Coping strategies in relapsing–remitting multiple sclerosis non-depressed patients and their associations with disease activity
Abstract
Few studies evaluated coping strategies in people with multiple sclerosis (pwMS) in relation to annualized relapse rate (ARR) and lesion load (LL). Overall, results might have been influenced by the inclusion of depressed patients. To investigate the coping strategies and their association to disease activity, we studied relapsing-remitting pwMS accurately selected to avoid the confounding effect of depression. Sixty-seven relapsing-remitting pwMS and 67 healthy subjects (HS) underwent to Coping Orientation to Problems Experienced (I-COPE) and Coping Inventory for Stressful Situation (CISS) and Beck Depression Inventory-II. Cognitive performances, ARR, physical disability and magnetic resonance imaging T2-LL were assessed for correlation with coping and depression scores. pwMS showed lower scores than HSs on social support and turning to religion subscales of I-COPE and on emotion dimension of CISS. In pwMS, higher ARR was related to higher positive attitude and lower score on the turning to religion subscale of I-COPE. The present study revealed a less employment of emotion-based coping strategies in pwMS. A scarce use of faith for support and a frequent adoption of a positive attitude were associated with an increase of MS activity in terms of ARR.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Most studies have focused on habitual ways to manage stressors but not on specific multiple sclerosis-related stressors such as diagnosis.
“most studies have focused on habitual ways to manage stressors [24,25] but not on specific MS-related stressors (e.g., diagnosis, impact of early intensive treatment).”
From Coping strategies and their impact on quality of life and physical disability of people with multiple sclerosis (2021) · cites this paper as [24]
Cites
Eysenck, H. J. (1985) · Behaviour Research and Therapy · doi:10.1016/0005-7967(85)90087-7 · Cited by 32,026 · see citing works
“Stress: appraisal and coping,”
Folkman, S. (2013) · Encyclopedia of Behavioral Medicine · doi:10.1007/978-1-4419-1005-9_215 · Cited by 27,833 · see citing works
Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS)
Kurtzke, J. F. (1983) · Neurology · doi:10.1212/wnl.33.11.1444 · Cited by 15,011 · see citing works
Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria
Polman, C. H., Reingold, S. C., Banwell, B., Clanet, M., Cohen, J. A., Filippi, M., Fujihara, K., Havrdova, E., Hutchinson, M., Kappos, L., et al. (2011) · Annals of Neurology · doi:10.1002/ana.22366 · Cited by 9,802 · see citing works
Cognitive dysfunction in multiple sclerosis.
Rao, S. M., Leo, G. J., Bernardin, L., & Unverzagt, F. W. (1991) · Neurology · doi:10.1212/wnl.41.5.685 · Cited by 2,136 · see citing works
Does positive affect influence health?
Pressman, S. D., & Cohen, S. (2005) · Psychological Bulletin · doi:10.1037/0033-2909.131.6.925 · Cited by 2,087 · see citing works
Emotional states and physical health.
Salovey, P., Rothman, A. J., Detweiler, J. B., & Steward, W. T. (2000) · American Psychologist · doi:10.1037//0003-066x.55.1.110 · Cited by 864 · see citing works
Effects of stress on the immune system
Khansari, D. N., Murgo, A. J., & Faith, R. E. (1990) · Immunology Today · doi:10.1016/0167-5699(90)90069-l · Cited by 664 · see citing works
Emotional states and physical health.
