicators of adjustment (mental health: Sobel z-value = 1.97; depression: Sobel z-value = −2.02; affective well-being: Sobel z-value= 2.05; p < 0.05).

Conclusions:

Emotional and avoidant coping strategies seem to be adaptive among recently diagnosed multiple sclerosis patients. A mediating role between coping strategies and adjustment is played by sense of coherence.

Executive function is an important consideration for coping strategy use in people with multiple sclerosis

INTRODUCTION

Executive function deficits are prevalent in people with multiple sclerosis (PwMS), and PwMS use less adaptive coping than healthy controls. This cross-sectional study assessed whether there is a relationship between executive function and coping in PwMS.

METHOD

One hundred and seven participants with relapsing remitting or secondary progressive MS (n = 83 and 24, respectively; age M = 48.8 ± 11.1 years) completed measures of coping and executive function.

RESULTS

A positive relationship was found between verbal fluency and use of active, emotional, and instrumental social support coping, and total executive function and substance abuse coping. There was a negative relationship between coping strategies and core (social support, acceptance, religion, restraint, and total coping), higher order (denial and humor), and total executive function indices (acceptance, religion, behavioral disengagement, denial, and total coping).

CONCLUSION

These directional differences provide support for the importance of specific executive functions in coping strategy utilization. Understanding these relationships will assist psychologists and neuropsychologists with patient psychoeducation, adaptive coping strategy intervention and management for PwMS with reduced executive function ability.

Coping with Multiple Sclerosis Scale: Reconsideration of the Factorial Structure

BACKGROUND

The Coping with Multiple Sclerosis Scale (CMSS) was developed to assess coping strategies specific to multiple sclerosis (MS). Despite its wide application in MS research, psychometric support for the CMSS remains limited to the initial factor analytic investigation by Pakenham in 2001.

METHODS

The current investigation assessed the factor structure and construct validity of the CMSS. Participants with MS (N = 453) completed the CMSS, as well as measures of disability related to MS (Multiple Sclerosis Impact Scale), quality of life (World Health Organization Quality of Life Brief Scale), and anxiety and depression (Hospital Anxiety and Depression Scale).

RESULTS

The original factor structure reported by Pakenham was a poor fit to the data. An alternate seven-factor structure was identified using exploratory factor analysis. Although there were some similarities with the existing CMSS subscales, differences in factor content and item loadings were found. Relationships between the revised CMSS subscales and additional measures were assessed, and the findings were consistent with previous research.

CONCLUSIONS

Refinement of the CMSS is suggested, especially for subscales related to acceptance and avoidance strategies. Until further research is conducted on the revised CMSS, it is recommended that the original CMSS continue to be administered. Clinicians and researchers should be mindful of lack of support for the acceptance and avoidance subscales and should seek additional scales to assess these areas.

A dyadic and longitudinal investigation of adjustment in couples coping with multiple sclerosis

BACKGROUND

Multiple sclerosis (MS) can affect adjustment at both the individual and couple level.

PURPOSE

This study examined differences and associations between MS patient and spouse adjustment, and whether one partner's adjustment predicts the other partner's adjustment over time.

METHODS

A total of 160 couples at Time 1 and 98 couples at Time 2 completed questionnaires.

RESULTS

Mixed-model ANOVAs found that patients reported poorer adjustment than their spouse on a range of adjustment indicators and that positive affect and relationship satisfaction declined over time for both patients and spouses. Intraclass correlations found that patient and spouse scores on all adjustment indicators were related at Time 1. Multilevel modelling showed that one's partner's relationship satisfaction at Time 1 positively predicted one's own relationship satisfaction at Time 2.

CONCLUSIONS

The findings indicate that a focus on the interpersonal nature of adjustment to MS may be beneficial for future research and practice.

Assessments of coping after acquired brain injury: a systematic review of instrument conceptualization, feasibility, and psychometric properties

OBJECTIVE

To identify measures of coping styles used by patients with acquired brain injury; to evaluate the conceptualization, feasibility, and psychometric properties of the instruments; and to provide guidance for researchers and clinicians in the choice of a suitable instrument.

DESIGN

Systematic review.

