Correlates of coping style in patients with multiple sclerosis

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.

Relationship Between Married Individuals' Relations with Their Family of Origin and Coping Styles with Stress

This study aims to determine the relationship between the family of origin relations and coping styles with stress in the married individuals. This research, which was conducted as a relational screening model was carried out with 150 married and at least high school graduates living in Ankara, selected with a purposeful sample. The data was obtained using the Information Form, Family of Origin Relations Inventory (FORI) and Styles of Coping Inventory (SCI). In married individuals,(n=150) the mean total score of SCI was 78.32±7.98; The mean total score of the FORI was found to be 26.51±4.50. There was no significant relationship between the total scores of FORI and SCI; It was determined that there is a positive correlation between the self-confident approach, helpless approach and submissive approach, which are the sub-dimensions of SCI, and the total score of the FORI. As a result, it was found that there was no relationship between family of origin relations and stress coping styles in married individuals, but as the relations with the family of origin relations improved, the use of self-confident approach, helpless approach and submissive approach increased among coping styles. For this reason, it is recommended to plan psychosocial interventions that will raise awareness about the relationship between their family of origin relations and their coping styles in order to enable married individuals to cope functionally.

Relationship of coping strategies with mood symptoms, disease related characteristics and demographic variables in patients with multiple sclerosis: A systematic review study

OBJECTIVE

the aim of this systematic review was to summarize the coping strategies utilized by people with multiple sclerosis (pwMS) and the association of these strategies with mood symptoms, quality of life, fatigue and disability in pwMS.

METHODS

search in the literature was performed across electronic databases of PubMed, Web of Science, and Scopus. No time constraint was applied for searching across the databases. Manual search was also performed on the list of references of the retrieved papers. Two authors independently evaluated the retrieved citations based on predetermined inclusion criteria in two screening stages. This systematic review followed Joanna Briggs Institute (JBI) guidelines for cross-sectional research. The findings related to the coping patterns against MS as well as the relationship between the patterns and MS symptoms were extracted and synthesized.

FINDINGS

A total of 2390 records were identified. After removing duplicates and based on screening, 39 papers met the eligibility criteria for qualitative synthesis, and they were evaluated in terms of quality of study. When comparing genders, women used more religious coping, social support seeking, and positive coping compared to men. Depression and anxiety were associated with maladaptive and emotion-oriented coping strategies. The patients who used positive and problem solving oriented coping strategies had a better score of quality of life. Disability and fatigue were associated with applying avoidance and maladaptive coping strategies.

CONCLUSION

the findings of this review suggest that understanding the relationship between coping strategies and quality of life as well as the symptoms related to the disease is important to understand development of psychological interventions adopted by specialists to support these patients.

Coping Strategies and Their Impact on Quality of Life and Physical Disability of People with Multiple Sclerosis

The aim of the study is to investigate the impact of coping strategies on Health-Related Quality of Life (HRQoL) and physical disability assessed with the Expanded Disability Status Scale (EDSS) of people with multiple sclerosis (pwMS). PwMS were asked to focus on "MS diagnosis" as the core stressor. One hundred eight pwMS completed the Coping Responses Inventory-Adult form (CRI-Adult), the Multiple Sclerosis Quality of Life-29 (MSQoL-29), and the Depression Anxiety Stress Scale-21 (DASS-21). Multiple regression analyses (first block: EDSS, disease duration, and DASS-21) revealed that physical MSQoL-29 was positively associated with Alternative Rewards and negatively with Resigned Acceptance of the CRI-Adult. The mental MSQoL-29 was positively associated with Problem-Solving and negatively with Emotional Discharge. The Expanded Disability Status Scale (EDSS; first block: disease duration and general distress) was negatively associated with Positive Reappraisal. The Analysis of covariance (ANCOVA) revealed that pwMS with lower physical disability showed higher scores in Positive Reappraisal and lower scores in Emotional Discharge than pwMS with a higher physical disability. Coping strategies can play a role on HRQoL and physical disability in pwMS above and beyond EDSS, disease duration, and general distress. Psychological interventions should be considered in pwMS since the time of diagnosis to promote engagement in adaptive coping strategies and contrast the maladaptive ones.

