Actively ‘Coping’ With Daily Stress of MS Tied to Better Life Quality

Patricia Inacio, PhD avatar

by Patricia Inacio, PhD |

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Actively taking steps to cope with the chronic stress of multiple sclerosis (MS) — from keeping a sense of humor to seeking emotional and tangible support — can help to improve patients’ quality of life, a small questionnaire-based study from Poland suggests.

The study, “The Role of Stress Perception and Coping with Stress and the Quality of Life Among Multiple Sclerosis Patients,” was published in the journal Psychology Research and Behavior Management.

Quality of life can be poorer in people with MS relative to their healthy peers, given chronic symptoms that range from fatigue, pain, cognitive issues, and stress. Previous studies, the researchers noted, report high levels of stress in people with this disease relative to the general population, and that most patients consider stress a factor in disease worsening.

As such, adequate stress management strategies can benefit patient well-being, both physically and psychologically. However, it is important to identify and understand factors that induce stress and successful coping mechanisms.

A group of researchers at Wroclaw Medical University recruited 109 adults with relapsing-remitting MS (RRMS) undergoing treatment with a disease-modifying therapy (DMT) to take part in a questionnaire-based study.

Patients were asked to answer questions concerning their clinical history, and demographic details such as age, gender, education, and place of residence. Self-reported stress levels were assessed using the Polish version of the Perceived Stress Scale (PSS-10), in which higher scores indicate greater stress.

Their stress-coping strategies were evaluated using a Polish version of the Inventory for Measuring Coping with Stress (Mini-COPE), and quality of life using the Multiple Sclerosis International Quality of Life Questionnaire (MusiQoL). MusiQoL is specifically designed to evaluate quality of life in MS patients, with 31 items that focus on the multiple disease dimensions, and whose scores range from zero to 100 (higher scores indicate better quality of life).

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Among the 109 patients (mean age, 37.45), 70 were women (64.22%) and around a third had attended a university or held a degree (38 patients, 34.86%). While they had been living with MS for a mean of 9.63 years, most (54.12% or 59 people) had been under treatment with a disease-modifying therapy for four or fewer years.

A majority of these people, 68.81%, were aware of MS support groups, but only 27.52% participated in such groups.

The questionnaires revealed high levels of stress reported by nearly half — 47.71% — of this patient group, while 17.43% reported moderate stress levels, and 34.86% felt their level of stress to be low.

Higher stress levels were more frequently reported by divorced or widowed patients (a score of 24.77) compared with single patients (18.38) and those who were married (17.03). Patients currently working also perceived stress as less severe (score of 18.27) than those who were not working (22.21).

The most common stress coping strategies identified were seeking emotional support and active coping. Religion and substance use were the least used coping mechanisms.

As patients grew older with this disease, they tended more frequently to adopt positive thinking, to rely on sense of humor, and to seek instrumental support (tangible support from others) as coping strategies, the study reported.

But “individuals with primary, lower secondary, and vocational education are considerably more likely than those with higher education to turn to substance use … [and] professionally inactive individuals were significantly more likely to employ sense of humor, denial, venting, substance use, behavioral disengagement, and self-blame as stress coping strategies” than active patients, the researchers noted.

As time since diagnosis lengthened, these people were less likely to follow a set coping plan, but those with longer active treatment were more likely to hold to positive thinking and a sense of humor, and to seek tangible support.

Women, significantly more often than men, used positive thinking and planning, and turned to religion, sought out support and found ways to distract themselves and vent as coping strategies, results showed. Married patients were also significantly more likely to use positive thinking and seek emotional support than were those who never married or were no longer in a marriage.

The overall MusiQol score was 65.39 points (range, 27.43 to 96.18). Men reported significantly higher (better) scores compared with women on psychological well-being (64.9 vs. 50.45) and coping (62.18 vs. 45.89).

Data also showed that older age correlated with a perceived lower quality of life, while employment was associated with a better life quality.

Patients living in larger cities had significantly higher quality of life scores than those in rural areas, in terms of relationships with friends (88.1 vs. 69.3), relationships with family (77.68 vs. 66.67), their  satisfaction with the healthcare system (70.83 vs. 62.5), and their views of their sentimental and sexual life (69.64 vs. 42.5).

A longer time since disease diagnosis was associated higher quality of life in terms of being better able to cope with rejection, but lower scores in terms of symptoms and relationships with friends. Longer time on a “drug program” also helped in accepting rejection.

Results from these three surveys associated a better quality of life to more frequent engagement in active coping, and in seeking emotional or tangible support, the study found.

“Quality of life in MS patients is negatively affected by a higher level of perceived stress,” the researchers wrote, but “the use of coping strategies such as active coping, positive reframing, acceptance, and seeking emotional and instrumental support is positively correlated with the quality of life of MS patients.”

In contrast, “coping strategies such as sense of humor, turning to religion, self-distraction, denial, venting, substance use, behavioral disengagement, and self-blame are negatively correlated” with life quality, they added.

As such, the researchers suggested that “healthcare providers, especially nursing staff, should support the patient in developing the ability to cope with stress.”