Quality of life and depression in multiple sclerosis patients: longitudinal results of the BetaPlus study

Abstract

Enhancing quality of life (QoL) is an important objective of disease-modifying therapies in multiple sclerosis (MS). Strategies to substantiate the effect on QoL and depression have been suggested, including injection devices and nursing support. This study assesses QoL and depression in MS patients treated with interferon beta-1b (IFNB-1b) and evaluates the impact of different elements of a patient support programme and of coping strategies on QoL and depression. A prospective, observational, 2-year cohort study was conducted. MS patients were eligible if they had previously switched to IFNB-1b. Data were collected every 6 months. For the measurement of QoL the Functional Assessment of MS (FAMS) was used. Depression symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D); coping strategies were assessed using the 66-item version of Ways of Coping Questionnaire. A total of 1,077 patients were recruited into the study. Seven hundred (65 %) patients completed the study. Within the subgroup completing questionnaires on QoL (N = 472) and depression (N = 363), QoL increased (110.4 vs. 115.8, p < 0.001), and the proportion of depressed patients decreased from 53.7 to 43.3 % (p < 0.001). Modelling QoL and depressions, the use of the autoinjector Betaject(®) over time showed a positive association with QoL (p = 0.049). The support from a nurse was positively associated with lower depressive symptoms (p = 0.039). The coping strategies 'planful problem-solving' and 'positive reappraisal' were associated with higher QoL and lower depressive symptoms. Patients on IFNB-1b treatment who were included in the patient support programme and completed the study showed an improvement in QoL. Moreover, compared to baseline the proportion of depressive patients decreased. Coping strategies as well as supportive elements such as autoinjectors and nurses had a significant impact on QoL and depression. However, the study had the general limitations of a non-controlled design.

Effect on Cognition of Estroprogestins Combined with Interferon Beta in Multiple Sclerosis: Analysis of Secondary Outcomes from a Randomised Controlled Trial

“…Consistently with previous reports, which have demonstrated a beneficial effect of IFN beta on quality of life, [28][29] we have also observed some benefit on "Change in health" of MSQoL in all treatment groups. However, we also found a decrease of the "satisfaction with sexual function" in the groups treated with estroprogestins.…”

Managing treatment fatigue in patients with multiple sclerosis on long-term therapy: the role of multiple sclerosis nurses

“…Another study assessed quality of life (QoL) and depression in 700 patients on long-term DMT (median disease duration 83.6 months) who were offered nurse support and the use of an autoinjector. The results showed that patients who used the autoinjector reported higher QoL and lower scores on a depression inventory than those who did not use the autoinjector ( P <0.05) 24. This study also found that use of an autoinjector was a strong predictor of medication adherence 25…”

Target Coping Strategies for Interventions Aimed at Maximizing Psychosocial Adjustment in People with Multiple Sclerosis

“…This strategy was a sig-cial adjustment outcomes, when individually analyzed, restraint, active, and the adaptive coping index predicted lower depressive symptoms, and restraint also predicted higher mental health QOL. Similarly, active coping has predicted lower depression in people with MS in previous research, 33 suggesting that people with MS benefit from the use of these problem-solving strategies in areas of their life that are changeable, and this should be encouraged. An interesting and unexpected finding was the negative relationship between physical health QOL and suppression coping (also considered a problem-solving strategy) because this strategy is generally considered to be an adaptive coping style.…”

“…Growth also significantly predicted lower trait anxiety in the final model of this analysis, as well as being an individual predictor of better mental health QOL. Consistent with this, growth coping has been related to lower depression in previous cross-sectional and longitudinal research with people with MS. 16,33 Growth and acceptance are intimately linked. As psychologist Carl Rogers famously wrote about personal growth attributed to acceptance, "…the curious paradox is that when I accept myself as I am, then I change."…”