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Sabin J, Salas E, Martín-Martínez J, Candeliere-Merlicco A, Barrero FJ, Alonso A, Sánchez-Menoyo JL, Borrega L, Rodríguez-Rodríguez M, Gómez-Gutiérrez M, Eichau S, Hernández-Pérez MÁ, Calles C, Fernández-Díaz E, Carmona O, Orviz A, López-Real A, López-Muñoz P, Mendonza A, Agüera E, Maurino J. Perceived illness-related uncertainty among patients with mid-stage relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2024; 91:105861. [PMID: 39265268 DOI: 10.1016/j.msard.2024.105861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 08/01/2024] [Accepted: 08/30/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) have to deal with a variable disease trajectory often associated with disability and productivity loss. OBJECTIVE This study aimed to assess illness-related uncertainty and associated correlates in patients with relapsing-remitting multiple sclerosis (RRMS) beyond the near diagnosis phase. METHODS We conducted a multicenter, non-interventional study including patients diagnosed with RRMS (2017 revised McDonald criteria) and a disease duration of 3 to 8 years. Perceived uncertainty was measured using the Mishel Uncertainty of Illness Scale (MUIS). Associations between the MUIS and different patient-based outcome measures were analyzed using Spearman's rank correlation. RESULTS A total of 201 patients were studied (mean age (standard deviation): 38.7 (8.4) years, 71.4 % female). The median disease duration (interquartile range) was 6.0 (4.0-7.0) years and the median EDSS score was 1.0 (0.0-2.0). The mean MUIS score was 38.2 (10.8). Perceived uncertainty was positively correlated with fatigue (p < 0.001), symptom severity (p < 0.001), anxiety (p < 0.001), depressive symptoms (p < 0.001), and a threatening illness perception (p < 0.001), and negatively correlated with self-management (p < 0.001), self-efficacy (p < 0.001), processing speed (p < 0.001), knowledge of MS (p = 0.006), and quality of life (p < 0.001). CONCLUSION Illness-related uncertainty was common in a population of mid-stage RRMS. Identifying uncertainty and its associated factors may be useful for implementing preventive strategies to help patients cope with the disease throughout life.
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Affiliation(s)
- Julia Sabin
- Department of Neurology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Elisa Salas
- Medical Department, Roche Farma, Madrid, Spain.
| | | | | | | | - Ana Alonso
- Department of Neurology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Laura Borrega
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | | | | | - Sara Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Carmen Calles
- Department of Neurology, Hospital Universitari Son Espases, Palma De Mallorca, Spain
| | - Eva Fernández-Díaz
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Olga Carmona
- Department of Neurology, Fundació Salut Empordà, Figueres, Spain
| | - Aida Orviz
- Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ana López-Real
- Department of Neurology, Complejo Hospitalario Universitario de Coruña, La Coruña, Spain
| | - Pablo López-Muñoz
- Department of Neurology, Hospital Arnau de Vilanova, Valencia, Spain
| | - Amelia Mendonza
- Department of Neurology, Complejo Asistencial de Segovia, Segovia, Spain
| | - Eduardo Agüera
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
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Liu Y, Lan D, Zhou Y, Tian H, Xiao J, Gan L, Zhang Y. Role of subjective well-being and resilience in the relationship between hopelessness and suicidal ideation among older adults with moderate to severe ADL limitations in Chinese nursing homes. Geriatr Nurs 2024; 59:418-425. [PMID: 39141949 DOI: 10.1016/j.gerinurse.2024.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/11/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE Hopelessness is a risk factor for suicidal ideation, whereas subjective well-being and resilience are protective factors. Nevertheless, the complicated mechanism underlying these factors has not been fully investigated among older people with moderate to severe ADL limitations in nursing homes. This cross-sectional study investigated the potential role of resilience in mediating the relationship between hopelessness and suicidal ideation as well as whether subjective well-being can moderate this mediating effect. METHODS Older individuals (N = 332; aged ≥ 65 years; 158 males, 174 females) with moderate to severe ADL limitations from 10 nursing homes in Chongqing, China, completed this cross-sectional study from July to December 2022. Hopelessness, resilience, subjective well-being and suicidal ideation were measured. The mediating and moderating effects were explored via regression analysis with bootstrap methods. RESULTS A total of 32.8 % (109/332) of the participants reported current suicidal ideation. The relationship between suicidal ideation and hopelessness was partly influenced by resilience (indirect effect = 0.13, 95 % CI = 0.07∼.20). Subjective well-being moderated the impact of resilience on suicidal ideation (moderating effect = 0.01, 95 % CI = 0.00∼.01) and indirectly impacted the effect of hopelessness on suicidal ideation. CONCLUSION These results emphasize the importance of resilience and subjective well-being in mitigating suicidal ideation, which is a prevalent issue among older adults residing in nursing homes with moderate to severe ADL limitations in China.