Salovey, P., Rothman, A. J., Detweiler, J. B., et al. (2000) · American Psychologist · doi:10.1037/0003-066x.55.1.110 · Cited by 638 · see citing works
Calabrese, M., Agosta, F., Rinaldi, F., Mattisi, I., Grossi, P., Favaretto, A., Atzori, M., Bernardi, V., Barachino, L., Rinaldi, L., et al. (2009) · Archives of Neurology · doi:10.1001/archneurol.2009.174 · Cited by 556 · see citing works
Religion, Spirituality, and Medicine: Research Findings and Implications for Clinical Practice
Koenig, H. G. (2004) · Southern Medical Journal · doi:10.1097/01.smj.0000146489.21837.ce · Cited by 444 · see citing works
Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis
Mohr, D. C., Hart, S. L., Julian, L., Cox, D., & Pelletier, D. (2004) · BMJ · doi:10.1136/bmj.38041.724421.55 · Cited by 401 · see citing works
Some Aspects of the Natural History of Disseminated Sclerosis
McAlpine, D., & Compston, N. (1952) · QJM · doi:10.1093/qjmed/21.2.135 · Cited by 237 · see citing works
Maes, S., Leventhal, H., & de Ridder, D. T. D. (1996) · Cited by 220 · see citing works
LYNCH, S. G., Kroencke, D. C., & Denney, D. R. (2001) · Multiple Sclerosis Journal · doi:10.1177/135245850100700611 · Cited by 190 · see citing works
Disease activity and emotional state in multiple sclerosis
Dalos, N. P., Rabins, P. V., Brooks, B. R., & O'Donnell, P. V. (1983) · Annals of Neurology · doi:10.1002/ana.410130517 · Cited by 183 · see citing works
Self reported stressful life events and exacerbations in multiple sclerosis:prospective study
Buljevac, D., Hop, W. C. J., Reedeker, W., Janssens, A. C. J. W., van der Meché, F. G. A., van Doorn, P. A., & Hintzen, R. Q. (2003) · BMJ · doi:10.1136/bmj.327.7416.646 · Cited by 162 · see citing works
Sica, C., Magni, C., Ghisi, M., Altoè, G., Sighinolfi, C., Chiri, L. R., & Franceschini, S. (2008) · Padua Research Archive (University of Padova) · Cited by 146 · see citing works
Psychometric properties and validity of Beck Depression Inventory II in multiple sclerosis
Sacco, R., Santangelo, G., Stamenova, S., Bisecco, A., Bonavita, S., Lavorgna, L., Trojano, L., d’Ambrosio, A., Tedeschi, G., & Gallo, A. (2016) · European Journal of Neurology · doi:10.1111/ene.12932 · Cited by 140 · see citing works
Relationship Between Coping, Cognitive Dysfunction and Depression in Multiple Sclerosis
Arnett, P. A., Higginson, C. I., Voss, W. D., Randolph, J. J., & Grandey, A. A. (2002) · The Clinical Neuropsychologist · doi:10.1076/clin.16.3.341.13852 · Cited by 135 · see citing works
Depression, coping and level of neurological impairment in multiple sclerosis
Mohr, D. C., Goodkin, D. E., Gatto, N. M., & Wende, J. V. D. (1997) · Multiple Sclerosis Journal · doi:10.1177/135245859700300408 · Cited by 130 · see citing works
Stressor-Induced Alteration of Cytokine Production in Multiple Sclerosis Patients and Controls
Ackerman, K. D., Martino, M., Heyman, R. A., Moyna, N. M., & Rabin, B. S. (1998) · Psychosomatic Medicine · doi:10.1097/00006842-199807000-00016 · Cited by 124 · see citing works
Emotional stress and coping in multiple sclerosis (MS) exacerbations
Warren, S., Warren, K. G., & Cockerill, R. W. (1991) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(91)90005-9 · Cited by 124 · see citing works
AN INVESTIGATION OF THE PSYCHIATRIC ASPECTS OF DISSEMINATED SCLEROSIS
Pratt, R. T. C. (1951) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.14.4.326 · Cited by 102 · see citing works
Goretti, B., Portaccio, E., Zipoli, V., Razzolini, L., & Amato, M. P. (2010) · Neurological Sciences · doi:10.1007/s10072-010-0372-8 · Cited by 96 · see citing works
Mohr, D., Goodkin, D. E., Nelson, S., Cox, D., & Weiner, M. (2002) · Psychosomatic Medicine · doi:10.1097/01.psy.0000024238.11538.ec · Cited by 85 · see citing works
