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Cited by 99Multiple Sclerosis Research StudiesCancer survivorship and careOptimism, Hope, and Well-being

Quality of life and psychological well-being in the early stages of multiple sclerosis (MS): importance of adopting a biopsychosocial model

Open access
Strober, L.B.·2018·Disability and health journal
DOI 10.1016/j.dhjo.2018.05.003PMC PMC6177284
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Abstract

BACKGROUND: Reductions in quality of life (QOL) exist among individuals with multiple sclerosis (MS). OBJECTIVE: The present investigation aimed to adopt a biopsychosocial model in examining QOL in the early stages of MS. METHODS: Individuals with MS (34 with average to low QOL and 35 with high QOL) were compared on measures of disease symptoms, psychological functioning, personality, self-efficacy, locus of control (LOC), social support, and coping to determine the most salient predictors of QOL. RESULTS: Individuals were matched on disease course and duration. Individuals with lower QOL reported more fatigue, sleep problems, pain, depression, and anxiety (d = 0.83-1.49, p's < 0.001). They also reported lower levels of self-efficacy, LOC, and social support (d = 0.75-1.50 p's < 0.01). They indicated higher levels of neuroticism (d = 1.31, p < .001) and lower levels of extraversion (d = 1.21, p < .001) and reported greater levels of disengagement as a means of coping (d = 0.75, p = .002). Those with high QOL endorsed more use of adaptive coping (d = 0.52 - 0.86, p's < 0.05). When taken together, LOC and anxiety were the most significant predictors, accounting for 40% of the variance. CONCLUSION: Even early on in the illness, there exists differing levels of QOL. Identifying the psychological and social variables as well as the disease related factors is important, and in this case, may make a much greater contribution. Efforts to assure routine assessment and effective intervention aimed at these factors are warranted, particularly as an early intervention to assure maintenance/improvement in QOL among individuals with MS.

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Crossref · 10.1016/j.dhjo.2018.05.003

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Statistics

Nothing to recompute.

Claims the paper makes

0 of 21 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The low to average quality of life group had worse psychological well-being than the high quality of life group (d=.70-1.71, p≤.001).

    “PWB (d’s=.70-1.71, p≤.001)”
    Quote in the paperSubstantial claim
  • Findingown data

    The groups did not differ on the other personality factors.

    “There were no other differences with regard to the other factors of personality.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The high quality of life group had higher MS-specific self-efficacy than the low to average quality of life group (d=.76, p=.003).

    “individuals with high QOL reported higher levels of general and MS-specific self- efficacy (d=.78, p=.002 and d=.76, p=.003, respectively)”
    Quote in the paperSubstantial claim
  • Findingown data

    The low to average quality of life group had higher perceived stress than the high quality of life group (d=1.48, p<.001).

    “Large effect sizes were also found on measures of perceived stress (d=1.48, p<.001)”
    Quote in the paperSubstantial claim
  • Findingown data

    The low to average quality of life group had worse subjective well-being, including depression and anxiety, than the high quality of life group (d=1.02-1.49, p≤.001).

    “subjective well-being (i.e., depression, anxiety) (d’s=1.02-1.49, p≤.001)”
    Quote in the paperSubstantial claim
  • The quote only partly states this claim. 2
  • May combine two claims. 9
  • Classified as probably not a substantial claim. 3

  • The quote only partly states this claim.

    Findingown data

    In the coping model, behavioral disengagement and acceptance were retained as predictors of quality of life.

    “Finally, of the coping measure, only behavioral disengagement and acceptance were retained in the model.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Locus of control had the largest effect size and was the strongest predictor distinguishing high quality of life from lower quality of life in people diagnosed with MS within the previous five years.

    “In the present study, LOC demonstrated the largest effect size and was the greatest predictor in distinguishing those with high QOL from those with less in a sample of individuals diagnosed with MS in the last five years.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Findingown data

    In the personality model, neuroticism and extraversion remained as predictors of quality of life.

    “Both neuroticism and extraversion remained in the model when examining personality.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the final model with pain, anxiety, neuroticism, extraversion, locus of control, behavioral disengagement, and acceptance, only locus of control and anxiety remained significant and together accounted for 40% of variance in quality of life.

    “When taken together, the only significant factors that remained in the final model when considering pain, anxiety, neuroticism, extraversion, LOC, behavioral disengagement, and acceptance was LOC and anxiety, accounting for 40% of the variance (See Table 5).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The quality of life groups differed in psychological well-being, particularly self-acceptance, personal relationships, purpose in life, and to a lesser extent personal growth.

