Development and Validation of Fear of Relapse Scale for Relapsing-Remitting Multiple Sclerosis: Understanding Stressors in Patients

A Self-Reported Study on Explanatory Variables of Stress in Multiple Sclerosis Patients: Exploring the Effect of Physical Conditions and Emotion Regulation Processes

BACKGROUND

Multiple sclerosis (MS)-linked stress is frequent, multidetermined and facilitates the onset/exacerbation of MS. However, few explanatory models of stress analysed the joint explanatory effect of emotion regulation and clinical outcomes of MS in those patients.

OBJECTIVE

This study explored whether self-reported MS-related conditions (number of relapses, fatigue and global disability) and specific emotion regulation processes (experiential avoidance and self-compassion) explain stress symptoms in MS patients.

METHODS

The MS sample comprised 101 patients with MS diagnosis receiving treatment in hospitals and recruited through the Portuguese MS Society. The no-MS sample included 134 age-, sex- and years of education-matched adults without MS recruited from the general Portuguese population. Both samples did not report other neurological disorders. Data were collected using self-response measures.

RESULTS

All potential explanatory variables differed significantly between samples, with higher scores found in MS patients. In MS clinical sample, those variables and years of education correlated with stress symptoms and predicted stress symptoms in simple linear regression models. These results allowed their selection as covariates in a multiple linear regression model. Years of education, the number of relapses, fatigue and experiential avoidance significantly predicted 51% of stress symptoms' total variance.

CONCLUSIONS

This study provides preliminary evidence on the importance of clinicians and researchers considering the simultaneous contribution of years of education, the number of perceived relapses, fatigue and experiential avoidance as factors that can increase vulnerability to stress in MS patients. Psychological intervention programmes that tackle these factors and associated stress symptomatology should be implemented.

The development and validation of the Worries About Recurrence or Progression Scale (WARPS)

OBJECTIVES

Worry about recurrence or progression is a common concern among people with chronic physical illnesses. Although there are options to measure the fear of cancer recurrence and other illness-specific measures, there is only one transdiagnostic measure of fear of progression, which does not assess the fear of recurrence or relapse.

DESIGN

A multi-phase study outlining the development and validation of a novel transdiagnostic measure of fear of recurrence or progression, the Worries About Recurrence and Progression Scale (WARPS).

METHOD

From a prior systematic review, we used quotes from people with lived experience to generate 55 items. Next, we piloted the items with 10 people with a range of chronic conditions, leading to a final total of 57 items. We then recruited four groups of people with cardiac disease, rheumatic disease, diabetes and respiratory disease (n = 804). An exploratory factor analysis in a randomly split sample resulted in an 18 item, single factor scale. We then performed confirmatory factor analysis on these 18 items in the remaining sample.

RESULTS

The 18-item WARPS demonstrated good construct validity, internal consistency and test-retest reliability. Specifically, the WARPS was strongly correlated with the Fear of Progression Questionnaire, and with illness-specific fears. Significant, moderate correlations were observed with depression, anxiety, stress, and death anxiety. The WARPS demonstrated the validity and reliability amongst people with four of the most common chronic conditions and the factor structure was invariant across genders.

CONCLUSION

The WARPS is a valid and reliable tool to measure transdiagnostic worries about recurrence and progression.

Assessing illness-related uncertainty in relapsing-remitting multiple sclerosis: A psychometric analysis of the Mishel Uncertainty of Illness Scale

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.

Psychometric properties of the Croatian version of the Multiple Sclerosis Walking Scale (MSWS-12)

PURPOSE

Walking difficulties in people with multiple sclerosis (pwMS) are one of the most pronounced predictors affecting patients' quality of life. The study objective was to determine the psychometric properties of the Croatian version of the Multiple Sclerosis Walking Scale (MSWS-12) among pwMS in Croatia and to examine the association between MSWS-12 and Depression, Anxiety, and Stress Scale-21 (DASS-21), and Multiple Sclerosis Impact Scale-29 (MSIS-29).