Coping, treatment planning, and treatment outcome: Discussion
Beutler, L. E., Moos, R. H., & Lane, G. W. (2003) · Journal of Clinical Psychology · doi:10.1002/jclp.10216 · Cited by 82 · see citing works
Relationship between stress and relapse in multiple sclerosis: part I. Important features
Brown, R. F., Tennant, C. C., Sharrock, M., Hodgkinson, S. J., Dunn, S. M., & Pollard, J. D. (2006) · Multiple Sclerosis Journal · doi:10.1191/1352458506ms1295oa · Cited by 81 · see citing works
Brown, R. F., Tennant, C. C., Sharrock, M., Hodgkinson, S. J., Dunn, S. M., & Pollard, J. D. (2006) · Multiple Sclerosis Journal · doi:10.1191/1352458506ms1296oa · Cited by 76 · see citing works
Coping with multiple sclerosis: a 5-year follow-up study
Lode, K., Bru, E., Klevan, G., Myhr, K. M., Nyland, H., & Larsen, J. P. (2009) · Acta Neurologica Scandinavica · doi:10.1111/j.1600-0404.2009.01313.x · Cited by 59 · see citing works
Impact of Cognitive Impairment on Coping Strategies in Multiple Sclerosis
Goretti, B., Portaccio, E., Zipoli, V., Hakiki, B., Siracusa, G., Sorbi, S., & Amato, M. P. (2010) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2009.10.019 · Cited by 58 · see citing works
Jean, V. M., Beatty, W., Paul, R. H., & Mullins, L. (1997) · Multiple Sclerosis · doi:10.1177/135245859700300304 · Cited by 55 · see citing works
Stress and coping in multiple sclerosis: exacerbation, remission and chronic subgroups
Kroencke, D. C., & Denney, D. R. (1999) · Multiple Sclerosis Journal · doi:10.1177/135245859900500204 · Cited by 52 · see citing works
A Correlational Study of Disabilities, Stressors and Coping Methods in Victims of Multiple Sclerosis
Buelow, J. M. (1991) · Journal of Neuroscience Nursing · doi:10.1097/01376517-199108000-00012 · Cited by 48 · see citing works
Quality of life and coping strategies in Lebanese multiple sclerosis patients: a pilot study
Farran, N., Ammar, D., & Darwish, H. (2016) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2015.12.003 · Cited by 42 · see citing works
Mood and coping in clinically isolated syndrome and multiple sclerosis
Bianchi, V., Giglio, L. D., Prosperini, L., Mancinelli, C. R., Angelis, F. D., Barletta, V. T., & Pozzilli, C. (2013) · Acta Neurologica Scandinavica · doi:10.1111/ane.12194 · Cited by 29 · see citing works
Somer, E., Golan, D., Dishon, S., Cuzin-Disegni, L., Lavi, I., & Miller, A. (2010) · Multiple Sclerosis · doi:10.1177/1352458509358714 · Cited by 26 · see citing works
Multiple sclerosis and demyelinating diseases
Freedman, M. S. (2006) · Cited by 25 · see citing works
Emotional stress in relation to attacks of multiple sclerosis.
Rm, B., & Dj, S. (1950) · PubMed · Cited by 22 · see citing works
Coping Strategies in Multiple Sclerosis Patients with Frontal Cognitive Disorders
Montel, S., Spitz, É., & Bungener, C. (2012) · European Neurology · doi:10.1159/000337905 · Cited by 17 · see citing works
Development and validation of the coping with multiple sclerosis questionnaire
Dehghani, A., Nayeri, N. D., & Ebadi, A. (2017) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2017.09.007 · Cited by 10 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
COVID‐19 pandemic and mental distress in multiple sclerosis: Implications for clinical management
Costabile, T., Carotenuto, A., Lavorgna, L., Borriello, G., Moiola, L., Inglese, M., Petruzzo, M., Trojsi, F., Ianniello, A., Nozzolillo, A., et al. (2020) · European Journal of Neurology · doi:10.1111/ene.14580 · Cited by 60 · see citing works
“People with MS adopt different coping strategies according to their level of disease activity and disability [12,13] and, while no coping strategy is, per se, maladaptive, a specific strategy might prove more effective than others to counterbalance mental distress.”