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Affiliation(s)
- Ying Liu
- Department of Nursing, Faculty of Nursing, Chongqing Medical and Pharmaceutical College, Shapingba District, Chongqing, 401331, China
| | - Ding Lan
- Department of Training center, Chongqing Medical and Pharmaceutical College, Shapingba District, Chongqing, 401331, China
| | - Yujing Zhou
- Department of Nursing, Faculty of Nursing, Chongqing Medical and Pharmaceutical College, Shapingba District, Chongqing, 401331, China
| | - Hongmei Tian
- Department of Nursing, Faculty of Nursing, Chongqing Medical and Pharmaceutical College, Shapingba District, Chongqing, 401331, China
| | - Juan Xiao
- Department of Training center, Chongqing Medical and Pharmaceutical College, Shapingba District, Chongqing, 401331, China
| | - Lu Gan
- Outpatient Department, Rehabilitation Facility for Retired Cadres, Shapingba District, Chongqing, 400038, China
| | - Yi Zhang
- Higher Education Research Institute, Chongqing Medical and Pharmaceutical College, Shapingba District, Chongqing, 401331, China.
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Jellinger KA. Depression and anxiety in multiple sclerosis. Review of a fatal combination. J Neural Transm (Vienna) 2024; 131:847-869. [PMID: 38869643 DOI: 10.1007/s00702-024-02792-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/01/2024] [Indexed: 06/14/2024]
Abstract
Depression and anxiety are the most frequent neuropsychiatric symptoms of multiple sclerosis (MS), an autoimmune-mediated demyelinating neurodegenerative disease. Their prevalence is 25-65% and 20-54%, respectively, often associated with chronic fatigue and cognitive impairment, but usually not correlated with motor and other deficits, suggesting different pathophysiological mechanisms. Both disorders often arise before MS diagnosis, lead to faster disability and impair the quality of life. Risk factors are (young) age, genetic and family history burden. While no specific neuropathological data for depression (and anxiety) in MS are available, modern neuroimaging studies showed bilateral fronto-temporal, subcortical and limbic atrophies, microstructural white matter lesions and disruption of frontoparietal, limbic and neuroendocrine networks. The pathogenesis of both depression and anxiety in MS is related to shared mechanisms including oxidative stress, mitochondrial dysfunction, neuroinflammation and neuroendocrine mechanisms inducing complex functional and structural brain lesions, but they are also influenced by social and other factors. Unfortunately, MS patients with anxiety, major depression or suicidal thoughts are often underassessed and undertreated. Current treatment, in addition to antidepressant therapy include transcranial magnetic stimulation, cognitive, relaxation, dietary and other healthcare measures that must be individualized. The present state-of- the-art review is based on systematic analysis of PubMed, Google Scholar and Cochrane Library until May 2024, with focus on the prevalence, clinical manifestation, neuroimaging data, immune mechanisms and treatment options. Depression and anxiety in MS, like in many other neuroimmune disorders, are related, among others, to multi-regional patterns of cerebral disturbances and complex pathogenic mechanisms that deserve further elucidation as a basis for early diagnosis and adequate management to improve the quality of life in this disabling disease.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, Vienna, A-1150, Austria.