MATERIALS AND METHODS

A cross-sectional study included a sample of pwMS (N = 148). Psychometric properties were examined by estimating the validity and reliability of the MSWS-12. The predictive validity of MSWS-12 and demographic and disease-related factors were assessed by a hierarchical regression model using MSIS-29 and DASS-21 as criterion variables.

RESULTS

Scale reliability was good for the MSWS-12 scale, expressed by Cronbach's alpha coefficient (α = 0.98). Correlations between MSWS-12 and DASS-21 (0.20-0.27) and between MSWS-12 and MSIS-29 subscales (0.47-0.83) provided initial support for the convergent validity. Factor analysis demonstrated the unidimensional structure of the MSWS-12.

CONCLUSIONS

The Croatian version of the MSWS-12 is a reliable, valid, and clinically useful tool for assessing walking impairments in pwMS.Implications for rehabilitationWalking difficulties in people with multiple sclerosis (pwMS) are one of the most pronounced predictors affecting patients' quality of life.Multiple Sclerosis Walking Scale (MSWS-12) is a measure of the disease's impact on walking abilities from the patient's perspective.MSWS-12 is a reliable scale for assessing walking speed, endurance, and gait quality in multiple sclerosis and is validated in several languages (Korean, Italian, Brazilian, and Persian).The Croatian version of the MSWS-12 is a reliable, predictive, and valid tool for screening walking impairments in pwMS.

Mood Symptoms and Chronic Fatigue Syndrome Due to Relapsing-Remitting Multiple Sclerosis Are Associated with Immune Activation and Aberrations in the Erythron

BACKGROUND

Multiple sclerosis (MS) is a chronic autoimmune and neuroinflammatory disease of the central nervous system characterized by peripheral activation of immune-inflammatory pathways which culminate in neurotoxicity causing demyelination of central neurons. Nonetheless, the pathophysiology of relapsing-remitting MS (RRMS)-related chronic fatigue, depression, anxiety, cognitive impairments, and autonomic disturbances is not well understood.

OBJECTIVES

The current study aims to delineate whether the remitted phase of RRMS is accompanied by activated immune-inflammatory pathways and if the latter, coupled with erythron variables, explain the chronic fatigue and mood symptoms due to RRMS.

MATERIAL AND METHODS

We recruited 63 MS patients, 55 in the remitted phase of RRMS and 8 with secondary progressive MS, and 30 healthy controls and assessed erythron variables, and used a bio-plex assay to measure 27 serum cytokines.

RESULTS

A significant proportion of the MS patients (46%) displayed activation of the immune-inflammatory response (IRS) and compensatory immune response (CIRS) systems, and T helper (Th)1 and Th17 cytokine profiles. Remitted RRMS patients showed increased chronic fatigue, depression, anxiety, physiosomatic, autonomic, and insomnia scores, which could partly be explained by M1 macrophage, Th1, Th-17, growth factor, and CIRS activation, as well as aberrations in the erythron including lowered hematocrit and hemoglobin levels.

CONCLUSIONS

Around 50% of remitted RRMS patients show activation of immune-inflammatory pathways in association with mood and chronic-fatigue-like symptoms. IRS and CIRS activation as well as the aberrations in the erythron are new drug targets to treat chronic fatigue and affective symptoms due to MS.

Fear of re-infection, relapse, and anxiety during COVID-19 pandemic in patients with multiple sclerosis: A multi-center study

