The relationship between disability and depression in multiple sclerosis: the role of uncertainty, coping, and hope

Abstract

The relationship between disability and depression was studied in 188 patients with clinically definite multiple sclerosis (MS). Patients were administered the Zung Self-Rating Depression Scale, Ways of Coping, Uncertainty of Illness Scale, and Hope Scale during their regular clinic appointments. Their current level of disability was rated by the attending physician using the Expanded Disability Status Scale. Even when the depression measure was corrected for items overlapping with other symptoms or consequences of MS, depression was correlated with disability. Depression was also correlated with an array of psychological variables, including uncertainty concerning ones illness, hope, and the use of various emotion-centered, though not problem-centered coping strategies. Multiple regression analyses revealed that none of these psychological correlates mediated or moderated the relationship between disability and depression. Instead, disability, uncertainty, hope, and emotion-centered coping were significant independent predictors of depression, together accounting for approximately 40% of the variance in patients' self-reported depression. The relationship between disability and depression in MS is usually interpreted as evidence that depression is psychogenic and reactive to the demands and limitations of this disease. The demonstration that this relationship is not diminished when an array of potentially intervening psychological variables are included in the analysis raises questions concerning the validity of this interpretation.

Disability Status, Disease Parameters, Defense Styles, and Ego Strength Associated with Psychiatric Complications of Multiple Sclerosis

“…Studies investigating the relationship between psychiatric complications of MS and clinical parameters have resulted in conflicting results. Most studies suggest that there is no association between the duration of the illness and psychopathology [12,14,15]. Others, however, consistent with our findings, suggest that patients in the first period after diagnosis of MS are at greater risk to develop depression [10,11], and that the ability to handle MS might improve with time over the course of the disease [44].…”

Quality of life and cognitive functions in early onset multiple sclerosis

“…Although the onset of a chronic disease during the early phases of life is dramatic, our data suggests that coping with a disease with its onset in childhood or adolescence has a lower impact on quality of life and on patients mood, as self reported, with respect to adult onset. 24 This might depend also on a higher integration of the disease status into ones subjectivity when it intervenes in a specific developmental phase, such as adolescent, a phase in which persons are still busy in building their personality. The best quality of life of patients with early onset may also be justified by the possibility of a progressive transformation and adaptation of life goals in this particular population.…”

Measures of cognitive and emotional changes in multiple sclerosis and underlying models of brain dysfunction

“…We are at present constructing a modified version of that scale, which takes into account the typical symptoms and problems of depressed MS patients, since this scale could contribute clarifying a very controversial issue in this field, namely the biological or psychological nature of major depression in MS. Mood disorders of MS patients have, indeed, been considered by some authors as a psychological reaction to high levels of perceived stress, lack of social support and reduced quality of life [31,49], but other authors have questioned this interpretation stressing the lack of relationship between disability and depression [50]. Some authors have therefore attributed depression of MS patients to structural brain abnormalities [51,52], or to a genetic link between major depression and multiple sclerosis [53].…”