Do coping strategies mediate the association between Type D personality and quality of life among people with multiple sclerosis?

The aim of this study is to explore whether different coping strategies are able to mediate the association between Type D personality and quality of life. We collected information from 156 consecutive patients (response rate: 72.9%; 75.0% women; median age: 40 ± 3 years). Patients completed the Type D Scale-14, the Coping Self-Efficacy Scale and the Short-Form Health Survey for measuring physical and mental quality of life. The mediating effect of coping was analysed using correlations, linear regressions and the Sobel z-test. In the mental quality of life, all three studied coping strategies mediated the association between Type D personality and quality of life.

Self-esteem, social participation, and quality of life in patients with multiple sclerosis.

The aim of this study is to explore whether self-esteem and social participation are associated with the physical and mental quality of life (Physical Component Summary, Mental Component Summary) and whether self-esteem can mediate the association between these variables. We collected information from 118 consecutive multiple sclerosis patients. Age, gender, disease duration, disability status, and participation were significant predictors of Physical Component Summary, explaining 55.4 percent of the total variance. Self-esteem fully mediated the association between social participation and Mental Component Summary (estimate/standard error = -4.872; p < 0.001) and along with disability status explained 48.3 percent of the variance in Mental Component Summary. These results can be used in intervention and educational programs.

Importance of an individual's evaluation of functional status for health-related quality of life in patients with multiple sclerosis.

BACKGROUND: Quantifying the clinical impact of multiple sclerosis (MS) is one of the most important determinants for optimizing individual patient care. Useful clinical measures for MS can be evaluated from different perspectives. OBJECTIVE/HYPOTHESIS: This cross-sectional study compared physical disability and functional status as assessed by a neurologist and by a patient and explored how they are associated with the health-related quality of life (HRQoL). METHODS: We collected data from 223 patients. One neurologist scored functional disability using the Kurtzke's Expanded Disability Status Scale (EDSS) and patients evaluated their functional status using the Incapacity Status Scale (ISS). HRQoL was assessed using the Physical and Mental Component Summary (PCS, MCS) of the Short Form-36 Health Survey (SF-36). Multiple linear regressions were applied to analyze the data. RESULTS: Total EDSS and ISS scores correlated significantly (r = .67; p ≤ .001). Regression analyses showed that EDSS was significantly related to PCS, but not to MCS. After adding ISS into the analysis the association between EDSS and PCS became non-significant. ISS contributed significantly to the explained variance in both models. The final model explained 49% of the total variance for PCS and 15% for MCS. CONCLUSIONS: Functional disability as measured by a neurologist (EDSS) is associated with PCS, but not with MCS, whereas functional disability as measured by patients (ISS) is significantly associated with both HRQoL dimensions. Neurologists should target their attention more on patients' evaluations of their functional status in order to detect the most bothersome problems that are affecting a patient's quality of life.

The mediating effect of coping on the association between fatigue and quality of life in patients with multiple sclerosis.

Fatigue, as one of the most frequent symptoms in patients with multiple sclerosis (MS), has various adverse effects on the physical and mental health-related quality of life (PCS, MCS) of patients. The aim of this study was to explore whether coping mediates the relationship between fatigue and PCS and MCS. We collected data from 154 consecutive MS patients (76.0% women; mean age 40.0 ± 9.9). Patients completed the Short-Form Health Survey (SF-36), the multidimensional fatigue inventory (MFI-20) and the coping self-efficacy scale. The mediating effect of coping was analysed using linear regressions and the Sobel z-test. In PCS significant mediation was found in some of the fatigue dimensions (general, physical and reduced Motivation), while in MCS, it was significant in all dimensions. These results can be implemented into educational programmes for patients, their caregivers or physicians, and can also be helpful in the treatment process.

Social participation and health-related quality of life in people with multiple sclerosis.