Impaired self-awareness after traumatic brain injury: A systematic review. Part 2. Consequences and predictors of poor self-awareness

BACKGROUND

Impaired self-awareness (ISA) has frequently been found both frequent and deleterious in patients with moderate to severe traumatic brain injury (TBI).

OBJECTIVES

This is the second of a two-part systematic review on ISA after TBI, focusing on the consequences and predictors of ISA after TBI.

METHODS

Following the PRISMA guidelines, 95 articles meeting the inclusion criteria were included; 46 were specifically related to this second part of the review.

RESULTS

Among 16 studies that investigated the effect of ISA on outcome, most (n=13) found poor self-awareness associated with poor rehabilitation, functional, social and vocational outcome and with increased burden on relatives. Multiple factors have been found associated with increased frequency of ISA. ISA was found significantly related to injury severity in 8 of 10 studies, impaired executive functions in 12 of 15 studies, and poor social cognition in 3 studies, but paradoxically inverse associations were repeatedly found between self-awareness and emotional status (11 of 12 studies). Finally, although research in the field is still scarce, ISA seems associated with a dysfunction within brain networks involving the anterior cingulate cortex, anterior insula and fronto-parietal control network.

CONCLUSIONS

ISA is a complex and multifaceted disorder associated with poor rehabilitation outcome, severe injuries, and deficits of executive functions and social cognition but has an inverse association with mood impairments.

How personality traits affect functional outcomes in patients with multiple sclerosis: A scoping review on a poorly understood topic

Personality is an important variable when explaining individual differences in disease acceptance, coping styles and psychological well-being. Personality changes, such as social inadequacy, disinhibition, apathy, emotional lability, and impulsivity, have been reported in many patients with multiple sclerosis (MS). This review sought to assess the role of personality traits in people with MS, focusing on how this may affect the patient's outcome. Studies were identified by searching on PubMed, Web Of Science and Cochrane databases. Our review shows that the personality traits commonly found in MS are often dysfunctional. In particular, it has been suggested that people with MS present with lower levels of conscientiousness, extraversion and agreeableness, as well as higher levels of neuroticism than healthy controls. These personality traits negatively affect cognitive domains, mood, and psychological well-being. As personality may affect the clinical manifestations and disabilities of patients with MS, personality assessment should be an integral part of the management of the disease, in order to achieve better functional outcomes.

Apathy as a herald of cognitive changes in multiple sclerosis: A 2-year follow-up study

Background:

Behavioral symptoms, such as apathy and depression, are common in multiple sclerosis (MS) but their relationship with cognitive and clinical characteristics often remains underinvestigated and not monitored over time.

Objective:

The aim of this study was to assess the evolution of cognitive profile of patients affected by MS in relation to apathy and depression using a 2-year follow-up study.

Methods:

Two years after the first assessment, 100 of 125 MS patients were re-evaluated on a comprehensive neuropsychological battery, and on specific scales for assessment of apathy (Apathy Evaluation Scale—Self-reported) and depression (Hamilton Depression Rating Scale).

Results:

After 2 years (T1), we found a relatively consistent prevalence of apathy (about 40%) and a reduction in prevalence of depression (from 44% to 30%). Higher level of apathy at baseline predicted the progressive cognitive changes at follow-up; and patients with apathy without depression (“pure” apathy) than patients without apathy had poorer performance on the interference task of the Stroop test assessing inhibitory control.

Conclusion:

The present results suggested that apathy in MS was associated with more severe executive dysfunctions (in particular cognitive control). Apathy rather than depression predicted cognitive impairment in MS over time.

Use of coping strategies in multiple sclerosis: Association with demographic and disease-related characteristics✰

BACKGROUND

Coping positively and negatively influences psychosocial and other outcomes in multiple sclerosis (MS), but there is conflicting evidence about the use of different coping strategies and their associations with demographic and disease characteristics. Our aims were to examine which coping strategies are used by a large sample of people with MS, then to identify any associations between demographic and disease related factors with use of individual coping strategies.