BackgroundKoffman, J., Penfold, C., Cottrell, L., Farsides, B., Evans, C., Burman, R., Nicholas, R. S., Ashford, S. A., & Silber, E. (2022) · PLoS ONE · doi:10.1371/journal.pone.0265861 · Cited by 27 · see citing works
Cerea, S., Ghisi, M., Pitteri, M., Guandalini, M., Strober, L. B., Scozzari, S., Crescenzo, F., & Calabrese, M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10235607 · Cited by 24 · see citing works
“Although coping strategies and their relationship with HRQoL have been widely assessed in pwMS, most studies have focused on habitual ways to manage stressors [24,25] but not on specific MS-related stressors (e.”
BackgroundLandi, D., Ponzano, M., Nicoletti, C. G., Cecchi, G., Cola, G., Mataluni, G., Mercuri, N. B., Sormani, M. P., & Marfia, G. A. (2020) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2020.102359 · Cited by 22 · see citing works
Altunan, B., Ünal, A., Bingöl, A., Dilek, F., & Girgin, D. (2021) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2021.103039 · Cited by 21 · see citing works
Th17-cells in depression: Implication in multiple sclerosis
Melnikov, M., & Lopatina, A. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.1010304 · Cited by 19 · see citing works
Coping with multiple sclerosis: reconciling significant aspects of health-related quality of life
Gil-González, I., Rodríguez, A. M., Conrad, R., & Pérez-San-Gregorio, M. Á. (2022) · Psychology Health & Medicine · doi:10.1080/13548506.2022.2077395 · Cited by 10 · see citing works
Bahmani, B., Mehraban, S., Contentti, E. C., Azkhosh, M., Khanjani, M. S., & Azimian, M. (2022) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2022.104163 · Cited by 8 · see citing works
Pain, quality of life, and religiosity in people with multiple sclerosis
Sparaco, M., Miele, G., Abbadessa, G., Ippolito, D., Trojsi, F., Lavorgna, L., & Bonavita, S. (2021) · Neurological Sciences · doi:10.1007/s10072-021-05759-1 · Cited by 7 · see citing works
“[9] did not find any association between the adoption of turning to religion strategy (a coping strategy) and demographic or clinical–radiological aspects of MS, including depression (assessed with the Beck depression inventory).”
BackgroundMethodCoping Strategies Furthering Post-Traumatic Growth in Multiple Sclerosis: A Longitudinal Study
Gil-González, I., Rodríguez, A. M., Conrad, R., & Pérez-San-Gregorio, M. Á. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912679 · Cited by 8 · see citing works
“In keeping with this assumption, preceding studies indicate a relation between avoidant coping and a more severe MS clinical profile [35,36].”
ResultMultiple Sclerosis Nursing to Improve Care and Education (MSNICE): an observational study
Hijfte, L. V., Cambron, M., Crols, R., Meilleure, G. D. L., Govers, N., Vanopdenbosch, L. J., Laureys, G., Willekens, B. M. P., for the MSNICE Study Group, Buyle, M., et al. (2025) · BMC Nursing · doi:10.1186/s12912-024-02682-6 · Cited by 4 · see citing works
“Another study examined emotion-oriented coping strategies in non-depressed pwMS and showed that this subgroup more often adapts a passive coping posture against stressful situations because they may feel limited in their abilities to influence the disease course [23].”