BACKGROUND: Social participation is an integral part of everyday life in society; however, evidence about its association with health-related quality of life (HRQoL) in people with multiple sclerosis (MS) is lacking. OBJECTIVE: The aim of this study is to explore whether social participation is associated with the Physical Component Summary of HRQoL (PCS) and Mental Component Summary of HRQoL (MCS) in people with MS, controlled for age, gender, disease severity and disease duration. METHODS: The sample consisted of 116 consecutive people with MS (response rate: 75.8%; 72.4% women; mean age 40.3 ± 9.8). People with MS completed the Short-Form Health Survey (SF-36) for measuring PCS and MCS and the Participation Scale, which measures the level of social participation. Disability was assessed using the Expanded Disability Status Scale (EDSS). The associations between social participation, PCS and MCS, were analyzed using linear regression that controlled for sociodemographic and clinical variables. RESULTS: PCS was significantly associated with age, disease duration, EDSS and social participation. MCS did not show significant association with the studied variables. Overall, a multiple regression model explained 48% of the PCS variance, while the proportion of MCS variance explained was not significant. CONCLUSIONS: Social participation was significantly associated with PCS, suggesting a possibility for intervention in this domain.

Factors associated with poor sleep quality in patients with multiple sclerosis differ by disease duration.

BACKGROUND: Sleep disturbance is a common symptom of multiple sclerosis (MS) and knowledge about factors that contribute to poor sleep quality is scarce. OBJECTIVE: The aim was to explore the differences in the prevalence and determinants of poor sleep quality in a sample of patients with MS with disease duration ≤ 5 years and >5 years. METHODS: We collected data from 152 consecutive patients with MS; 66 patients (78% women, averaged 37.35 ± 10.1 years) were in the group with disease duration ≤ 5 years and 86 patients (73.3% women, averaged 42.10 ± 9.4 years) in the group with disease duration >5 years. Patients filled out the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, the Multidimensional Fatigue Inventory, one item of the Incapacity Status Scale regarding bladder problems and one item of the Short Form-36 regarding pain. Multiple linear regression was used to analyze the relationship between the study variables. RESULTS: The prevalence of poor sleep is significantly higher in patients with longer disease duration (34.8 vs. 51.2%). Anxiety, reduced motivation and mental fatigue (all p < 0.05) were associated with poor sleep quality in patients with disease duration ≤5 years, whereas pain (p < 0.01), depression and mental fatigue (both p < 0.05) were in patients with disease duration >5 years. CONCLUSION: Sleep problems are present in patients with MS with both short and long disease duration, but these problems are associated with different factors. These should be recognized and managed in addition to the treatment of sleep disorders.

The role of social support in anxiety and depression among Parkinson's disease patients.

PURPOSE: To explore how social support is associated with anxiety and depression in Parkinson's disease (PD) patients controlling for gender, disease duration and disease severity. METHODS: The sample consisted of 124 patients (52.4% male; mean age 68.1 ± 8.4 years; mean disease duration 6.3 ± 5.5 years). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale, social support with the Multidimensional Scale of Perceived Social Support and disease severity with the Unified Parkinson Disease Rating Scale. Data were analyzed using linear regression. RESULTS: Gender, disease duration, disease severity and social support explained 31% of the total variance in anxiety in younger PD patients but did not significantly contribute to the explanation of depression. In the older group, this model explained 41% of the variance in depression but did not significantly contribute to the explanation of anxiety. CONCLUSION: PD patients experience the positive influence of social support differently according to age. In the younger group, disease duration plays the primary role regarding anxiety. In the older group, poor social support especially from friends is associated with more depression after controlling for the relevant variables. Implications of Rehabilitation PD is a disease of older age with a neurodegenerative character and treatment should focus on increasing quality of life. Anxiety and depression are common co-morbidities in PD patients. The support network should also be screened regularly and involved in enhancing the quality of life.

Health-related quality of life in multiple sclerosis patients with bladder, bowel and sexual dysfunction.

