The interrelations between spiritual well-being, pain interference and depressive symptoms in patients with multiple sclerosis

Abstract

Depressive symptoms are common in individuals with multiple sclerosis (MS), and are frequently exacerbated by pain; however, spiritual well-being may allow persons with MS to more effectively cope with pain-related deficits in physical and role functioning. We explored the associations between spiritual well-being, pain interference and depressive symptoms, assessing each as a potential mediator, in eighty-one patients being treated for MS, who completed self-report measures: Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale, Pain Effects Scale, and Center for Epidemiologic Studies Depression Scale Revised. At the bivariate level, spiritual well-being and its subscale of meaning and peace were negatively associated with depression and pain interference. In mediation models, depression was not related to pain interference via spiritual well-being, or to spiritual well-being via pain interference. Pain interference was related to depression via spiritual well-being and meaning/peace, and to spiritual well-being and meaning/peace via depressive symptoms. Finally, spiritual well-being and meaning/peace were related to depression via pain interference, and to pain interference via depressive symptoms. For patients with MS, a multi-faceted approach to treatment that includes pain reduction and promotion of spiritual well-being may be beneficial, although amelioration of depression remains a critical task.

Does Religiosity/Spirituality Play a Role in Function, Pain-Related Beliefs, and Coping in Patients with Chronic Pain? A Systematic Review

“…However, few of the authors of identified studies reported the duration of pain of their study participants. We therefore modified the inclusion criteria to include studies that explicitly said that they included participants with "chronic pain" or who had a primary medical condition often associated with chronic pain (Bartlett et al 2003;Basinski et al 2013;Büssing and Koenig 2008;Büssing et al 2009;Cooper-Effa et al 2001;Dezutter et al 2009Dezutter et al , 2010Harris et al 2017;Harrison et al 2005;Keefe et al 2001;McParland and Knussen 2010;Meier 1982;Nsamenang et al 2016;Offenbaecher et al 2017;Rzeszutek et al 2017). Also, the aims we initially proposed in the PROSPERO protocol for this systematic review included examining whether religion is associated with measures of pain and function and the extent to which pain-related beliefs, pain-coping responses, and catastrophizing in adults with chronic pain are different or similar in people with different religious affiliations.…”

“…Thus, 20 studies were included in the final analysis of the systematic review. (Ammondson 2009;Bartlett et al 2003;Cooper-Effa et al 2001;Dunn 2005;Harris et al 2017;Harrison et al 2005;Keefe et al 2001;Lavin and Park 2011;Meier 1982;Nsamenang et al 2016;Rippentrop et al 2005;Ruzicka et al 2007). All but one study (n = 19 [95%]) were cross-sectional observational studies, while one was a descriptive and exploratory mixed-method study (Ammondson 2009).…”

“…In most studies (n = 17 [85%] studies), participants were predominantly women (range 56-95%), with only three studies (Gomes et al 2018;Harris et al 2017;Lavin and Park 2011) having enrolled predominantly men (range 58-88%), and one study (Ruzicka et al 2007) with unknown number of women or men. In 12 out of 13 studies (60%) for which the participants' average age was known, participants were middle-aged or older, with the mean age at the time of study enrollment ranging from 53 to 76 years old (Ammondson 2009;Bartlett et al 2003;Büssing and Koenig 2008;Büssing et al 2009;Dunn 2005;Harris et al 2017;Keefe et al 2001;McParland and Knussen 2010;Meier 1982;Nsamenang et al 2016;Rippentrop et al 2005;Rzeszutek et al 2017). Fourteen studies (70%) reported participants' religious affiliation (Ammondson 2009;Bartlett et al 2003;Büssing and Koenig 2008;Büssing et al 2009;Dezutter et al 2009Dezutter et al , 2010Dezutter et al , 2011Dunn 2005;Gomes et al 2018;Harris et al 2017;Lavin and Park 2011;Meier 1982;Rippentrop et al 2005;Ruzicka et al 2007).…”

“…Most studies (n = 17 [85%]; Ammondson 2009; Bartlett et al 2003;Cooper-Effa et al 2001;Dezutter et al 2009Dezutter et al , 2010Dezutter et al , 2011Dunn 2005;Harris et al 2017;Harrison et al 2005;Keefe et al 2001;Lavin and Park 2011;McParland and Knussen 2010;Meier 1982;Nsamenang et al 2016;Rippentrop et al 2005;Ruzicka et al 2007;Rzeszutek et al 2017) evaluated the association between religiosity/spirituality and function. Twelve (60%) of these studies conducted a correlational analysis only (Ammondson 2009;Bartlett et al 2003;Dezutter et al 2009Dezutter et al , 2010Dezutter et al , 2011Harris et al 2017;Lavin and Park 2011;McParland and Knussen 2010;Nsamenang et al 2016;Rippentrop et al 2005;Ruzicka et al 2007;Rzeszutek et al 2017 (Dunn 2005). A total of 8 (40%) studies evaluated the association between religiosity/spirituality and either pain-related beliefs (Gomes et al 2018;Ruzicka et al 2007), coping responses (Büssing and Koenig 2008;Büssing et al 2009;Dezutter et al 2011;Dunn 2005;Keefe et al 2001) or catastrophizing (Harris et al 2017).…”

“…The only measure of religiosity or spirituality that was used in more than one study was the Spiritual Well-being Scale (SWBS), which assesses the respondent's sense of well-being in relation to God and sense of life purpose and life satisfaction (Cooper-Effa et al 2001;Ruzicka et al 2007). The religiosity/spirituality domains assessed included religiosity (e.g., religious experience, frequency of religious practices; Ammondson 2009;Dezutter et al 2010Dezutter et al , 2011Harrison et al 2005;McParland and Knussen 2010;Meier 1982;Rippentrop et al 2005), spirituality (e.g., daily spiritual experiences, transcendence; Bartlett et al 2003;Gomes et al 2018;Keefe et al 2001;Rippentrop et al 2005;Rzeszutek et al 2017), spiritual and religious attitudes or attitudes toward religion (Büssing et al 2009;Dezutter et al 2009), religions and/or spiritual well-being (Cooper-Effa et al 2001;Dunn 2005;Lavin and Park 2011;Nsamenang et al 2016;Ruzicka et al 2007;Rzeszutek et al 2017), beneficial effects of spiritual/religious involvement (Büssing and Koenig 2008;Büssing et al 2009), and spiritual distress (Harris et al 2017).…”