Background: Fear of relapse and re-infection during the coronavirus disease 2019 (COVID-19) pandemic can affect people with chronic relapsing diseases, such as multiple sclerosis (MS). We evaluated fear of re-infection, anxiety, and relapse during the COVID-19 pandemic in Iranian people with MS. Methods: This multicenter, cross-sectional study was performed in the MS clinic of Sina Hospital, Tehran, Iran, and Hakim Private Hospital, Isfahan, Iran, between January and April 2022. We asked the participants to fill out validated Persian versions of Fear of Relapse Scale (FoR), and Beck Anxiety Inventory (BAI) questionnaires and answer a binary question about their fear of getting reinfected with COVID-19. Results were reported as mean ± standard deviation (SD) for continuous variables or frequencies for categorical variables. For continuous variables which did not have a normal distribution, we reported the median and interquartile range (IQR). Spearman correlation coefficient between anxiety score and FoR score was calculated. An independent samples t-test was used to compare continuous variables. Results: Three hundred and sixty-eight patients participated in this study. The median scores of FoR and BAI were 49.7 and 34.3, respectively. Fifty-three had new relapses in their last infection. Thirty-six percent of the patients had a fear of getting COVID-19 again, and 43% had a fear of relapse during infection. Three hundred and twenty-three had two doses of COVID-19 vaccine; the most frequent type of vaccine was Sinopharm. There was a significant difference between the median FoR scores among patients with and without relapse during the last COVID-19. There was also a significant positive correlation between anxiety score and FoR (r = 0.49, P < 0.001). Conclusion: More than one-third of enrolled cases had fear of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) re-infection. Patients who experienced exacerbation of symptoms even in the form of relapse or pseudo relapse (possible clinical relapse) had a higher fear of infection.

Explaining the burden of psychosocial factors on the worsening symptoms of MS: a qualitative study of patients' experiences

BACKGROUND

This study was conducted with the aim of identifying the burden of psychosocial factors on the worsening symptoms of multiple sclerosis.

METHODS

This as conducted with a qualitative approach and conventional content analysis among patients with Multiple sclerosis in Mashhad. Data were collected through semi-structured interviews with patients with Multiple sclerosis. Twenty-one patients with Multiple sclerosis were selected through purposive sampling and snowball sampling. The data were analyzed using Graneheim and Lundman method. Guba and Lincoln's criteria were used for evaluating research transferability. The data collection and management was performed by using the MAXQADA 10 software.

RESULTS

In explanation of the psychosocial factors of patients with Multiple sclerosis, one category (psychosocial tensions) and three subcategories of stress (physical symptoms, emotional symptoms, and behavioral symptoms), agitation (family disorder, treatment-related concerns, and social relationship concerns), and stigmatization (social stigma and internalized stigma) were extracted.

CONCLUSION

The results of this study show that patients with Multiple sclerosis are faced with concerns such as stress, agitation, and fear of stigma, and need support and understanding from the family and community to overcome these concerns. Society must base its health policies on addressing the challenges faced by patients. Accordingly, the authors argue that health policies, and consequently, healthcare systems, need to address patients' ongoing challenges as a priority in caring for patients with Multiple sclerosis.

Potentially modifiable associates of anxiety in people with multiple sclerosis: a systematic review

PURPOSE

A high percentage of people with multiple sclerosis (PwMS) experience anxiety, which can negatively impact quality of life. Despite this, anxiety in PwMS remains under researched. This review aims to identify associates with anxiety in PwMS that are amenable to change, with a view to informing the development of interventions in the area.

MATERIALS AND METHODS

The following databases were searched for studies investigating anxiety in PwMS from 2015 to 2021: PsycINFO, PubMed, EMBASE, Web of Science. The search consisted of keywords relating to MS and fear, anxiety or worry. Once screening was completed by two reviewers, a narrative synthesis was used to analyze the data, with the MMAT used for quality appraisal.

RESULTS

Of the 3117 unique abstracts screened, 39 studies met the criteria for inclusion. Evidence was found linking anxiety in PwMS to several modifiable factors broadly categorized as either psychological, social or lifestyle factors. Perceptions of self and one's ability to cope/adjust to MS emerged as important psychological factors. Physical activity and social support from friends were also linked with improved anxiety outcomes.