    “differences were found between the two groups, particularly for self-acceptance, personal relationships, and purpose in life, and to a lesser extent, personal growth.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    The Satisfaction with Life Scale is valid and reliable in the multiple sclerosis population.

    “The SWLS has been used previously in the MS literature49 and found to be valid and reliable in this population.50,51”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [50] Lucas-Carrasco, 2014, Preliminary validation study of the Spanish version of the satisfaction with life scale in persons with multiple sclerosis, Disabil Rehabil source

      Not checked in the free run.

    • cites [51] Learmonth, 2014, Psychometric properties of quality of life and health-related quality of life assessments in people with multiple sclerosis, Qual Life Res source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    A multivariate analysis of variance was used on coping subscales to reduce Type I error from multiple comparisons.

    “A multivariate analysis of variance (MANOVA) was conducted among the subscales of the coping measure to reduce the likelihood of a Type I error given the multiple comparisons.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Conscientiousness and depression together explained 63% of variance in overall quality of life in multiple sclerosis.

    “More specifically, the facet of conscientiousness, in conjunction with depression, accounted for 63% of the variance when predicting overall QOL.46”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [46] Benedict, 2005, Predicting quality of life in multiple sclerosis: accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change, J. Neurol. Sci. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    An internal locus of control is associated with a milder MS course, greater MS knowledge, and more health behaviors than an external locus of control.

    “More specifically, individuals with an internal LOC were found to have a milder course, were more knowledgeable regarding their MS, and engaged in more health-related behaviors or self-care than those with an external oriented LOC.45”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Wassem, 1991, A test of the relationship between health locus of control and the course of multiple sclerosis, Rehabil Nurs source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The high quality of life and low to average quality of life groups did not differ in age, gender, education, or disease duration.

    “There were no differences with regard to age, gender, education, or disease duration between those with high QOL and those with low to average QOL. (See Table 1).”
    • Also stated in: § Results · plain
      “Individuals were matched on disease course and duration.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The study was cross-sectional and cannot support causal inferences.

    “However, the present study is cross-sectional and does not lends itself to any causal inferences.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Despite the small sample, effect sizes greater than 1.0 for most variables suggest the effects would be larger in a larger sample and the study was likely not underpowered.

    “However, despite the small sample size, effect sizes greater than 1.0 were found for the majority of variables investigated suggesting that these effects could only be larger in a larger sample size and that this study was likely not underpowered.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Psychological and social variables, along with disease-related factors, are important and may contribute more to quality of life in early multiple sclerosis.

    “Identifying the psychological and social variables as well as the disease related factors is important, and in this case, may make a much greater contribution.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The biopsychosocial model requires biological, psychological, and social factors to be considered together to understand illness impact.
13 of 13

  • The paper relies on this without support.

    Psychological well-being has received little attention in multiple sclerosis research.

    “To date, PWB has received very little attention in MS as the majority of studies focus on general QOL, such as life satisfaction and HRQOL.”

  • The authors state this as an assumption.

    The biopsychosocial model requires biological, psychological, and social factors to be considered together to understand illness impact.

    “which suggests that biological, psychological, and social factors must all be considered simultaneously in order to fully appreciate the patient’s subjective experience of their illness and its overall impact on their functioning, QOL, and overall well-being.”

  • The paper relies on this without support.

    Early multiple sclerosis patients are prior to significant disease involvement.

    “It was proposed that early on in the disease process, prior to significant disease involvement, social and psychological factors were likely to have a substantive role on QOL and adjustment to MS”

  • The paper relies on this without support.

    The employed relapsing-remitting MS sample with disease duration up to five years represents the broader early MS population.

    “Individuals with a relapsing remitting course and disease duration of less than or equal to five years were selected for the current investigation.”
    “and being presently employed.”
4 of 4

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?

  • Among sociodemographic variables, age has consistently been shown to have no significant relationship with QoL in MS patients.

    “Among the sociodemographic variables, age has consistently been shown to have no significant relationship with the QoL in MS patients [4,8,11].”

    From Biopsychosocial Correlates of Quality of Life in Multiple Sclerosis Patients (2022) · cites this paper as [4]

    The Results report no age difference between the high-QOL and low-to-average-QOL groups. That supports a lack of an observed age association in this study of people in the early stages of MS, but does not establish that age has consistently had no significant relationship with QOL across MS patients generally. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Depression has been observed to be the strongest predictor of QoL in several studies.