PURPOSE: Bladder, bowel and sexual dysfunction are often overlooked symptoms in patients with multiple sclerosis (MS) and can be associated with lower health-related quality of life (HRQoL). The aim is to explore the association of bladder, bowel and sexual dysfunction with HRQoL in MS patients stratified by disease duration (≤5 and >5 years) and controlled for clinical and sociodemographic variables. METHODS: The study comprised 223 MS patients (mean age 38.9 ± 10.8 years, 67% female, mean EDSS 3.0 ± 1.5) who filled out the Short-Form-36 Health Survey, the Bladder Control Scale, the Bowel Control Scale and the Incapacity Status Scale. The relationships between the variables were analyzed with multiple linear regression using the SF36's Physical Component Summary (PCS) and Mental Component Summary (MCS) as dependent variables. RESULTS: More severe bladder dysfunction was associated with lower PCS in both disease duration groups (ß = -0.35, p ≤ 0.001 versus ß = -0.43, p ≤ 0.001), whereas more severe sexual dysfunction was associated with lower MCS in the group with shorter disease duration (ß = -0.23, p ≤ 0.05). CONCLUSION: Bladder and sexual dysfunction are associated with a poorer HRQoL in MS patients even if they have had MS for a relatively short time. Recognition and proper treatment is needed to prevent the development of more severe dysfunction; this may also lead to a better HRQoL. IMPLICATIONS FOR REHABILITATION: Bladder and sexual dysfunction are associated with a poor health-related quality of life in MS patients. Sexual dysfunction may explain mental health issues among individuals with a short disease duration. Recognition and treatment may prevent the development of more severe sexual and bladder dysfunction and increase physical health-related quality of life.

Coping and its importance for quality of life in patients with multiple sclerosis.

PURPOSE: The aim of this study was to analyse whether problem-focused coping, coping focused on getting support and coping focused on stopping unpleasant emotions and thoughts are associated with different levels of physical and mental quality of life (PCS, MCS), controlling for gender, age and disease severity among MS patients. METHOD: The sample consisted of 113 consecutive MS patients (response rate: 79.6%; 77.0% women; mean age 40.8 ± 9.2). Patients completed the Short-Form Health Survey (SF-36) and the Coping Self-Efficacy Scale (CSE). Disability was assessed by Expanded Disability Status Scale (EDSS). The associations between CSE and PCS and MCS were analysed using linear regression. RESULTS: EDSS and age were significantly associated only with PCS. The regression model for problem-focused coping, coping focused on getting support and coping focused on stopping unpleasant emotions and thoughts explained 29%, 24% and 35% of the variance in MCS, respectively. In PCS coping was not significant. CONCLUSIONS: Coping is significantly associated with MCS, but not with PCS. Stopping unpleasant emotions and thoughts seems to be the most important type of coping in MS patients. Thus, patients, their caregivers and their physicians should be educated about this type of coping and its positive association with MCS. Implications for Rehabilitation All types of coping are associated positively with mental component of Quality of life. Coping focused on stopping negative emotions and thoughts seems to be very adaptive for patients with MS. This type of coping can help patients with chronic conditions when problem-focused coping can not effectively solve the problem.

Suicidal behavior and attitudes in Slovak and Turkish high school students: a cross-cultural investigation.

Suicidal behavior and its variation across social contexts are of importance for the science of suicidology. Due to its special character controlled experimental studies on suicide are ruled out for ethical reasons. Cross-cultural studies may throw light on the etiology of both suicidal behavior and its cross-cultural variation. The present study compared suicidal behavior and attitudes in 423 Slovak and 541 Turkish high school students by means of a self-report questionnaire. The two groups reported similar percentages (Slovak = 36.4%; Turkish = 33.8%) of lifetime, past 12-months or current suicidal ideation but significantly more Turkish (12.2%) than Slovak (4.8%) students reported lifetime or past 12-months suicide attempts. Slovak adolescents displayed more liberal and permissive attitudes toward suicide, while those of Turkish adolescents were more rejecting. Turkish students rated themselves to be more religious and hence they believed to a greater extent that suicidal persons would be punished in a life after death than their Slovak peers. However, attitudes of Turkish students toward an imagined suicidal close friend were more accepting than the attitudes of Slovak students. Comparison of suicidal and nonsuicidal students revealed that those reporting suicidal ideation or attempts were more accepting of suicide and viewed suicide as a solution to a greater extent than the nonsuicidal ones. The results from this study suggest that cultural factors play a role in suicidal behavior, attitudes and reactions in a predicted direction.

Clinical determinants of primary and secondary fatigue in patients with Parkinson's disease.

