Greater Sense of Life Control May Curb Depression

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by Marta Figueiredo PhD |

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Having a greater sense of control over life circumstances — a coping resource called mastery — is associated with a significantly lower risk of future depression in multiple sclerosis (MS) patients, an international study shows.

The findings suggest that developing greater mastery may prevent MS patients from developing depression, and therefore it should be a point of intervention to improve patients’ mental health, the researchers noted.

The study, “Greater mastery is associated with lower depression risk in a large international cohort of people with multiple sclerosis over 2.5 years,” was published in the journal Quality of Life Research.

“The multiple physical, emotional, and social challenges faced by people with MS (pwMS) have a significant impact on feelings of control over their lives,” the researchers wrote.

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A person’s psychological resources and characteristics, including self-esteem and mastery, can be critical for the development of coping mechanisms. Mastery is “the extent to which an individual perceives their life circumstances as being under their control and not predominantly influenced by external factors,” the researchers wrote.

While higher self-esteem has been associated with improved ability to handle challenging life situations in people with MS, there is limited data on the link between mastery and health outcomes in MS.

To address this, a team of researchers at Melbourne School of Population and Global Health, in Australia, evaluated whether mastery was associated with fatigue, disability, relapse number, and depression risk in 839 adults with MS who had been recruited online for a large international study.

Mastery, as well as clinical outcomes, were assessed through online, validated self-reported questionnaires at 2.5 and five years into the study. Participants also were asked to report the number of diagnosed relapses in the previous 12 months.

Results showed that most participants (94.5%), with a mean age of 51, completed the mastery questionnaire, with most of them being women (82.4%) and reporting between two and five support people in their lives (64.2%).

Most had relapsing-remitting MS (70.7%) and had been living with the disease for a mean of 19 years at the 5-year assessment.

After adjusting for potential influencing sociodemographic and clinical factors, mastery was significantly higher among those with postgraduate degrees, higher perceived socioeconomic status, more than six members in their social support network, and those who were physically active.

Patients with progressive MS, severe disability, clinically significant fatigue, and higher depression risk showed significantly lower mastery.

Notably, at first assessment (2.5 years), the researchers found that greater mastery was significantly associated with a lower risk of depression, fatigue, and relapses, after adjusting for influencing factors.

Particularly, compared with those with lowest mastery scores, patients with the highest levels of mastery were 90% less likely to be at risk of depression, had a 60% lower frequency of clinically significant fatigue, and were 77% less likely to report relapses in the previous 12 months. 

In addition, patients showing the highest levels of mastery had a 70% lower risk of developing depression 2.5 years later, but no other significant associations were found for future fatigue, disability, or relapse number.

These findings suggest that “developing a greater sense of mastery may prevent pwMS from developing depression,” the researchers wrote.

Patients with greater mastery may be more resilient and therefore, less at risk of becoming depressed due to the disease, or even represent a population in which the disease has a lesser impact on mood, the team hypothesized.

“Another possibility is that greater mastery could lead to an increased likelihood to engage in positive lifestyle behaviors like physical activity, cognitive training, or other social behaviors that could potentially realize the positive impacts on depression risk,” the researchers wrote.

While more studies are needed to clarify this, resilience and mastery could be increased “through mindfulness or other mental health interventions,” potentially contributing to a lower risk of developing depression, they added.

The team also noted that future research should assess potential associations between self-efficacy and clinical outcomes. Self-efficacy refers to a person’s belief and confidence in their ability to successfully perform a given activity to attain a certain goal.

“While we believe that sense of self-control is important in coping for people with MS and thence to potentially have effects on aspects of mood and clinical progression, certainly for depression as an outcome, the other elements included in self-efficacy could be important as well,” the researchers wrote.

“Moreover, mastery and self-efficacy would likely relate and so greater mastery could improve self-efficacy, as has been demonstrated in other settings,” they added.

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