RESULTS

The search identified 47 instruments, of which 14 were selected. The instruments focused on dispositional coping, situation-specific coping, or domain-specific coping. Psychometric properties were scarcely investigated. The COPE stood out in terms of psychometric properties but had low feasibility. The brief COPE, Coping Scale for Adults-short form, and Utrecht Coping List stood out in terms of feasibility, and the available psychometric properties of these instruments were good. Only the Coping With Health Injuries and Problems was used as other report.

CONCLUSION

Information on psychometric properties of coping instruments in acquired brain injury is scarcely available and limits the strength of our recommendations. For patients with mild injuries, we cautiously recommend the COPE and for patients with more severe injuries the brief COPE, Coping Scale for Adults-short form, Utrecht Coping List, and Coping With Health Injuries and Problems-other-report. Other instruments may be used to address particular issues such as coping with a specific stressful situation or illness.

Couples coping with multiple sclerosis: a dyadic perspective on the roles of mindfulness and acceptance

This study investigated the roles of mindfulness and acceptance on adjustment in couples coping with multiple sclerosis (MS) by examining the effects of an individual's mindfulness and acceptance on their own adjustment (actor effects) and the effects of their partner's mindfulness and acceptance on their adjustment (partner effects) using the Actor-Partner Interdependence Model. The study was a cross-sectional standard dyadic design that collected data from couples coping with MS. Sixty-nine couples completed measures of mindfulness, acceptance and adjustment (depression, anxiety, life satisfaction, positive affect and relationship satisfaction). As hypothesised there were actor effects of mindfulness and acceptance on better adjustment, however, the beneficial actor effects of mindfulness were only evident on depression and anxiety. The actor effects of both mindfulness and acceptance on relationship satisfaction were moderated by MS status. Regarding partner effects, there was support for the beneficial impact of acceptance on partner relationship satisfaction. In addition, the partner effect of acceptance moderated the actor effect of acceptance on depression, such that the actor effect on lower depression was weaker when the partner reported high acceptance. Findings support the roles of mindfulness and acceptance in shaping individual and dyadic adjustment in couples coping with chronic illness.

Relations between acceptance of multiple sclerosis and positive and negative adjustments

This study examines relations between acceptance as defined in Acceptance and Commitment Therapy (ACT) and adjustment to multiple sclerosis (MS). A first step in this investigation was the development of a measure of acceptance of MS called the MS Acceptance Questionnaire (MSAQ). Consistent with prior findings and theoretical propositions, it was predicted that acceptance would be associated with better adjustment to MS (lower distress and higher positive affect, life satisfaction and marital adjustment and better health). A total of 128 persons with MS completed measures of demographics, illness and adjustment at Time 1 and measures of acceptance and adjustment 12 months later (Time 2). Factor analyses of the MSAQ revealed two factors, action and willingness. Associations between the MSAQ and other validated acceptance measures supported convergent validity. As predicted, after controlling for the effects of initial adjustment and relevant demographic and illness variables, greater acceptance was related to better adjustment, although the action factor emerged as the strongest predictor of better adjustment. This is the first study to examine the role of acceptance (as defined in ACT) in adjusting to MS over time and as such provides a first step for further investigation of acceptance in MS.

Patients with multiple sclerosis in a war zone: coping strategies associated with reduced risk for relapse

The objective of this article is to examine the role of coping strategies in multiple sclerosis outcomes among civilians under a military attack during the 2006 war between Hezbollah and Israel. Participants were 156 patients with relapsing—remitting multiple sclerosis. We analysed the relationships between coping and emotional distress and between coping and multiple sclerosis exacerbation. We also assessed a model of the relationship between perceived stress, event-related stress, and coping with increased risk of multiple sclerosis exacerbations using multivariate logistic regression. Ways of coping and subjective stress were evaluated by means of structured interviews using questionnaires previously validated. The more distressed our respondents were during the war, the more likely they were to employ a variety of ways of coping. Correlation coefficients between coping scores and perceived war stress ranged from 0.2 to 0.44 ( p < 0.001—0.01). Correlation coefficients between the various coping scores and broader indices of distress ranged from 0.28 to 0.5 ( p < 0.001). Of the remitting patients during and following the war, 47.1% reported the use of ‘direct coping and planning’, compared to 16.7% of patients who relapsed during the same period ( p = 0.014). ‘Direct coping and planning’ was negatively related to exacerbation of multiple sclerosis symptoms (OR = 0.1, 95% CI = 0.02—0.5). The Nagelkerke R2 was 0.26. Our findings point to an association between ‘direct coping and planning’ and reduced multiple sclerosis relapse rate during wartime. Further research should explore whether the employment of specific ways of coping can reduce the risk for relapse among patients with multiple sclerosis during periods of distress.