CONCLUSIONS

Anxiety in PwMS is linked to a number of modifiable factors. Findings may help inform the development of rehabilitation interventions to decrease anxiety in MS.Implications for rehabilitationThis review highlights interventions which have successfully lowered anxiety in people with MS (PwMS); however, there is a clear need for the development of further interventions which target the pathologically specific concerns surrounding anxiety in this population.We show how a number of factors amenable to change associate with anxiety, suggesting that these factors may be appropriate targets for anxiety interventions in PwMS.Enhancing physical activity and self-efficacy are important means in which healthcare professionals can reduce anxiety in MS.Identifying ways of encouraging positive coping and increasing social support are further targets for improving comorbid anxiety in PwMS.Focusing on the modifiable factors highlighted here offers considerable potential for enhancing psychological wellbeing in this group.

Psychometric Characteristics of Persian Version of Adult Hope Scale (AHS) in Iranian Females with Multiple Sclerosis (MS)

Background: Hope is essential for MS patients to recognize favorable genetically challenging conditions and develop a positive outlook on life. Objectives: This study aimed to evaluate the psychometric characteristics of Snyder’s Adult Hope Scale (AHS) in Iranian females with multiple sclerosis (MS). Methods: This cross-sectional study was conducted on all female patient members of the Iran MS Society of Tehran Province from November 2017 to August 2019. This study was used a convenience sampling method used to select a sample of 321 Iranian females with MS (age: 40.61 years, SD = 9.89). A series of questionnaires was administered to the participants, including sociodemographic data, hope (Snyder's Adult Hope Scale; AHS), anxiety and depression (Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), and self-efficacy (General Self-efficacy Scale (GSE)). Through the analysis of psychometric features of the AHS, construct validity was determined via confirmatory factor analysis (CFA), reliability was determined via Cronbach's alpha, divergent validity was determined by examining the relationship between anxiety and depression, and convergent validity was determined using the General Self-efficacy Scale. Results: The confirmatory factor analysis revealed that the data were well fit by a two-factor structure: sbX2 = 66.93 (P < 0.01); SRMR = 0.07; CFI = 0.91; NFI = 0.90; IFI = 0.92; PNFI = 0.61; GFI = 0.93; RMSEA = 0.079. The mean and standard deviation (SD) of the Adult Hope Scale (AHS) was calculated as much as 31.28 (4.58). There was a significant negative correlation between AHS with the Beck’s Depression Inventory (r = -0.51; P < 0.01) and Beck’s Anxiety Inventory (r = -0.42; P < 0.01). Additionally, it was observed that there was a positive correlation between self-efficacy and AHS (r = -0.41; P < 0.01). Conclusions: According to the results, the 12-item AHS indicated good psychometric characteristics in assessing hope among Iranian females with MS. The AHS is one of the primary scales in assessing hope, which can be applied in clinical and research settings.

Fear of relapse in schizophrenia: a mixed-methods systematic review

INTRODUCTION

Fears of relapse in people diagnosed with schizophrenia have long been recognised as an impediment to recovery and wellbeing. However, the extent of the empirical basis for the fear of relapse concept is unclear. A systematic review is required to collate available evidence and define future research directions.

METHODS

A pre-registered systematic search (PROSPERO CRD42020196964) of four databases (PubMED, MEDLINE-Ovid, PsycINFO-Ovid, and Cochrane Central Register of Controlled Trials) was conducted from their inception to 05/04/2021.

RESULTS

We found nine eligible studies. Five were quantitative (4 descriptive and 1 randomised controlled trial), and four were qualitative. The available quantitative evidence suggests that fear of relapse may have concurrent positive relationships with depression (r = 0.72) and suicide ideation (r = 0.48), and negative relationship with self-esteem (r = 0.67). Qualitative synthesis suggests that fear of relapse is a complex phenomenon with behavioural and emotional components which has both direct and indirect effects on wellbeing.