The Role of Radiological Imaging in Assessing Risk Factors for Physical Disability: A Scoping Review
Yousef, M., Zumrawi, E., Elamin, A. Y., Alamoudi, R. A., Alsalamah, A., Albadri, S., Garout, R., Osman, H. E., Hakami, A. A., & Sulieman, A. (2026) · Journal of Disability Research · doi:10.57197/jdr-2026-0733 · Cited by 2 · see citing works
Lavorgna, L., Miele, G., Ponzano, M., Maida, E., Abbadessa, G., Bile, F., Marfia, G. A., Landi, D., Proietti, F., Inglese, M., et al. (2026) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2026.106534 · Cited by 1 · see citing works
Kołtuniuk, A., & Chojdak-Łukasiewicz, J. (2021) · The Journal of Neurological and Neurosurgical Nursing · doi:10.15225/pnn.2021.10.3.4 · Cited by 1 · see citing works
Sieber, C., Chiavi, D., Haag, C., Kaufmann, M., Horn, A. B., Dressel, H., Zecca, C., Calabrese, P., Pot, C., Kamm, C. P., et al. (2022) · doi:10.2196/preprints.38709
زكی, ز. ص. م., أحمد, م. ش., & الهدى, أ. ح. ا. ح. أ. (2023) · مجلة جامعة الفيوم للعلوم التربوية والنفسية · doi:10.21608/jfust.2023.296600
Segiet, N. M., Przyborowska, N., Kruk, M., Rusek, S., Klimkowicz‐Mrowiec, A., & Bober-Płonka, B. (2023) · Neuropsychiatria i Neuropsychologia · doi:10.5114/nan.2023.134152
“In turn, lower intensity of depressive traits promotes the selection of coping strategies other than emotional coping strategies (Santangelo et al .”
BackgroundPawar, P., Xie, S. M., Varghese, A. R., Smith, A., Gao, J., Kamp, E. V., Kirklin, K., Jones, B. S., Meador, W. R., & Yuen, H. K. (2025) · Healthcare · doi:10.3390/healthcare13101104
Social determinants of health in multiple sclerosis in Italy: A scoping review
Ponzano, M., Fedriga, M., Signori, A., Bergamaschi, R., Schiavetti, I., Landi, D., Lavorgna, L., Sapio, A. D., Fantozzi, R., Marinelli, F., et al. (2025) · Multiple Sclerosis Journal · doi:10.1177/13524585251353196
The impact of multiple sclerosis on social determinants of health: Results from the SocialMS study
Ponzano, M., Signori, A., Schiavetti, I., Landi, D., Bellavia, A., Lavorgna, L., Fantozzi, R., Buttari, F., Sapio, A. D., Quartana, D., et al. (2026) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2026.107402
- Authors
- Santangelo, G., Corte, M. D., Sparaco, M., Miele, G., Garramone, F., Cropano, M., Esposito, S., Lavorgna, L., Gallo, A., Tedeschi, G., & Bonavita, S.
- Affiliations
- University of Campania "Luigi Vanvitelli" (IT)
- Corresponding author
- Santangelo, Gabriella
- ORCID
- Venue
- Acta Neurologica Belgica
- Published
- 2019-09-30
- Volume
- 121
- Issue
- 2
- Pages
- 465-471
- ISSN
- 0300-9009 (ISSN-L)
- 2240-2993
- OpenAlex
- W2977327416
- Cited by
- 20
- References
- 40
- Citations by year
- 2026: 3 · 2025: 3 · 2023: 2 · 2022: 6 · 2021: 4 · 2020: 2
- FWCI
- 2.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Neurologica Belgica (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Social Sciences › Psychology › Clinical Psychology › Resilience and Mental Health
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- relapsing-remitting multiple sclerosis, coping strategies, disease activity, annualized relapse rate, lesion load, depression, emotion-focused coping, positive attitude, social support, physical disability, cognitive performance
- MeSH terms
- Adaptation, Psychological, Adult, Depression, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Prospective Studies, Disease Progression, Multiple Sclerosis, Relapsing-Remitting
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
