Illness intrusiveness: A key part of the cognition-mood link in multiple sclerosis.

Abstract

Purpose: The current study attempted to expand the literature on cognition and mood in MS by determining if illness intrusiveness may potentially serve as an intermediary factor in the wellestablished cognition-mood relationship in people with MS. Method: This study employed a retrospective cross-sectional design to answer this question. Baseline neuropsychological test data and mood questionnaires from 199 participants with clinically definite MS were used in this study. The sample was middle-aged (M = 48.4, SD = 11.8), highly educated (M = 14.6, SD = 2.2), majority female (76.9%) and majority White (74.5%). Assumptions for parametric statistics and ordinary least squares regression were met. Conditional process models evaluated whether illness intrusiveness mediated the relationship between cognitive functioning and psychiatric symptoms. Results: In total, 33.2% of the sample met criteria for clinically significant anxiety, 41.7% met criteria for depression, and 27.8% of the sample met criteria for processing speed impairment, consistent with other MS samples. Illness intrusiveness was found to mediate the relationship between processing speed and depression, ab = À.07, 95% CI [À.15, À.002], processing speed and anxiety, ab = À.06, 95% CI [À.12, À.02], and processing speed and more general mood disturbance, ab = À.08, 95% CI [À.13, À.0005]. Conclusions: Illness intrusiveness was found to be a potential important intermediary mechanism by which the primary cognitive impairment in MS, processing speed, impacts mood in this disease population. Conclusions, treatment implications, and directions for future research in light of these findings were discussed. Impact and ImplicationsProcessing speed is related to mood symptoms in people with MS, and illness intrusiveness is a possible pathway by which slowed processing speed influences mood. A potential explanation for these findings is that processing speed is the most common cognitive impairment in MS, and often affects people earlier in life when people's careers and relationships are less well-established. It will be important for clinicians to assess how cognitive impairment is influencing the lives of people with MS including their relationships, goals, and engagement in recreational activities. Cognitive rehabilitation may be an important treatment recommendation, as improving cognition may be able to reduce the perceived burden of the disease and enhance mood. Cognitive behavioral psychotherapy may be another important recommendation for helping MS patients to view their illness from a new perspective.

A Concept Analysis of Illness Intrusiveness in Chronic Disease: Application of the Hybrid Model Method

“…In medicine, the attributes of the physical domain of illness intrusiveness in patients with chronic disease included being affected by the illness due to pain [12,[22][23][24][25][26], fatigue [22,23], and physical dysfunction [8,9,23,24,27,28] in addition to sexual dysfunction 19,22,30,46] and sleep disturbance [29]. The psychological domain included depression [11,22,30].…”

“…In psychology, the physical domain included patients experiencing disease-related pain [39,40] and physical disability [41]. The psychological domain included mood disorders such as depression [28,39,42,43], loss of self-esteem [41,[44][45][46], and uncertainty due to the characteristics of chronic disease [30,40]. The social/contextual domain included work restrictions including social role impairment [44], dietary change [40], the worsening of financial status [47,48], and limited hobbies [47,48].…”

“…Physical pain [18] Pain [12,[22][23][24][25][26] Disease-related pain [39,40] Weakness [19] Fatigue [22,23] Decreased mobility [12,18] Physical dysfuction [8,9,23,24,27,28] Physical disability [41] Sexual dysfuction [19] Sexual dysfuction [18,22,26,35] Sleep disturbance [29] Psychological Depression [10,20] Depression [11,22,30] Mood disorder [28,39,42,43] Loss of self-esteem [41,[44][45][46]] Loss of willpower [20] Uncertainty [30,40] Social/contextual Distruption of role play [10] Role restriction [11,26,[31][32][33] Socia...…”