CONCLUSIONS

Evidence in this area is limited and research with explicit service user and carer involvement is urgently needed to develop new and/or refine existing measurement tools, and to measure wellbeing rather than psychopathology. Nonetheless, clinicians should be aware that fear of relapse exists and appears to be positively associated with depression and suicide ideation, and negatively associated with self-esteem. Fear of relapse can include fears of losing personal autonomy and/or social/occupational functioning. It appears to impact carers as well as those diagnosed with schizophrenia.

Cross-cultural adaptation, reliability and validity of the Turkish version of the Fear of Relapse Scale (FoR) in individuals with multiple sclerosis

OBJECTIVE

The study aimed to translate and cross-culturally adapt the Fear of Relapse Scale (FoR) into Turkish and determine its psychometric properties.

METHODS

International guidelines were used for the translation and adaptation process. The patients were asked to fill the FoR, Intolerance of Uncertainty (IUS-12) and Depression Anxiety and Stress Scale (DASS-21). One week later, participants refilled the FoR. The test-retest reliability, internal consistency, and construct validity of the FoR were analyzed.

RESULTS

A total of 101 MS patients (37.6 ± 10.0 years, 81.2% women) were included in the research. The test-retest reliability of the FoR was excellent (ICC:0.883; CI:0.64-0.92). The reproducibility of the items of the FoR ranged from 0.2 to 0.8. The Cronbach's alpha coefficient of the FoR was 0.914. The internal consistency of the items was ranged between 0.90 and 0.91 The relationship between FoR with IUS-12, DASS-21 (depression), DASS-21 (anxiety), DASS-21 (stress) was 0.609, 0.641, 0.648 and 0.631, respectively. The correlation coefficients were greater than 0.50 (p < 0.01).

CONCLUSION

The Turkish version of the FoR is a reliable and valid tool to measure relapse fear in patients with MS.

Fear of Progression in chronic illnesses other than cancer: A systematic review and meta-analysis of a transdiagnostic construct

Fear of cancer recurrence (FCR) is the most common psychosocial issue amongst cancer survivors. However, fear of progression (FoP) has been studied outside of the cancer context. This review aimed to: (1) meta-synthesize qualitative studies of FoP in illnesses other than cancer; and (2) quantify the relationship between FoP and anxiety, depression, and quality of life (QoL) in non-cancer chronic illnesses. We identified 25 qualitative and 11 quantitative studies in a range of chronic illnesses. Participants described fears of progression and recurrence of their illness, including fears of dying, and fears of becoming a burden to family. Fears were often triggered by downward comparison (i.e. seeing people worse off than themselves). Participants coped in different ways, including by accepting the illness or seeking knowledge. Those for whom these fears caused distress reported hypervigilance to physical symptoms and avoidance. Distress, and seeking information, were associated with adherence. In quantitative analyses, FoP was moderately associated with QoL, and strongly associated with anxiety and depression. These results suggest that FoP in illnesses other than cancer is similar to FCR. FoP appears to be an important transdiagnostic construct associated with distress. Evidence-based FCR interventions could be adapted to better manage FoP in other illnesses.

The effect on the anxiety level of the social support given to multiple sclerosis patients

PURPOSE

This is a descriptive study aiming at determining the effect on the anxiety level of the social support given to multiple sclerosis (MS) patients.

DESIGN AND METHODS

This study was conducted with 123 MS patients. The data were collected the Multidimensional Scale of Perceived Social Support (MSPSS), the Hamilton Anxiety Rating Scale (HAM-A).

RESULTS

The Multidimensional Scale of Perceived Social Support total score average was 57.18 ± 18.5, and the HAM-A total score average was 20.33 ± 10.42. A negative weak significant relationship was found between the MSPSS total score average and the HAM-A total score and its sub-dimensions.

PRACTICE IMPLICATIONS

MS nurses should plan their anxiety management accordingly by giving holistic care and evaluating social support mechanisms.