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Fauver M, Clark EM, Schwartz CE. A new framework for understanding stress and disease: the developmental model of stress as applied to multiple sclerosis. Front Integr Neurosci 2024; 18:1365672. [PMID: 38957213 PMCID: PMC11218666 DOI: 10.3389/fnint.2024.1365672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/17/2024] [Indexed: 07/04/2024] Open
Abstract
This paper proposes a new model of stress that integrates earlier models and adds insights from developmental psychology. Previous models describe the behavioral and physical effects of stress events, but have not explained the translation of experiences into stress itself. The Developmental Model of Stress shows how psychosocial developmental challenges in childhood create persistent negative beliefs and behaviors that increase threat perception and maladaptive stress responses. These developmental challenges produce early psychological and physiological predispositions for increased stress responses over time. Ongoing stress leads to dysregulation of physical stress-response systems (allostatic load), which is associated with multiple diseases. High allostatic load provides the necessary preconditions for the diathesis-stress model, which says the addition of an acute stressor to a weakened or predisposed system can lead to disease development. The paper also documents the evolving measurement of stress to better understand the stress-disease relationship, helping to resolve conflicting results between studies. The Developmental Model of Stress was combined with clinician insight and patient reports to build an integrative framework for understanding the role of stress in the development and progression of multiple sclerosis (MS). It includes the first mapping of maladaptive beliefs and behaviors arising from developmental challenges that are common to people with MS. An initial comparison shows these may be distinct from those of people with other chronic diseases. These beliefs and behaviors form the predisposing factors and contribute to the triggering factors, which are the acute stressors triggering disease onset. These often took two forms, a prolonged incident experienced as feeling trapped or stuck, and threat of a breach in a relationship. The reinforcing factors add the stress of a chronic disease with a poor prognosis and seemingly random symptom fluctuation, still managed with the same beliefs and behaviors developed in childhood, increasing physiological dysregulation and symptom severity. A pilot study is described in which these three categories of stress factors in MS were explicitly addressed. This study noted clinically important improvements in physical and mental well-being, providing preliminary support for the Developmental Model. Future research might expand on the pilot using a more robust sample and design.
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Affiliation(s)
- Michelle Fauver
- Integral Health Program, California Institute for Human Science, Encinitas, CA, United States
| | - Eva M. Clark
- MIND based Healing, Santa Cruz, CA, United States
| | - Carolyn E. Schwartz
- DeltaQuest Foundation, Inc., Concord, MA, United States
- Department of Medicine and Departments of Orthopaedic Surgery, Tufts University Medical School, Boston, MA, United States
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Sabin J, Salas E, Martín-Martínez J, Candeliere-Merlicco A, Barrero FJ, Alonso A, Sánchez-Menoyo JL, Borrega L, Rodríguez-Rodríguez M, Gómez-Gutiérrez M, Eichau S, Hernández-Pérez MÁ, Calles C, Fernández-Díaz E, Carmona O, Orvíz A, López-Real A, López-Muñoz P, Mendoza A, Agüera E, Maurino J, Ballesteros J. Assessing illness-related uncertainty in relapsing-remitting multiple sclerosis: A psychometric analysis of the Mishel Uncertainty of Illness Scale. Mult Scler J Exp Transl Clin 2024; 10:20552173241247680. [PMID: 38638273 PMCID: PMC11025437 DOI: 10.1177/20552173241247680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024] Open
Abstract
A multicenter study involving 204 adults with relapsing-remitting multiple sclerosis (RRMS) assessed the dimensionality and item characteristics of the Mishel-Uncertainty of Illness Scale (MUIS), a generic self-assessment tool. Mokken analysis identified two dimensions in the MUIS with an appropriate item and overall scale scalability after excluding nonclassifiable items. A refined 12-item MUIS, employing a grade response model, effectively discriminated uncertainty levels among RRMS patients (likelihood ratio test p-value = .03). These findings suggest the potential value of the 12-item MUIS as a reliable measure for assessing uncertainty associated with the course of illness in RRMS.
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Affiliation(s)
- Julia Sabin
- Department of Neurology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Elisa Salas
- Medical Department, Roche Farma, Madrid, Spain
| | | | | | | | - Ana Alonso
- Department of Neurology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Laura Borrega
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | | | | | - Sara Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Carmen Calles
- Department of Neurology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Eva Fernández-Díaz
- Department of Neurology, Hospital Universitario de Albacete, Albacete,
Spain
| | - Olga Carmona
- Department of Neurology, Fundació Salut Empordà, Figueres, Spain
| | - Aida Orvíz
- Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ana López-Real
- Department of Neurology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Amelia Mendoza
- Department of Neurology, Complejo Asistencial de Segovia, Segovia, Spain
| | - Eduardo Agüera
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba,
Spain
| | | | - Javier Ballesteros
- Department of Neurosciences, University of Basque Country (UPV/EHU), CIBERSAM, Leioa, Spain
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