Attributional Style and Depression in Multiple Sclerosis

Abstract

Several etiologic theories have been proposed to explain depression in the general population. Studying these models and modifying them for use in the multiple sclerosis (MS) population may allow us to better understand depression in MS. According to the reformulated learned helplessness (LH) theory, individuals who attribute negative events to internal, stable, and global causes are more vulnerable to depression. This study differentiated attributional style that was or was not related to MS in 52 patients with MS to test the LH theory in this population and to determine possible differences between illness-related and non-illness-related attributions. Patients were administered measures of attributional style, daily stressors, disability, and depressive symptoms. Participants were more likely to list non-MS-related than MS-related causes of negative events on the Attributional Style Questionnaire (ASQ), and more-disabled participants listed significantly more MSrelated causes than did less-disabled individuals. Non-MS-related attributional style correlated with stress and depressive symptoms, but MS-related attributional style did not correlate with disability or depressive symptoms. Stress mediated the effect of non-MS-related attributional style on depressive symptoms. These results suggest that, although attributional style appears to be an important construct in MS, it does not seem to be related directly to depressive symptoms; rather, it is related to more perceived stress, which in turn is related to increased depressive symptoms. Int J MS Care. 2013;15:81-89. Multiple sclerosis (MS) is a chronic, unpredictable, and degenerative disease that causes a variety of symptoms affecting patients' quality of life. The disease course is highly variable, its outcome is hard to predict, and there is no known cure. Depression is extremely common in MS, with an estimated lifetime prevalence of up to 50%.1 This prevalence rate is higher than that found in the general population and in people with most other chronic diseases. 2,3However, the etiology of depression in people with MS remains unclear.Although biological, psychological, and social factors are thought to be involved in depression in MS, individually they show weak or inconsistent relationships. For instance, although some studies show that a combination of the most robust neuropathology measures explains 43% of the variance in depression in MS, 4 other studies have not found strong relationships between neuropathology and depression. Furthermore, MS symptoms such as physical disability, pain, and cognitive dysfunction also demonstrate inconsistent or weak relationships with depression.5 Therefore, interaction among biological, psychological, and social factors seems most likely to predict depressive symptoms in these patients. However, the most conducive combination of factors and the nature of the possible interactions are still unknown. Adapting models of depression used in the general population to MS may improve our understanding of these complex inter...

Characterizing the phenotype of multiple sclerosis–associated depression in comparison with idiopathic major depression

“…On a conceptual level, our results from the CFA extend the findings from a recent report that neurovegetative symptoms are poor indicators of depression in MS. 32 Moreover, our findings are in line with an empirical exploration of attributional style and learned helplessness in MS-depression, where MS patients more likely listed non-MS-related than MS-related causes of negative events. 33 Our results now integrate such findings into a larger conceptual framework to indicate that while vegetative symptoms are frequently correlated with depression, they have little impact on the underlying construct of depression, which is indistinguishable in depressed patients with or without a neurological disorder such as MS.…”

A Longitudinal Examination of the Hopelessness Theory of Depression in People Who Have Multiple Sclerosis

“…On this account, the reformulated theory of learned helplessness would appear particularly applicable to people with this condition. Two studies [ 5 , 6 ] have considered the application of this theory of depression [ 4 ] to people with MS, demonstrating that stress interacts with attributional style to explain significant depressive symptoms. Kneebone and Dunmore [ 5 ] found global attributional style which interacted with negative events including life stressors and the time since last symptom exacerbation, to explain significant amounts of depression.…”

“…Kneebone and Dunmore [ 5 ] found global attributional style which interacted with negative events including life stressors and the time since last symptom exacerbation, to explain significant amounts of depression. More recently, another study found that stress, operationalised as daily hassles, mediated the relationship between attributional style and depression [ 6 ]. Unfortunately, a major limitation with these studies is that the support for the relationship has only been based on cross-sectional data.…”