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

BACKGROUND

Multiple sclerosis (MS) relapses are associated with increased disability, reduced quality of life and negative psychosocial impacts. However, they often go unrecognised; people with MS (MSers) may face barriers to self-identification of relapses or seeking support for them. The charity Shift.ms sought to better understand 1) MSers' challenges in self-identifying potential relapses, 2) where MSers' seek support for potential relapses, and 3) the impact of the anticipation of relapses on MSers' wellbeing and daily living.

METHODS

Shift.ms developed a patient perspective 8-question pilot survey (included likert-style, multiple-choice, and optional free-text responses) and shared it with Shift.ms' international online community (n = 20,052). Descriptive quantitative analysis, and content analysis and thematic analysis of qualitative free-text responses were used.

RESULTS

1,737 MSers responded. Just under one third (29.9%) of MSers reported that it takes them 24 h or less to self-identify a potential relapse, while more than half (54.5%) reported that identification occurs within 48 h; 55% MSers felt that the "at least 24 h" clinical criterion of relapse classification was appropriate. Challenges to relapse self-identification included confounding background symptoms or infection, variability of relapse symptoms, and individualistic nature of MS. Fatigue was reported to be the most common symptom of relapse (75%), however fatigue was also the symptom most commonly mistaken for relapse (40%). Barriers to relapse self-identification were a shorter duration since MS diagnosis and a perceived lack of consensus around relapse classification. Respondents reported they most often seek relapse support/advice from healthcare professionals (HCPs) (37.1%), family/friends (32.1%), or not at all (16.9%). Rather than temporal criteria (i.e. the 24 h criterion), participants felt that severity of symptoms could play a more critical role in whether to seek support for a potential relapse. Barriers to seeking support/advice included variability in HCP advice and feelings of invalidation. Anticipation of relapses negatively impacted MSers wellbeing; led to reduced participation in activities, and the development of adjustment/coping strategies. Relapse triggers included stress, reduced self-care, infection/illness; 78.5% reported stress or anxiety had triggered relapse.

CONCLUSIONS

These findings highlight difficulties MSers face in self-identifying relapses, barriers to accessing support, and impact of anticipation of relapses. They also highlight opportunities for improved MSer and HCP communication, dialogue and two-way education to help optimise patient access to relapse support and intervention.

Fear of relapse in patients suffering from RRMS influence their quality of life

Multiple Sclerosis (MS) is a chronic, potentially debilitating disease that affects millions of patients worldwide. About 85% of patients experience a disease subtype characterised by relapses and remittance (RRMS). While many studies have investigated factors influencing patients'' health-related quality of life (HRQoL) in RRMS, none have taken patients' fear of relapses into account. In this study, we measured the patients' self-reported HRQoL, fear of relapse (FoR), health anxiety (HA), number of relapses, duration of disease, type of medication and perceived level of side effects. Treating neurologists provided an estimate of patients' disease severity. All covariates and demographic (personal and disease-related) characteristics were included in regression modelling of their association with HRQoL. The model showed that HRQoL was most strongly associated with disease severity estimated by neurologists, which was highly correlated with the number of relapses and disease duration. However, upon adjustment for FoR (in the presence of all covariates), this association between disease severity and HRQoL attenuated, and FoR remained the only covariate significantly associated with HRQoL. Notably, our modelling also revealed a significant association between HA and FoR in RRMS patients. This study's findings have important implications for the management of MS in RRMS patients and point to the critical roles of FoR and HA as drivers of HRQoL in RRMS. Given the importance of HRQoL to the patient experience and economically, we argue that a more nuanced understanding is needed of the subjective nature of quality of life and its determinants. Interventions aimed at reducing psychological distress and anxiety should be explored.

Fear of COVID-19, problems accessing medical appointments, and subjective experience of disease progression, predict anxiety and depression reactions in patients with Multiple Sclerosis

Background

During the current COVID-19 pandemic there are studies that have suggested a negative impact of the pandemic on the mental health of patients with multiple sclerosis (PwMS). In this sense, several factors may be related to the increase in experiences of anxiety and depression in PwMS during the current pandemic.