METHODS

Participants in the Trajectories of Outcomes in Neurological Conditions (TONiC) study completed the Coping Orientations to Problems Experienced (COPE60) questionnaire. Relationships between demographic and clinical characteristics and coping strategies were examined by multiple ordinal logistic regression to assess the effect of each potential predictor after adjustment for other possible covariates.

RESULTS

From 722 patients, the most commonly used strategy was Acceptance, followed by Active Coping, Planning and Positive Reinterpretation and Growth. All but two strategies showed significant associations with demographic and clinical characteristics. The most marked effects were found for Restraint, with people in employment 2.1 times as likely to utilise this strategy compared to those unemployed, and Seeking of Emotional Social Support and Focus on and Venting of Emotions, which were utilised twice as much by women compared to men. Behavioural and Mental Disengagement were highly associated with greater disability and not being in employment.

CONCLUSION

Clinicians should be aware of several disease and demographic characteristics that are associated with use of potentially maladaptive coping strategies.

Do coping styles mediate the relationship between disability status and psychosocial loss in people with relapsing remitting multiple sclerosis?

The main aim of this cross-sectional study was to analyse the degree to which coping may act as a mediator between disability and psychosocial loss in people with relapsing remitting multiple sclerosis. Participants ( N = 158) completed measures of psychosocial loss and ways of coping. Disability status was evaluated by attending neurologists. Coping partially mediated the relationship between disability and psychosocial loss. Disability leads to the experience of psychosocial loss but it is not the sole factor determining the formation of psychosocial loss. Coping is also associated with such losses in multiple sclerosis.

Coping with stress and quality of life in women with stress urinary incontinence

Introduction

Urinary incontinence (UI) involves uncontrolled leakage of urine through the urethra as a result of damage to its sphincter muscle and a disturbed function of the urogenital diaphragm within the pelvis minor. The symptoms of UI radically impair psychological, somatic, and social functioning. The aim of each disease stress coping process is to reduce the impact of harmful agents as well as the acquisition of necessary preventive measures in order to combat the disorder. Aim of the study was to assess the relationship between coping styles used when dealing with stress associated with disease and the quality of life.

Material and methods

The study was carried out at an outpatients’ clinic located in the Lublin Province (eastern Poland), covering 150 women with diagnosed stress urinary incontinence, aged between 32 and 79. The following methods were used: (a) Coping Inventory for Stressful Situations (Endler, Parker) to assess coping styles, (b) CASP-19 scale (Higgins, Hyde, Wiggins, Blade) to measure the overall quality of life, and (c) Urinary Incontinence Life Quality Scale (Szymona-Pałkowska, Kraczkowski).

Results

The preferred style in the studied group of women was Task-Oriented Coping. This style is associated with a low score on the Independence from Symptoms scale and low Control, being simultaneously correlated with Autonomy and Self-Realisation. Emotion-Oriented Coping is associated with low psychological, physical and social well-being, as well as with little independence from the disease symptoms, little pleasure and self-realisation, but it gives a sense of internal control. Avoidance-Oriented Coping does not significantly correlate with any of the Overall Quality of Life dimensions.

Conclusions

Women suffering from UI tend to try to solve their problem by means of cognitive transformation. In their situation, clinging to the problem turns out to be a depressing factor and entails a lower quality of their life.

Self-awareness and traumatic brain injury outcome

PRIMARY OBJECTIVE

Impaired self-awareness following a traumatic brain injury (TBI) can reduce the effectiveness of rehabilitation, resulting in poorer outcomes. However, little is understood about how the multi-dimensional aspects of self-awareness may differentially change with recovery and impact outcome. Thus, this study examined four self-awareness variables represented in the Dynamic Comprehensive Model of Awareness: metacognitive awareness, anticipatory awareness, error-monitoring and self-regulation.

RESEARCH DESIGN

This study evaluated change of the self-awareness measures with recovery from TBI and whether the self-awareness measures predicted community re-integration at follow-up.

METHODS AND PROCEDURES

Participants were 90 individuals with moderate-to-severe TBI who were tested acutely following injury and 90 age-matched controls. Forty-nine of the TBI participants and 49 controls were re-tested after 6 months.

MAIN OUTCOME AND RESULTS

Results revealed that the TBI group's error-monitoring performance was significantly poorer than controls at both baseline and follow-up. Regression analyses revealed that the self-awareness variables at follow-up were predictive of community re-integration, with error-monitoring being a unique predictor.

