Health-related quality of life in multiple sclerosis: Links to mental health, self-esteem, and self-compassion

Objective: To examine the association of health-related quality of life (HRQoL) with mental health, self-esteem, and self-compassion in multiple sclerosis (MS) patients.Method: For this descriptive and cross-sectional study, a total of 89 volunteer Turkish MS patients completed the patient information form, Rosenberg Self-Esteem Scale, Self-Compassion Scale, Hospital Anxiety and Depression Scale, and MS International Quality of Life Questionnaire. Depressed patients were compared with nondepressed patients regarding HRQoL, self-esteem, and self-compassion. Bivariate correlations between HRQoL, self-esteem, self-compassion, and mental health indices were calculated followed by hierarchical regression analyses.Results: Depressed MS patients had significantly lower HRQoL, self-esteem, and self-compassion compared to their nondepressed counterparts. Hierarchical multiple regression analysis showed that physical HRQoL was significantly predicted by disability status and self-compassion, explaining 48% of the total variance. Anxiety and self-esteem explained 52% of the total variance of psychological HRQoL. Social HRQoL was significantly predicted by depression and self-esteem, which explained 21% of the total variance.Conclusion: The effects of MS and disability may not be avoidable, but self-related traits including self-esteem and self-compassion can be modified through psychosocial interventions to improve HRQoL. The findings of the current study provided insights into which psychosocial factors to address in improving different domains of HRQoL in MS patients. Cultivating self-compassion may increase HRQoL in the physical domain, while working with self-esteem and self-worth may improve the psychosocial domain.

PDF

___

1. Sadovnick AD, Ebers GC. Epidemiology of multiple sclerosis: a critical overview. Can J Neurol Sci 1993; 20:17-29.

2. Browne P, Chandraratna D, Angood C, Tremlett H, Baker C, Taylor BV, et al. Atlas of multiple sclerosis 2013: a growing global problem with widespread inequity. Neurology 2014; 83:1022-1024.

3. Patwardhan MB, Matchar DB, Samsa GP, McCrory DC, Williams RG, Li TT. Cost of multiple sclerosis by level of disability: a review of literature. Mult Scler J 2005; 11:232-239.

4. Bettencourt A, Leal B, Ferreira M, Carvalho C, Moreira I, Santos E, et al. Depression symptoms in multiple sclerosis patients: the role of IL1B. J Neurol Sci 2017; 381(Supplement):242.

5. Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS, et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review. Mult Scler J 2015; 21:305-317.

6. Benedetti F, Bernasconi A, Pontiggia A. Depression and neurological disorders. Curr Opin Psychiatry 2006; 19:14-18.

7. Benito-Leon J, Morales JM, Rivera-Navarro J, Mitchell AJ. A review about the impact of multiple sclerosis on health-related quality of life. Disabil Rehabil 2003; 25:1291-1303.

8. McCabe MP, McKern S. Quality of life and multiple sclerosis: comparison between people with multiple sclerosis and people from the general population. J Clin Psychol Med Settings 2002; 9:287-295.

9. Hermann B, Vickrey B, Hays R, Cramer J, Devinsky O, Meador K, et al. A comparison of health-related quality of life in patients with epilepsy, diabetes and multiple sclerosis. Epilepsy Res 1996; 25:113-118.

10. Papuc E, Stelmasiak Z. Factors predicting quality of life in a group of Polish subjects with multiple sclerosis: accounting for functional state, socio-demographic and clinical factors. Clin Neurol Neurosurg 2012; 114:341-346.

11. Skevington SM, Lotfy M, O’Connell KA. The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial, a report from the WHOQOL group. Qual Life Res 2004; 13:299-310.

12. Dorstyn DS, Roberts RM, Murphy G, Haub R. Employment and multiple sclerosis: a meta-analytic review of psychological correlates. J Health Psychol 2019; 24:38-51.

13. Lysandropoulos AP, Havrdova E. ‘Hidden’ factors influencing quality of life in patients with multiple sclerosis. Eur J Neurol 2015; 22(Suppl.2):28-33.

14. Mikula P, Nagyova I, Krokavcova M, Vitkova M, Rosenberger J, Szilasiova J, et al. Self-esteem, social participation, and quality of life in patients with multiple sclerosis. J Health Psychol 2017; 22:984-992.

15. Mikula P, Nagyova I, Krokavcova M, Vitkova M, Rosenberger J, Szilasiova J, et al. Do coping strategies mediate the association between Type D personality and quality of life among people with multiple sclerosis? J Health Psychol 2018; 23:1557-1565.

16. Motl RW, McAuley E, Wynn D, Sandroff B, Suh Y. Physical activity, self-efficacy, and health-related quality of life in persons with multiple sclerosis: analysis of associations between individual-level changes over one year. Qual Life Res 2013; 22:253-261.

17. Yamout B, Issa Z, Herlopian A,El Bejjani M, Khalifa A, Ghadieh AS, et al. Predictors of quality of life among multiple sclerosis patients: a comprehensive analysis. Eur J Neurol 2013; 20:756-764.