Objective

In this study we first explored the reactions of anxiety, depression and fear to COVID-19 in a group of PwMS that belong to the Ibero-American region. Besides, we explored whether having been positive to COVID-19, fear of COVID-19, the obstacles to attend medical appointments during the outbreak and subjective experience of MS progression, could predict the anxiety and depression reactions in our PwMS sample.

Materials and methods

An online cross-sectional survey was conducted on 202 MS patients from six countries (Argentina, Mexico, Spain, Dominican Republic, Venezuela and Cuba). For comparisons between variables an independent-samples t-test and one-way analysis of variance were used. Multiple linear regression was used to evaluate the effects of potential predictor variables over emotional reactions.

Results

Our results showed that PwMS who were positive for COVID-19 reported higher levels of fear of COVID-19 (p<.001) and also higher levels of anxiety (p<.001) compared to non-positive patients. Those patients who had difficulties attending their medical appointments during the outbreak showed higher levels of depression (p=.03) and anxiety (p=.019). Levels of anxiety (p<.001) and depression (p=.006) were also higher among patients with the subjective experience of MS disease progression. The reactions of fear of COVID-19, having been positive to COVID-19, problems attending medical appointments, and subjective experience of MS disease progression showed a high association with the negative impact of the pandemic on mental health of PwMS.

Conclusions

Our results show that the situation generated by the COVID-19 pandemic has had a negative impact on the mental health of PwMS in our sample. Our results also alert to the importance of offering psychological care to patients with multiple sclerosis during the current outbreak, regardless of whether they have been positive for COVID-19.

Fear of relapse, social support, and psychological well-being (depression, anxiety, and stress level) of patients with multiple sclerosis (MS) during the COVID-19 pandemic stage

Background

Psychological well-being assessment during the COVID-19 pandemic is essential for patients with multiple sclerosis (MS). The goal of this study is to evaluate fear of relapse, social support, and psychological well-being (depression, anxiety, and stress level) of Iranian patients with MS during the COVID-19 pandemic stage.

Methods

One hundred and sixty-five patients were enrolled. We asked all cases to fill valid and reliable Persian version of depression, anxiety, and stress scale (DASS-21), perceived social support, and fear of relapse scale questionnaires.

Results

One hundred and sixty-five patients were enrolled. Female to male ratio was (F/M) = 4.6. Mean age and mean duration of disease were 35.3±8.6 and 7.1±5 years, respectively. Mean scores of social support, DASS, and FoR questionnaires were 63.1±16.8, 16.4±13.4, and 51.4±17.3, respectively. There was a significant negative correlation between social support and FoR scores and also significant positive correlations between components of DASS and FoR. Linear regression analysis by considering FoR as dependent variable and age, sex, marital status, duration of the disease, and EDSS as dependent variables showed that sex was an independent predictor of FoR score.

Conclusion

Psychological well-being as well as fear of relapse should be considered in patients with MS during the COVID-19 pandemic stage.

Development of a Web-Based Mindfulness Program for People With Multiple Sclerosis: Qualitative Co-Design Study

Background

Mindfulness-based stress reduction is an efficacious treatment for people with chronic health problems; however, it is highly intensive and time-consuming, which is a barrier for service provision.

Objective

This study aims to develop an internet-delivered adapted version of mindfulness-based stress reduction for people with multiple sclerosis to make the intervention more accessible.

Methods

We co-designed a web-based mindfulness program with end users, that is, people with multiple sclerosis (N=19). Iterative feedback was also collected from a subsample of the initial group of end users (n=11), and the program was reviewed by experts (n=8).

Results

We identified three main themes common to people with multiple sclerosis: dealing with uncertainty and fears for the future, grief and loss, and social isolation. These themes were incorporated into narratives throughout the program. People with multiple sclerosis who reviewed the program gave feedback that the program was relatable, feasible, and acceptable. Experts agreed that the program appropriately represented the main tenets of mindfulness. Iterative feedback was used to further refine the program.