CONCLUSIONS

The results highlight the importance of error-monitoring and suggest that interventions targeted at improving error-monitoring may be particularly beneficial. Understanding the multi-dimensional nature of self-awareness will further improve rehabilitation efforts and understanding of the theoretical basis of self-awareness.

Translation and validation of Chinese version of the problems in everyday living (PEDL) test in patients with mild cognitive impairment

BACKGROUND

Cognitive impairment places older adults at increased risk of functional decline, injuries, and hospitalization. Assessments to determine whether older persons are still capable of meeting the cognitive challenges of everyday living are crucial to ensure their safe and independent living in the community. The present study aims to translate and validate the Chinese version of the Problems in Everyday Living (PEDL) test for use in Chinese population with mild cognitive impairment (MCI).

METHODS

The cultural relevancy and content validity of the Chinese version of PEDL (C-PEDL) was evaluated by a seven-member expert panel. Forty patients with MCI and 40 cognitively healthy participants were recruited to examine the psychometric properties of C-PEDL.

RESULTS

Significant differences in the C-PEDL scores were found between the patients with MCI and the cognitively healthy controls in both educated (F = 9.96, p = 0.003) and illiterate (F = 10.43, p = 0.004) populations. The C-PEDL had excellent test-retest and inter-rater reliabilities, with intraclass correlation coefficient at 0.95 and 0.99 respectively. The internal consistency of C-PEDL was acceptable with Chronbach's α at 0.69. The C-PEDL had moderate correlation with the Mini-Mental State Examination (r = 0.45, p = 0.004) and the Category Verbal Fluency Test (r = 0.40, p = 0.012), and a moderate negative Spearman's correlation with the Global Deteriorating Scale (r = -0.42, p = 0.007).

CONCLUSIONS

The C-PEDL is a valid and reliable test for assessing the everyday problem-solving ability in Chinese older population with MCI.

Neuropsychological dysfunction, depression, physical disability, and coping processes in families with a parent affected by multiple sclerosis

Background

Families with a parent suffering from multiple sclerosis (MS) must cope with the unpredictable course of the disease. Most studies analyzing factors that influence coping abilities in families with a member affected with MS used questionnaires to assess this ability.

Methods

On the contrary, the present study used a semi-structured psychiatric interview and used the resulting information to calculate a general measure of coping ability (coping index [CI]). We administered this interview to 44 MS patients, their partners and offspring and conducted a neuropsychological and physical evaluation of the patients to determine the impact of physical disability, cognitive dysfunction, and depression on the process of coping by the patient, the healthy partner, and children.

Results

The CI of patients was best predicted by measures of their depressive symptoms, divided attention, and estimated verbal intelligence. None of the patient variables predicted the CI of healthy partners or their offspring. We found an association between the CI of the healthy partner and the children.

Conclusions

These findings suggest that MS patients’ emotional and neuropsychological functions are associated with their ability to cope with the disease. These should be carefully assessed at the beginning of treatment so that those factors known to negatively influence patient coping are targeted in the treatment plan if necessary. Comprehensive care of a patient with MS should include support of coping abilities of the family members.

Patient information and coping styles in multiple sclerosis

Background Patients with multiple sclerose (MS) live with their disease for many years. The cause of the disease is unknown and there are no curative therapies. Patients' adaption to chronic disease is dependent on the effectiveness of coping behaviour.

Objectives To explore the correlation between the quality of perceived disease information and to estimate the correspondance between the quality of perceived disease information and later coping styles applied by MS-patients in stress situations related to their disease.

Methods Of a total of 108 patients recently diagnosed with MS, 93 agreed to participate in the study and 86 of these completed two different questionnaires, one assessing quality of the perceived information and the other asessing coping styles (the COPE scale).

Results 43.2% of the patients were dissatisfied or very dissatisfied with the information by the time of diagnosis. MS-related coping styles were influenced by general coping styles and the most frequently employed strategies were `positive reinterpretation and growth', `planning' and `restraint coping' while `denial' was the most infrequently employed strategy. Patients who were satisfied with the information employed avoidance coping to a lesser extent and more actively both plan and seek information about the situation.