Clinical and psychosocial factors associated separately with primary and secondary fatigue in Parkinson's disease (PD) patients have not been thoroughly studied before. The aim of our study was to assess factors associated with different fatigue domains in groups with primary and secondary fatigue in PD separately. We divided 165 non-demented PD patients according to the absence/presence of depression, anxiety and excessive somnolence into groups with primary fatigue (N = 63) and with secondary fatigue (N = 102). Fatigue domains examined using the multidimensional fatigue inventory were associated through multiple linear regression analyses for each group separately with sociodemographic data, disease duration, functional status as assessed by the Unified Parkinson's Disease Rating Scale, treatment, depression, anxiety, excessive somnolence and sleep quality. Out of the assessed non-motor symptoms, fatigue was the most frequent (77.6%). The prevalence of fatigue in the secondary fatigue group was significantly higher than in the primary fatigue group. Both fatigue groups differed significantly in factors associated with different fatigue domains. Functional status or other disease-related factors were not associated with primary fatigue. In the secondary fatigue group, we found associations between some fatigue domains and functional status, older age, male gender and higher anxiety scores. To our knowledge, this is the first study to separately describe clinical determinants and psychosocial factors associated with different fatigue domains in primary and secondary fatigue in PD, underlining the importance of distinguishing primary and secondary fatigue in future PD studies and clinical practice.

Type D, anxiety and depression in association with quality of life in patients with Parkinson's disease and patients with multiple sclerosis.

PURPOSE: The present study examines the role of Type D personality, anxiety and depression in quality of life (QoL) in patients with two chronic neurological diseases--Parkinson's disease (PD) and multiple sclerosis (MS). METHODS: This cross-sectional study included 142 PD patients (73 % males; mean age 67.6 ± 9.2 years) and 198 patients with MS (32.3 % males; 38.4 ± 10.8 years). Multiple regression analyses were used to analyze the association of UDPRS (PD patients) or EDSS (MS patients), Type D personality (DS-14) and anxiety and depression (HADS) with the physical (PCS) and mental summary (MCS) of QoL, as measured by the SF-36. RESULTS: In PD patients, Type D was significantly associated with MCS only; in MS patients, Type D was significantly associated with both dimensions--MCS and PCS. After adding anxiety and depression, the importance of Type D for the QoL model dramatically decreased. Anxiety and depression were strongly associated with lower scores in MCS and PCS in both PD and MS patients. CONCLUSIONS: The actual mood of PD and MS patients--the level of anxiety or depression--might have a greater impact on patients' QoL than their personality. Further longitudinal research should focus on how the pathway consisting of personality traits, anxiety and depression, and QoL might be constructed.

Employment status and perceived health status in younger and older people with multiple sclerosis.

This study explores how employment is associated with perceived physical and mental health status in people with multiple sclerosis (MS) adjusted for sociodemographic and clinical variables stratified by age. The sample consisted of 184 MS patients divided into a younger (<45 years) and an older (≥45 years) age group. Respondents underwent an interview, a neurological examination on disability [Expanded Disability Status Scale (EDSS)], and completed the Short Form-36 Health Survey. Of the respondents (mean age 40.5±6.2 years), 43.5% were employed. Significant differences between younger and older patients were found in employment, EDSS, disease duration, and five Short Form-36 Health Survey dimensions. Block-step multiple regression explained 32.4% of the variance in physical health and 14.5% in mental health in the younger group. Being employed was significantly related to good physical health, whereas EDSS diminished the effect of being employed on physical health. The most important variable for mental health was employment status in the younger group. For the older age group, 19.1% of the variance in physical health and 14.0% of the variance in mental health was explained by the studied variables. Male gender and a lower EDSS were significant explanatory variables of better physical health. Male gender significantly explained mental health in the older age group. In conclusion, employment status was an explanatory variable for physical health and mental health in the younger patients. EDSS played a significant role in physical health for all patients. A vocational rehabilitation program could prevent eventual nonemployment and improve health outcomes in older MS people.

Quality of life in patients with multiple sclerosis in Eastern Slovakia.

PURPOSE: Quality of life (QoL) is an important measure of the burden of disease and could be useful in evaluating patient management and practical interventions. The aim of this study was to explore the association of psychological and clinical variables with QoL in patients with multiple sclerosis (MS). METHODS: One hundred and fourteen consecutive patients (mean age 36.1 ±â€Š10.3 years, 72% female) from one MS centre completed the Hospital Anxiety and Depression Scale, the Fatigue Severity Scale and the Short-Form-36 Health Survey (SF-36). Functional disability was assessed using the Expanded Disability Status Scale. Multiple linear regression analyses were performed to analyse demographic, psychological and clinical data. RESULTS: Functional disability, depression and fatigue were found to be related inversely to the physical health subscale. Disease course, anxiety and depression were associated negatively with the mental health subscale. CONCLUSIONS: Functional disability, depression and fatigue were the main variables related to the perceived physical health subscale, and disease course, anxiety and depression to the perceived mental health subscale in the group of patients with MS. Thus, effective treatment of fatigue, anxiety and depression could be assumed to increase a patient's QoL.