18. Benedict RH, Wahlig E, Bakshi R, Fishman I, Munschauer F, Zivadinov R, et al. Predicting quality of life in multiple sclerosis:accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change. J Neurol Sci 2005; 231:29-34.

19. Berrigan LI, Fisk JD, Patten SB, Tremlett H, Wolfson C, Warren S, et al; CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis (ECoMS). Health-related quality of life in multiple sclerosis: direct and indirect effects of comorbidity. Neurology 2016; 86:1417-1424.

20. D’Alisa S, Miscio G, Baudo S, Simone A, Tesio L, Mauro A. Depression is the main determinant of quality of life in multiple sclerosis: a classification-regression (CART) study. Disabil Rehabil 2006; 28:307-314.

21. Fernandez-Jimenez E, Arnett PA. Impact of neurological impairment, depression, cognitive function and coping on quality of life of people with multiple sclerosis: a relative importance analysis. Mult Scler 2015; 21:1468-1472.

22. Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive Therapy of Depression. New York: Guilford Press, 1979.

23. Charmaz K. Loss of self: A fundamental form of suffering in the chronically ill. Sociol Health Illn 1983; 5:168-195.

24. Gay MC, Vrignaud P, Garitte C, Meunier C. Predictors of depression in multiple sclerosis patients. Acta Neurol Scand 2010; 121:161-170.

25. McCabe MP. Mood and self-esteem of persons with multiple sclerosis following an exacerbation. J Psychosom Res 2005; 59:161-166.

26. McCabe MP, Di Battista J. Role of health, relationships, work and coping on adjustment among people with multiple sclerosis: a longitudinal investigation. Psychol Health Med 2004; 9:431-439.

27. Neff KD. The development and validation of a scale to measure self-compassion. Self Identity 2003; 2:223-250.

28. Neff KD. Self-compassion: an alternative conceptualization of a healthy attitude toward oneself. Self Identity 2003; 2:85-101.

29. Rosenberg M. Society and the Adolescent Self-Image. Revised Edition. Middletown CT: Wesleyan University Press; 1989.

30. Duarte C, Ferreira C, Trindade IA, Pinto-Gouveia J. Body image and college women’s quality of life: the importance of being self-compassionate. J Health Psychol 2015; 20:754-764.

31. Patten SB, Metz LM, Reimer MA. Biopsychosocial correlates of lifetime major depression in a multiple sclerosis population. Mult Scler J 2000; 6:115-120.

32. Leary MR, Tate EB, Adams CE, Batts Allen A, Hancock J. Self-compassion and reactions to unpleasant self-relevant events: the implications of treating oneself kindly. J Pers Soc Psychol 2007; 92:887-904.

33. Neff KD, Rude SS, Kirkpatrick KL. An examination of self-compassion in relation to positive psychological functioning and personality traits. J Res Pers 2007; 41:908-916.

34. Sowislo JF, Orth U. Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychol Bull 2013; 139:213-240.

35. Taylor SE, Brown JD. Illusion and well-being: a social psychological perspective on mental health. Psychol Bull 1988; 103:193-210.

36. Taylor SE, Brown JD. Positive illusions and well-being revisited: separating fact from fiction. Psychol Bull 1994; 116:21-27.

37. Baumeister RF, Smart L, Boden JM. Relation of threatened egotism to violence and aggression: the dark side of high self-esteem. Psychol Rev 1996; 103:5-33.

38. Crocker J, Luhtanen RK, Cooper ML, Bouvrette A. Contingencies of self-worth in college students: theory and measurement. J Pers Soc Psychol 2003; 85:894-908.

39. Twenge JM, Campbell WK. “Isn’t it fun to get the respect that we’re going to deserve?” narcissism, social rejection, and aggression. Pers Soc Psychol Bull 2003; 29:261-272.

40. Colvin CR, Block J. Do positive illusions foster mental health? An examination of the Taylor and Brown formulation. Psychol Bull 1994; 116:3-20.

41. John OP, Robins RW. Accuracy and bias in self-perception: Individual differences in self-enhancement and the role of narcissism. J Pers Soc Psychol 1994; 66:206-219.

42. Breines JG, Chen S. Self-compassion increases self-improvement motivation. Pers Soc Psychol Bull 2012; 38:1133-1143.

43. Pinto‐Gouveia J, Duarte C, Matos M, Fraguas S. The protective role of self‐compassion in relation to psychopathology symptoms and quality of life in chronic and in cancer patients. Clin Psychol Psychother 2014; 21:311-323.

44. Gedik Z. Self-compassion and health-promoting lifestyle behaviors in college students. Psychol Health Med 2019; 24:108-114.

45. Neff KD, Vonk R. Self‐compassion versus global self‐esteem: two different ways of relating to oneself. J Pers 2009; 77:23-50.

46. Brion JM, Leary MR, Drabkin AS. Self-compassion and reactions to serious illness: the case of HIV. J Health Psychol 2014; 19:218-229.

47. Beatus J, O’Neill JK, Townsend T, Robrecht K. The effect of a one-week retreat on self-esteem, quality of life, and functional ability for persons with multiple sclerosis. J Neurol Phys Ther 2002; 26:154-159.