Denial of Chronic Illness and Disability: Part II. Research Findings, Measurement Considerations, and Clinical Aspects

The concept of denial has been an integral part of the psychological and disability studies bodies of literature for over 100 years.Yet, denial is a highly elusive concept and has been associated with mixed, indeed conflicting theoretical perspectives, clinical strategies, and empirical findings. In part II the author reviews empirical findings, measurement strategies, and clinical approaches associated with denial, with particular emphasis on rehabilitation-specific findings and implications. It focuses on empirical findings linking the use of denial to a number of psychosocial outcomes, measures that have been employed in the assessment of denial and, intervention strategies to manage denial. Part II concludes with a brief discussion of the implications generated by the current understanding of denial to rehabilitation practitioners and researchers.

Problem solving, treatment adherence, and weight-loss outcome among women participating in lifestyle treatment for obesity

OBJECTIVE

This study examined whether improvements in problem-solving abilities mediate the relation between treatment adherence and weight-loss outcome in the behavioral treatment of obesity.

METHOD

272 women (mean+/-SD age=59.4+/-6.2 years, BMI=36.5+/-4.8) participated in a 6-month lifestyle intervention for obesity. Body weight and problem-solving skills (as measured by the Social Problem Solving Inventory-Revised) were assessed pre- and posttreatment. The completion of self-monitoring logs during the intervention served as the marker of treatment adherence.

RESULTS

At posttreatment, participants lost 8.4+/-5.8 kg, an 8.8% reduction in body weight. Changes in weight were associated with increased problem-solving skills and with higher levels of treatment adherence. Improvements in problem-solving skills partially mediated the relation between treatment adherence and weight-loss outcome. Moreover, participants with weight reductions > or = 10% demonstrated significantly greater improvements in problem-solving skills than those with reductions <5%.

DISCUSSION

Improvements in problem-solving skills may enable participants to overcome barriers to adherence and thereby enhance treatment-induced weight losses.

The nature of sense making in caregiving for persons with multiple sclerosis

OBJECTIVE

Sense making refers to the development of explanations for adversity. This study investigated the nature of sense making in multiple sclerosis (MS) carers and relations between it and care recipient illness, caregiving context, carer religious-spiritual beliefs and carer and care recipient adjustment.

SUBJECTS

A total of 232 MS carers and their care recipients completed questionnaires.

METHOD

A questionnaire survey methodology was used to collect qualitative and quantitative data. Variables included: Demographics, caregiving context (caregiving duration, co-residency, carer-care recipient relationship, outside employment), care recipient illness (activities of daily living, number of symptoms, illness duration, course), sense making (anticipated sense making, number of sense making categories), carer and care recipient adjustment (positive states of mind, life satisfaction, anxiety, depression).

RESULTS

Half the carers generated sense making explanations for their caregiving situation and 12 sense making themes emerged from this qualitative data. Over a third of those carers who could not make sense of their situation were able to anticipate comprehending it and the strength of this anticipation was related to greater life satisfaction. Carer sense making was related to having a religious-spiritual belief, fewer care recipient symptoms, marital status and it predicted life satisfaction after controlling for relevant covariates. Carer and care recipient sense making was positively correlated, and the sense making of one partner was positively related to life satisfaction of the other partner.

CONCLUSIONS

Findings chart the nature of sense making in MS caregiving and support the notion of collective sense making within dyads and the proposed beneficial links between sense making and adjustment.

