Psychological resilience found to link relapse fear, life quality in MS

A patient’s ability to cope with and recover from adversity — called psychological resilience — was found to impact the observed relationship between fear of relapse and life quality among people with multiple sclerosis (MS) in a new study.

Essentially, MS patients who had a greater fear of future disease relapses proved to be less resilient, which in turn was associated with worse life quality, the study found.

“On the other hand,” the scientists wrote, “our results confirm that psychological resilience is a positive predictor of quality of life in [people with] MS.”

These findings indicate that interventions to boost psychological resilience could help improve MS patients’ well-being and minimize the negative impacts that a fear of relapse can confer, according to the researchers.

The study, “Fear of relapse and quality of life in multiple sclerosis: The mediating role of psychological resilience,” was published in Multiple Sclerosis and Related Disorders.

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Investigating the impact of relapse fear in MS

The array of symptoms that characterize MS — fatigue, stiffness, mobility problems, cognitive difficulties, sexual dysfunction, and mood disorders, among others — can have significant negative impacts on patients’ life quality.

Having a relapse, or a flare when symptoms suddenly get worse, can exacerbate this negative influence.

“Recently, it has also been suggested that not only does experiencing a relapse have a negative impact on the quality of life in PwMS [people with MS], but the expectation of a relapse itself is also a factor that undermines the perceived quality of life in PwMS,” the researchers wrote.

Indeed, the development in 2020 of a questionnaire to assess relapse fear, called the Fear of Relapse Scale, enabled scientists to demonstrate that MS patients with a higher fear of future relapse had a significantly lower life quality.

On the other hand, psychological resilience — which involves optimism, self-esteem, and a feeling of being in control and able — is thought to be one factor that might help preserve life quality.

This ability to cope with and recover quickly from problems and difficulties has been directly associated with outcomes related to better life quality, but has also shown an ability to buffer against the negative impacts of symptoms like pain and fatigue.

While the degree of psychological resilience in an MS patient may mediate, or influence, the relationship between relapse fear and life quality declines, there is a lack of research investigating this possibility.

To know more, a team of researchers in Argentina and Cuba conducted an online survey between August and November 2021, meant for Spanish-speaking adults, ages 18-75, diagnosed with MS.

The study was part of a larger project dubbed ME-POSITIVE, for Positive modulatory variables of perceived quality of life in patients with multiple sclerosis.

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A total of 240 MS patients in Spain and Central and South America completed the survey, which included the Fear of Relapse Scale, the Connor-Davidson Resilience Scale, and the Multiple Sclerosis Quality of Life inventory.

Patients had a mean age of 40.6, most were women (80%), and about three-quarters (74.6%) were diagnosed with relapsing-remitting MS. More than half (55.8 %) had a university-level degree; fewer than half (42.1%) were married.

The results showed an inverse relationship between fear of relapse and life quality, with greater fear being significantly linked to reduced quality of life. There also was a positive, significant relationship between resilience and life quality, in which a greater degree of resilience predicted better life quality.

Importantly, a greater fear of relapse was significantly associated with lower psychological resilience, “verifying that as fear of relapse increased, resilience decreased and vice versa,” the researchers wrote.

Additional analyses indicated that resilience played a significant, mediating role in the relationship between fear of relapse and life quality. In other words, fearing relapses was linked to lower psychological resilience, which in turn had a negative effect on life quality.

“The results of this study offer evidence on the importance of resilience as a mediating factor of quality of life in patients with multiple sclerosis,” the researchers wrote, adding that “psychological resilience could be interacting with other variables such as controllability, reducing anxiety related to anticipating a new relapse of the disease.”

Considering that resilience is a modifiable variable, the implementation of interventions aimed at enhancing resilience can have a favorable impact on the psychological well-being of patients with multiple sclerosis.

The scientists said their findings highlight the important of finding strategies to help MS patients improve their resilience.

“Considering that resilience is a modifiable variable, the implementation of interventions aimed at enhancing resilience can have a favorable impact on the psychological well-being of patients with multiple sclerosis,” the team wrote.

Among the study’s caveats, the team noted that other factors which could influence life quality, such as fatigue, depression, or anxiety, were not evaluated.

Future studies should take into account other influential clinical factors and examine whether MS type has an impact on the observed relationships, according to the scientists.