Conclusion Optimizing the information process in the early phase of the disease may induce coping styles that produce a better adaption to living with MS. Multiple Sclerosis 2007; 13: 792-799. http:// msj.sagepub.com

Longitudinal consistency of the relationship between depression symptoms and cognitive functioning in multiple sclerosis

BACKGROUND

Lifetime prevalence rates of cognitive dysfunction and depression in multiple sclerosis (MS) have typically been reported to be approximately 50 percent. However, an inconsistent relationship between these two common features of MS has been reported in the literature. Because neurovegetative depression symptoms overlap with MS symptoms, it may be that literature inconsistencies can partly be explained by the fact that only those depression symptom clusters unambiguously reflective of depression are associated with cognitive dysfunction.

OBJECTIVE

To explore the relationship between different depression symptom clusters and a battery of tests measuring cognitive domains commonly impaired in MS and was examined at two time points 3 years apart.

METHODS

The Chicago Multiscale Depression Inventory was employed to measure mood, negative evaluative, and neurovegetative symptom clusters in 53 MS patients who were also administered a battery of neuropsychological tests.

RESULTS

At time point 1, Mood and Evaluative Chicago Multiscale Depression Inventory scales were significantly associated with tasks of complex speeded attention, planning, and working memory. At time point 2, the Evaluative scale was still significantly associated with these domains, in addition to spatial memory; however, all of the significant correlations with the Mood scale dropped out.

CONCLUSION

These results show that negative evaluative depression symptoms are most consistently predictive of cognitive dysfunction in MS. It may be that negative evaluative depression symptoms use up available cognitive capacity, thus compromising performance on cognitive capacity demanding tasks in MS patients.

Depression during exacerbations in multiple sclerosis: the importance of uncertainty

The following correlates of depression were examined in a sample of 166 patients with clinically definite relapsing-remitting (n=140) or secondary progressive (n=26) multiple sclerosis: (a) the present state of the patients' illness (i.e., whether or not they were currently experiencing an exacerbation of their symptoms); (b) their level of uncertainty concerning their illness; and (c) their strategies for coping with their illness. A current exacerbation in symptoms, greater uncertainty of illness, and greater use of emotion-centered forms of coping were all related to depression. Multivariate analyses revealed that uncertainty of illness played a pivotal role as a mediating variable. Exacerbations in illness appeared to heighten patients' levels of uncertainty, and it was largely through this heightened uncertainty that the increases in depression came about.

Multiple sclerosis: empirical literature for the clinical health psychologist

This article reviews the empirical literature related to clinical health psychology in multiple sclerosis (MS). MS is a disease in which the immune system attacks the central nervous system. As such, the interactions between medical and psychological variables are complex, and potentially of considerable importance to patients. Common neuropsychological and psychological problems associated with MS and their etiologies are reviewed. The effects of stress and depression on MS exacerbation are discussed, including clinical, immune, endocrine, and neuroimaging findings. The types of coping common in MS and their effects on adjustment are discussed. The empirical literature on psychological and neuropsychological intervention is reviewed. The small literature on caregiving in MS is also summarized.

Personality as a predictor of coping efforts in patients with multiple sclerosis

The aim of the study was to explore personality traits as predictors of coping with disease-related distress in patients with multiple sclerosis (MS). All patients with clinically definite MS in a city with a population of approximately 100000 were asked to complete the NEO Personality Inventory and a multidimensional coping inventory (COPE). There was an 83% response rate yielding 49 patients for the study population and 49 controls, matched for age, gender and educational level to the MS-patients, were used as comparison. Only Neuroticism correlated significantly with emotion-focused coping in both groups. Extraversion and Openness to Experience were linked to task-oriented coping strategies in normal controls but not in the MS-group. Agreeableness was associated with avoidance-oriented coping strategies only in the MS-group. Thus, the relation of certain personality characteristics to the choice of strategies for coping with the disease-related distress appear to differ from coping with stressful problems in everyday life. As dispositional characteristics may interfere with adaptive coping responses, analysis of personality traits and coping strategies could contribute while attempting to relieve the consequences of chronic disease on everyday life.