48. Dlugonski D, Motl RW. Possible antecedents and consequences of self-esteem in persons with multiple sclerosis: preliminary evidence from a cross-sectional analysis. Rehabil Psychol 2012; 57:35-42.

49. Nery-Hurwit M, Yun J, Ebbeck V. Examining the roles of self-compassion and resilience on health-related quality of life for individuals with multiple sclerosis. Disabil Health J 2018; 11:256-261.

50. Kurtzke JF. Rating neurological impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS). Neurology 1983; 33:1444-1452.

51. Simeoni M, Auquier P, Fernandez O, Flachenecker P, Stecchi S, Constantinescu CS, et al; MusiQoL study group. Validation of the Multiple Sclerosis International Quality of Life questionnaire. Mult Scler 2008; 14:219-230.

52. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67:361-370.

53. Aydemir O, Guvenir T, Kuey L, Kultur S. Validity and reliability of Turkish version of Hospital Anxiety and Depression Scale. Turk J Psychiatr 1997; 8:280-287. (Turkish)

54. Cuhadaroglu F. Self-esteem in Adolescents. Master’s Thesis, Hacettepe University, Ankara, 1986. (Turkish)

55. Akin U, Akin A, Abaci R. Self-compassion scale: The study of validity and reliability. Hacet U J Educ 2007; 33:1-10.

56. Kocer E, Kocer A, Yaman, M, Eryilmaz M, Ozdem S, Boru UT. Quality of life in multiple sclerosis patients: impact of depression and physical limitations? Journal of Mood Disorders 2011; 1:63-67.

57. Boeschoten RE, Braamse AM, Beekman AT, Cuijpers P, van Oppen P, Dekker J, et al. Prevalence of depression and anxiety in multiple sclerosis: A systematic review and meta-analysis. J Neurol Sci 2017; 372:331-341.

58. Feinstein A. Multiple sclerosis and depression. Mult Scler 2011; 17:1276-1281.

59. Gold SM, Irwin MR. Depression and immunity: Inflammation and depressive symptoms in multiple sclerosis. Neurol Clin 2006; 24:507-519.

60. Diedrich A, Grant M, Hofmann SG, Hiller W, Berking M. Self-compassion as an emotion regulation strategy in major depressive disorder. Behav Res Ther 2014; 58:43-51.

61. Krieger T, Altenstein D, Baettig I, Doerig N, Holtforth MG. Self-compassion in depression: associations with depressive symptoms, rumination, and avoidance in depressed outpatients. Behav Ther 2013; 44:501-513.

62. Raes F. The effect of self-compassion on the development of depression symptoms in a non-clinical sample. Mindfulness 2011; 2:33-36.

63. Benito‐Leon J, Morales JM, Rivera‐Navarro J. Health‐related quality of life and its relationship to cognitive and emotional functioning in multiple sclerosis patients. Eur J Neurol 2002; 9:497-502.

64. Fruehwald S, Loeffler-Stastka H, Eher R, Saletu B, Baumhackl U. Depression and quality of life in multiple sclerosis. Acta Neurol Scand 2001; 104:257-261.

65. Janardhan V, Bakshi R. Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. J Neurol Sci 2002; 205:51-58.

66. Janssens AC, van Doorn PA, de Boer JB, Kalkers NF, van der Meche FG, Passchier J, et al. Anxiety and depression influence the relation between disability status and quality of life in multiple sclerosis. Mult Scler 2003; 9:397-403.

67. Patti F, Cacopardo M, Palermo F, Ciancio MR, Lopes R, Restivo D, et al. Health-related quality of life and depression in an Italian sample of multiple sclerosis patients. J Neurol Sci 2003; 211:55-62.

68. Li Wang J, Reimer MA, Metz LM, Patten SB. Major depression and quality of life in individuals with multiple sclerosis. Int J Psychiat Med 2000; 30:309-317.

69. Phillips LH, Saldias A, McCarrey A, Henry JD, Scott C, Summers F, et al. Attentional lapses, emotional regulation and quality of life in multiple sclerosis. Brit J Clin Psychol 2009; 48:101-106.

70. Wren AA, Somers TJ, Wright MA, Goetz MC, Leary MR, Fras AM, et al. Self-compassion in patients with persistent musculoskeletal pain: relationship of self-compassion to adjustment to persistent pain. J Pain Symptom Manage 2012; 43:759-770.

71. Goretti B, Portaccio E, Zipoli V, Hakiki B, Siracusa G, Sorbi S, et al. Coping strategies, psychological variables and their relationship with quality of life in multiple sclerosis. Neurol Sci 2009; 30:15-20.

72. Pham T, Jette N, Bulloch AG, Burton JM, Wiebe S, Patten SB. The prevalence of anxiety and associated factors in persons with multiple sclerosis. Mult Scler Relat Disord 2018; 19:35-39.

73. Eller LS, Rivero-Mendez M, Voss J, Chen WT, Chaiphibalsarisdi P, Iipinge S, et al. Depressive symptoms, self-esteem, HIV symptom management self-efficacy and self-compassion in people living with HIV. AIDS Care 2014; 26:795-803.