Self-rated health and employment status in patients with multiple sclerosis.

PURPOSE: The aim is to explore the association between self-rated health and employment status in patients with multiple sclerosis (MS) when controlling for age, gender, functional disability, disease duration, anxiety and depression. METHOD: One hundred eighty-four people with MS completed a sociodemographic questionnaire that included questions on employment status, the first item of the Short Form-36 Health Survey and the Hospital Anxiety and Depression Scale. Functional disability was assessed using the Expanded Disability Status Scale. The probability of good self-rated health in employed persons was investigated using stepwise logistic regression analyses. RESULTS: Patients with MS who reported good self-rated health were 2.46 times more likely to be employed (95% confidence interval [CI]: 1.08-5.59). Patients without anxiety were 2.64 times more likely to be employed (95%CI: 1.23-5.67). Patients with higher EDSS scores were 0.49 times less likely to be employed (95%CI: 0.33-0.70). Age, gender, disease duration and the presence of depression did not show an increased chance of patient employment. CONCLUSIONS: Patients with MS with good self-rated health are more likely to be employed, even after adjusting for age, gender, education, functional disability, disease duration, depression and anxiety. Dependent on the findings of longitudinal studies unravelling the relevant causal pahways, self-rated health might be used as a quick and cheap prognostic marker, which could warn about the possible loss of employment, or changes in functional disability.

Perceived health status as measured by the SF-36 in patients with multiple sclerosis: a review.

This review of literature gives an overview of recent studies about perceived health status as measured by the Short-Form-36 (SF-36) Health Survey in patients with multiple sclerosis (MS). The SF-36 is one of the tools measuring health status in patients used in international research and clinical practice. It measures two main health concepts - physical and mental. The SF-36 represents a valid instrument able to detect differences in perceived health status in patients. A computer-aided search in Medline and PsycINFO resulted in 504 articles in English published from 1996 to August 2006. After the screening process on the basis of abstracts, eight articles consisting of empirical studies remained in which perceived health status was evaluated using the SF-36 Health Survey. Seven studies focused on disability and perceived health status in the SF-36. Two studies focused on the relationship between depression and perceived health status. These studies showed that MS patients with low disability and minor depression scored significantly better than patients with high disability and major depression in the SF-36 health dimensions. Gender seems to have no influence on perceived health status in MS patients. The longer the disease duration and the more severe the disease, the lower the patients scored in perceived health status. The more disabled, the more depressive and the older the patients, the poorer their perceived health status was. Health providers supporting appropriate treatment might pay more attention to more disabled and more depressive patients, with longer disease duration. Perceived health status can be a predictor of prognosis and intervention outcomes. The study shows the importance of measuring perceived health status in MS patients with implications for their quality of life and provision of care.

Social support as a predictor of perceived health status in patients with multiple sclerosis.

OBJECTIVE: The main aim of this study was to investigate whether different levels of perceived social support are associated with different levels of perceived health status in multiple sclerosis (MS) patients. METHODS: Two hundred and seven MS patients (38.4+/-10.6 years, 66.2% female) completed the Short-Form-36 Health Survey (SF-36) as the measure for perceived health status, and the perceived social support scale (PSSS) as the measure for social support. Functional disability was assessed using Kurtzke's expanded disability status scale (EDSS). The contribution of EDSS and PSSS for explaining the variance in SF-36 was investigated with multiple linear regression analysis. RESULTS: Demographic variables and EDSS explained 44% of the variance of the physical health summary scale in the SF-36. Demographic variables, EDSS and PSSS from family and friends explained 24% of the variance in mental health summary scale in the SF-36. Results varied according to the multiple linear regression analyses of predictors of variance in the eight dimensions of the SF-36. CONCLUSION: PSSS from significant others was positively associated with general health dimension of perceived physical health status, while PSSS from family and friends was positively associated with perceived mental health status in MS patients. PRACTICE IMPLICATIONS: The results show the importance of supporting social ties and relationships between MS patients and others.