Conclusions

The web-based mindfulness program that we developed was viewed positively by both experts and end users. The program reflects common concerns for people with multiple sclerosis and has the potential to meet important unmet psychological needs. A randomized controlled trial was planned to determine the efficacy of the program.

Psychometric properties of the Croatian version of the depression, anxiety, and stress scale-21 and multiple sclerosis impact scale-29 in multiple sclerosis patients

OBJECTIVES

Depression, anxiety, stress, and physical disabilities are a common complaint in people with multiple sclerosis (MS), and monitoring of these symptoms are based on self-report questionnaires. The objective of this study was to determine psychometric properties of the Croatian version of the Depression, Anxiety, and Stress Scale-21 (DASS-21) and Multiple Sclerosis Impact Scale-29 (MSIS-29) in people with MS.

MATERIALS AND METHODS

We included data on 163 people with MS registered in the Association of multiple sclerosis societies of Croatia (AMSSC). Patients' demographic information, education level, and disease-related variables were ascertained. DASS-21 was applied for assessing depression, anxiety, and stress, while MSIS-29 scale was used for assessment of the physical and psychological impact of MS disease. Psychometric properties were examined by estimating the validity and reliability of the DASS-21 and MSIS-29 scale. Predictive validity of DASS-21 subscales and relevant demographic and disease-related variables was examined by the hierarchical regression model.

RESULTS

The Croatian version of the three DASS-21 subscales and two MSIS-29 subscales had excellent internal consistencies (Cronbach's alpha coefficients 0.88-0.93) and good convergent validity, as expressed by inter-correlations between DASS-21 and MSIS-29 subscales. Hierarchical regression analysis using MSIS-29 subscales as criterion variables showed consistent evidence for the predictive validity of depression, anxiety, and stress on psychological impact, and predictive validity of age, EDSS, and anxiety on physical impact.

CONCLUSIONS

The Croatian versions of DASS-21 and MSIS-29 are reliable and valid scales in people with MS.

Insights for Fostering Resilience in Young Adults With Multiple Sclerosis in the Aftermath of the COVID-19 Emergency: An Italian Survey

Objective: Recent evidence has demonstrated that the COVID-19 pandemic is taking a toll on the mental health of the general population. The psychological consequences might be even more severe for patients with special healthcare needs and psychological vulnerabilities due to chronic diseases, such as multiple sclerosis (MS). Thus, we aimed to explore the psychological impact of this pandemic and of the subsequent healthcare service changes on young adults with MS living in Italy and to examine their coping strategies and preferences regarding psychological support in the aftermath of the pandemic. Methods: Data were collected using a cross-sectional, web-based survey advertised on social networks. We report both quantitative (descriptive statistics, t-tests, and one-way ANOVA) and qualitative data (inductive content analysis). Results: Two hundred and forty-seven respondents (mean age 32 ± 7 years), mainly with relapsing-remitting MS, from all Italian regions participated. Participants felt more worried, confused, sad, and vulnerable because of the disease "during" the pandemic in comparison to their self-evaluation of the period "before" the COVID-19 outbreak. Similarly, their perception of control over MS decreased "during" the pandemic in comparison to the retrospective evaluation of the period "before" the COVID-19 outbreak (p < 0.01). Canceled/postponed visits/exams were listed as the most frequent MS management changes, with modified/postponed pharmacological treatment representing the most stressful change. Psychological support in dealing with pandemic-related fears and improving MS acceptance and well-being was considered extremely important by almost 40% of the respondents. Different coping strategies were mentioned in the qualitative section of the survey, with social support, hobbies, and keeping busy being the most frequent ones. Conclusions: Considering the enormous impact of the pandemic on young adults with MS, we urge MS clinical centers to implement psychological support programs that address the potentially long-lasting psychological negative impact, thus fostering the therapeutic alliance that is being threatened by the infection prevention measures imposed during the pandemic, and promoting psychological resources for adaptively managing future waves of COVID-19.