    “Depression has been observed to be the strongest predictor in several studies [4,8,10,11,17,20,24,25,26].”

    From Biopsychosocial Correlates of Quality of Life in Multiple Sclerosis Patients (2022) · cites this paper as [4]

  • Active coping, problem resolution, planning problem solving, cognitive positive restructuring, emotional and instrumental social support, emotional expression, acceptance and growth are related to higher quality of life in multiple sclerosis.

    “Active coping, problem resolution, planning problem solving, cognitive positive restructuring, emotional and instrumental social support, emotional expression, acceptance and growth were related to a higher QoL in MS.51 71 79–82”

    From Quality of life in adults with multiple sclerosis: A systematic review (2020) · cites this paper as [51]

  • High levels of self-efficacy, self-esteem, illness identity and sense of coherence correlate with higher quality of life in multiple sclerosis.

    “High levels of self-efficacy,51 88 self-esteem,88 illness identity88 and sense of coherence89 correlated with higher QoL”

    From Quality of life in adults with multiple sclerosis: A systematic review (2020) · cites this paper as [51]

  • Strategies based on acceptance and active commitment led to higher quality of life in multiple sclerosis.

    “On the contrary, strategies based on acceptance and active commitment, such as active coping, humour, problem resolution, cognitive positive restructuring and emotional expression, led to higher QoL in MS.51 71 79–82”

    From Quality of life in adults with multiple sclerosis: A systematic review (2020) · cites this paper as [51]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Neuroticism is both removed from and included in the final regression

    Minor

    The results say neuroticism was removed because of multicollinearity, but the next sentence lists it among the variables considered in the final model. The text does not make clear which model produced the reported result.

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The citation lists haven’t been fetched yet

References 69 · Cited by 99

Research works printed but not linked: 6

  1. Smith, 1993, Clinical features, assessment, and differential diagnosis of multiple sclerosis, Mult Scler: a Neuropsychol Disord, 1
  2. Hakim, 2000, The social impact of multiple sclerosis-a study of 305 patients and their relatives, Disabil Rehabil, 22, 288, 10.1080/096382800296755 · DOI
  3. Lobentanz, 2004, Factors influencing quality of life in multiple sclerosis: disability, depressive mood, fatigue and sleep quality, Acta Neurologica Scandanivica, 110, 6, 10.1111/j.1600-0404.2004.00257.x · DOI · Paper page
  4. Benedict, 2005, Predicting quality of life in multiple sclerosis: accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change, J. Neurol. Sci., 231, 29, 10.1016/j.jns.2004.12.009 · DOI · Paper page
  5. Ritvo, 1997, Multiple sclerosis quality of life inventory: a user's manual, N Y: Nat Multiple Sclerosis Soc, 1
  6. Schwarzer, 1995, Generalized self-efficacy scale, Measures in Health Psychol: User’s Portfolio Causal Contr Beliefs, 1, 35

Authors
Strober, L. B.
Affiliations
Rutgers, The State University of New Jersey (US)
Corresponding author
Strober, L.B.
ORCID
Strober, L.B.
Venue
Disability and health journal
Publisher
Elsevier BV
Published
2018-10
Volume
11
Issue
4
Pages
555-561
ISSN
  • 1876-7583 (ISSN-L)
  • 1936-6574
DOI
10.1016/j.dhjo.2018.05.003
PMC
PMC6177284
OpenAlex
W2806616775
Semantic Scholar
8deedef0955cc2a9c6a5c38c128fdd8345eabd31
Cited by
99
References
69
Citations by year
2026: 6 · 2025: 13 · 2024: 13 · 2023: 12 · 2022: 16 · 2021: 22 · 2020: 12 · 2019: 4 · 2018: 1
FWCI
7.41
Type
journal article
Language
en
Open access
Licence
Locations
  • Disability and health journal (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (NCMRRK23HD069494)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Social Sciences › Psychology › Applied Psychology › Optimism, Hope, and Well-being
Keywords
multiple sclerosis, quality of life, biopsychosocial model, psychological well-being, fatigue, sleep disorders, pain, depression, anxiety, self-efficacy, locus of control, social support, coping strategies, disengagement coping, adaptive coping, neuroticism, extraversion, predictors of quality of life
MeSH terms
Adaptation, Psychological, Adult, Female, Persons with Disabilities, Humans, Male, Middle Aged, Multiple Sclerosis, Quality of Life, Surveys and Questionnaires, Social Support, Stress, Psychological, Self Efficacy

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