Depression in multiple sclerosis: review and theoretical proposal

Because of its high prevalence and implications for quality of life and possibly even disease progression, depression has been intensively studied in multiple sclerosis (MS) over the past 25 years. Despite the publication of numerous excellent empirical research papers on this topic during that time, the publication of theoretical work that attempts to explain depression in a comprehensive way is scarce. In this study, we present a theoretical model that attempts to integrate existing work on depression in MS and provide testable hypotheses for future work. The model suggests that risk for depression begins with the onset of MS. MS results in disease-related changes such as increased lesion burden/brain atrophy and immunological anomalies that are associated with depression in MS, but explain only a relatively limited proportion of the variance. Common sequelae of MS including fatigue, physical disability, cognitive dysfunction, and pain, have all been shown to have an inconsistent or relatively weak relationship to depression in the literature. In the model, we propose that four variables--social support, coping, conceptions of the self and illness, and stress--may moderate the relationship between the above common MS sequelae with depression and help to explain inconsistencies in the literature.

The Measurement of Disability-Related Stress in Wheelchair Users

OBJECTIVE

To measure disability-related stress through the development of the Physical Disability Stress Scale (PDSS) for wheelchair users.

DESIGN

Cross-sectional.

SETTING

General community.

PARTICIPANTS

Sample of 119 wheelchair users with an acquired physical disability.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

General Health Questionnaire-28 (GHQ) and the World Health Organization Quality of Life (WHOQOL-BREF) (Australian version).

RESULTS

Factor analysis of PDSS items revealed 4 main factors of disability-related stress: access accounted for 33.7% of the variance, physical for 8.4% of the variance, social for 7.9% of the variance, and burden of care for 7.2% of the variance. Internal consistencies for the 4 factors were within acceptable ranges (alpha range, .78-.83). Concurrent validity was shown with the PDSS factors predicting 7% to 23% of the variance in GHQ subscales and total score and 12% to 31% of the WHOQOL-BREF subscales. Participants scoring in the GHQ psychiatric group showed significantly higher stress levels on the physical, social, and burden of care factors of the PDSS compared with the GHQ nonpsychiatric group.

CONCLUSIONS

The results suggest the PDSS factors are valid measures of disability-related stress with potential for clinical and research applications. Confirmatory factor analyses with larger sample sizes of wheelchair users are required to establish consistency in the measurement of disability-related stress.

The nature of caregiving in multiple sclerosis: development of the caregiving tasks in multiple sclerosis scale

Caregivers of persons with multiple sclerosis (MS) engage in many caregiving tasks and spend considerable time on these activities with such caregiving being of immense social and economic value. However, the lack of empirically derived psychometrically sound instruments for measuring caregiving tasks has hampered progress in this field. This study aimed 1) to examine the dimensional and psychometric structure of the Caregiving Tasks in MS Scale (CTiMSS), and 2) to examine caregiver and care recipient correlates of caregiving tasks. Participants were 232 caregivers of persons with MS and their care recipients. Questionnaires were completed at Time 1 and 12 months later (Time 2). Factor analyses showed that the CTiMSS could be represented by a single dimension or four caregiving domains: Instrumental Care, Activities of Daily Living Care, Psycho-emotional Care, Social-practical Care. The CTiMSS factors were psychometrically sound and evidenced differential relations with most caregiver and care recipient characteristics and predicted changes in adjustment over 12 months. Findings delineate the key dimensions of MS caregiving and show the differential links between caregiving task domains and caregiver and care recipient characteristics. Results provide preliminary reliability and validity data on the first published measure of caregiving tasks in MS. Such an instrument is important for theory building, across study comparisons and the development of services. Multiple Sclerosis 2007; 13: 929—938. http://msj.sagepub.com

Individual differences in adolescent health symptoms: the effects of gender and coping

Previous studies have suggested that adult men and women experience different types and severities of physical and psychological health symptoms. This study examined whether in the case of adolescents these reported gender differences in physical and psychological health symptoms could actually be the result of differences in coping styles. Five hundred and forty-six adolescents were questioned on their coping styles and symptoms. We found gender differences in physical and psychological health symptoms (e.g. anger, depression, tension, negative moods), as well as in coping styles. We also found that the relation between health symptoms and coping varied significantly by gender. The results of this study suggest that doctors, school counselors and family therapists may want to take gender differences in coping styles into account when seeing adolescent patients for physical or psychological health symptoms, and find ways to help the adolescents cope more effectively with their stressors.