Coping Strategies Can Improve Quality of Life, Physical Disability in People With MS

Coping strategies can play a role in improving the health-related quality of life (HRQOL) and physical disability of people with multiple sclerosis (MS), researchers concluded in a recent study published in Journal of Clinical Medicine.

The cross-sectional retrospective study was the first to investigate the strategies utilized by patients after receiving an MS diagnosis as a core stressor and to consider the focus (approach vs avoidance) and methods (cognitive vs behavioral) associated with those strategies. It was also the first to analyze the impact of the strategies on physical disability and HRQOL of people with MS (pwMS).

“These findings support the importance of coping-based interventions from the very beginning of the disease for pwMS…with the aim of increasing adaptive coping strategies and decreasing maladaptive coping strategies….Coping strategies should be carefully considered in pwMS since the time of diagnosis to encourage their active disease adjustment to MS disease and promote better clinical outcomes,” wrote the investigators.

Physical disability and cognitive impairment as a result of MS can lead to psychological distress, which may manifest as substantial limitations of daily life activities and compromise HRQOL. The ability to adapt and cope is critical for adjusting to the demands of MS.

Coping strategies are defined as the cognitive and behavioral efforts made to manage the internal and/or external demands that patients face. Active coping strategies can be adaptive, which help to overcome stress and return a patient to a healthy or desired state, or avoidant, such as denial and behavioral or mental disengagement.

Poor coping strategies could influence a patient’s ability to manage MS-related pain, adherence to treatments, and promotion of self-care activities. Adaptive coping strategies may be helpful for patients’ synergy with medical approaches to MS regarding early acute phase management and delay of disability progression. However, there are few studies focusing on assessing coping strategies used by pwMS when facing stressors related to MS diagnosis, and those that do exist have produced conflicting results.

Overall, 108 patients with relapsing-remitting MS were included in the study, 84 of whom were female. The patients had to have an absence of concomitant neurologic or other pathologic health conditions, major psychiatric disorders, substance abuse, and severe cognitive impairment. The mean (SD) age of the participants was 38.1 (10.6) years, the mean (SD) education was 14.3 (3.2) years, the mean (SD) disease duration was 6.35 (6.6) years, and the median Expanded Disability Status Scale (EDSS) score was 1.5. The patients were asked to complete several forms to measure their use of coping strategies and their impacts on different aspects of HRQOL.

The first regression model measuring physical HRQOL addressed first-order correlations, problem solving, cognitive avoidance, resigned acceptance, alternative rewards, and emotional discharge coping strategies. The model explained 51.0% of the variance, with disease duration, EDSS scores, and general distress accounting for 37.8% of the variance (P < .001) and coping strategies of resigned acceptance and alternative rewards explaining an additional 13.2% of the variance in physical health (P < .001).

To understand the impact on mental health, the investigators included problem solving, cognitive avoidance, resigned acceptance, and emotional discharge subscales into the model, finding that the model explained 47.9% of the variance in mental health and 39.3% of the variance in disease duration, EDSS, and general distress. The inclusion of the coping strategies explained an additional 8.6% of the variance. The investigators said that the results revealed that problem solving and emotional discharge strategies were significantly associated with mental health.

Disease duration and scores for the Depression Anxiety Stress Scale-21 were added to the model for analyzing coping strategies as predictors of physical disability. The overall model explained 28.7% of the variance of the EDSS scores. Disease duration and general distress were significantly associated with EDSS scores and explained 12.0% of the variance in scores (P = .001). Including coping strategies explained an additional 16.9% of the variance (P < .001) and controlling for disease duration and general distress revealed that positive reappraisal was significantly associated with EDSS scores.

The investigators listed the cross-sectional nature of the study, the long recall period, and the exclusion of patients with significant cognitive impairment as study limitations.

Reference

Cerea S, Ghisi M, Pitteri M, et al. Coping strategies and their impact on quality of life and physical disability of people with multiple sclerosis. J Clin Med. 2021;10(23):5607. doi:10.3390/jcm10235607