Hopelessness in Patients with Early-Stage Relapsing-Remitting Multiple Sclerosis

Abstract

Background Hopelessness is a risk factor for depression and suicide. There is little information on this phenomenon among patients with relapsing-remitting multiple sclerosis (RRMS), one of the most common causes of disability and loss of autonomy in young adults. The aim of this study was to assess state hopelessness and its associated factors in early-stage RRMS. Methods A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0–5.5 were included. The State-Trait Hopelessness Scale (STHS) was used to measure patients´ hopelessness. A battery of patient-reported and clinician-rated measurements was used to assess clinical status. A multivariate logistic regression analysis was conducted to determine the association between patients’ characteristics and state hopelessness. Results A total of 189 patients were included. Mean age (standard deviation-SD) was 36.1 (9.4) years and 71.4% were female. Median disease duration (interquartile range-IQR) was 1.4 (0.7, 2.1) years. Symptom severity and disability were low with a median EDSS (IQR) score of 1.0 (0, 2.0). A proportion of 65.6% (n=124) of patients reported moderate-to-severe hopelessness. Hopelessness was associated with older age (p=0.035), depressive symptoms (p=<0.001), a threatening illness perception (p=0.001), and psychological and cognitive barriers to workplace performance (p=0.029) in the multivariate analysis after adjustment for confounders. Conclusion Hopelessness was a common phenomenon in early-stage RRMS, even in a population with low physical disability. Identifying factors associated with hopelessness may be critical for implementing preventive strategies helping patients to adapt to the new situation and cope with the disease in the long term.

A new framework for understanding stress and disease: the developmental model of stress as applied to multiple sclerosis

“…Diagnosis dramatically increases rates of depression and anxiety in people with MS from a rate that was already much higher than the general population ( Hoang et al, 2016 ). Approximately two-thirds of people recently diagnosed with MS are likely to experience hopelessness ( Sainz de la Maza et al, 2023 ), and this prevalence increases as the disease progresses ( Patten and Metz, 2002 ). Hopelessness is independently associated with poorer ability to cope with the disease and a lower quality of life ( Patten and Metz, 2002 ).…”

Assessing illness-related uncertainty in relapsing-remitting multiple sclerosis: A psychometric analysis of the Mishel Uncertainty of Illness Scale

“… 2 – 4 Uncertainty about prognosis was associated with symptom severity, anxiety, depression, and low quality of life. 3 – 6 …”

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“…Diagnosis dramatically increases rates of depression and anxiety in people with MS from a rate that was already much higher than the general population (Hoang et al, 2016). Approximately two-thirds of people recently diagnosed with MS are likely to experience hopelessness (Sainz de la Maza et al, 2023), and this prevalence increases as the disease progresses (Patten and Metz, 2002). Hopelessness is independently associated with poorer ability to cope with the disease and a lower quality of life (Patten and Metz, 2002).…”