How personality traits affect functional outcomes in patients with multiple sclerosis: A scoping review on a poorly understood topic

Determinants of self-perceived quality of life in mildly disabled multiple sclerosis patients: a cross-sectional study

INTRODUCTION

While the determinants influencing self-perceived health-related quality of life (spHRQoL) in persons with multiple sclerosis (pwMS) and severe physical impairment have been well investigated, their impact on pwMS with mild disability is poorly addressed. We aimed to investigate possible drivers of spHRQoL among Sardinian pwMS with an EDSS lower than 2.5.

METHODS

A sample of 87 fully ambulatory (EDSS < 2.5) pwMS were included after screening for major cognitive impairment. spHRQoL was measured with the Italian version of 36-Item Short Form Health Survey (SF-36). The Physical Component Summary (PCS) and Mental Component Summary (MCS) were used as dependent variables for univariate analysis with Cognitive Behavioral Assessment (CBA) and specific individual factors as independent variables. Subsequent multivariate general linear models (GLMs) for PCS and MCS respectively were run after stepwise regression. Normative data referring to Italian population were used for comparison.

RESULTS

As compared to normative data, no statistically significant difference was found for PCS, while MCS was reduced. Multivariate GLMs showed a significant association between lower PCS scores and presence of psychosomatic symptoms, older age and fatigue (p < 0.05). Furthermore, a significant association was shown between lower MCS scores and presence of anxiety (p < 0.001).

CONCLUSION

Mood, presence of psychosomatic symptoms, fatigue and age can have a relevant impact on spHRQoL in people with mildly disabling MS and should be considered in the management of such individuals.

Multiple sclerosis and personality traits: associations with depression and anxiety

BACKGROUND

Depression and anxiety are commonly observed in people with multiple sclerosis (pwMS). There is a growing body of literature supporting the hypothesis that personality traits can influence the mood disorders. This study aimed to investigate the personality traits and their relationships with depression and anxiety among pwMS.

METHODS

234 pwMS were involved in this cross-sectional study. Personality traits, depression, and anxiety were assessed using the NEO Five-Factor Inventory (NEO-FFI) and Hospital Anxiety and Depression Scale (HADS), respectively. Pearson's correlation coefficient and generalized linear model were employed to evaluate the relationships between demographic and clinical characteristics, NEO-FFI, and HADS subscales.

RESULTS

In pwMS, longer disease duration was significantly associated with lower level of conscientiousness (β = - 0.23, p = 0.008) and agreeableness (β = - 0.2, p = 0.01). Moreover, higher expanded disability status scale (EDSS) of pwMS had a significant relationship with higher level of neuroticism (β = 0.89, p = 0.01). Increased level of neuroticism was significantly correlated with lower level of extraversion (r = - 0.28, p < 0.001), openness (r = - 0.37, p < 0.001), agreeableness (r = - 0.31, p < 0.001), and conscientiousness (r = - 0.45, p < 0.001). PwMS with higher level of conscientiousness showed more extraversion (r = 0.23, p < 0.001), openness (r = 0.61, p < 0.001), and agreeableness (r = 0.41, p < 0.001). Elevated level of neuroticism was significantly associated with higher level of anxiety (β = 0.47, p < 0.001) and depression (β = 0.11, p < 0.001) among pwMS.

CONCLUSION

The co-occurrence of depression and anxiety is probably associated with neuroticism among pwMS. Additionally, the impact of personality traits extends to influencing key disease aspects such as physical disability and disease duration in MS.

The influence of personality in persons with MS

BACKGROUND

Comprehending the influence of personality traits on functional outcomes in persons with Multiple Sclerosis (pwMS) can aid in tailoring interventions and support strategies. We explored how demographic variables and personality traits predicted current vocation, information processing speed, anxiety and depression symptoms, and disability level in pwMS.

METHODS

We used a retrospective chart review on pwMS treated at the London (ON) MS Clinic, that assessed demographic data and personality traits. Participants were 384 (68.8 % females, mean age of 37.8, SD = 10.4) individuals with relapsing and primary progressive MS. We performed hierarchical linear regressions to predict outcomes while considering demographic variables and personality traits.

RESULTS

Younger age, higher education, and conscientiousness were significant predictors for better information processing speed, current vocation, depression symptoms, and disability level. Neuroticism was positively associated with anxiety and depression symptoms, while extraversion was negatively associated with depression symptoms. Women showed higher anxiety symptoms, while men showed higher depression symptoms.

CONCLUSION

Personality traits, such as neuroticism and conscientiousness, influence psychological outcomes in pwMS. Younger age and higher education are associated with better functional outcomes. Thus, when considering personality traits, future interventions should focus on those with higher neuroticism and lower scores on both extraversion and conscientiousness. Consideration of social support, coping strategies, and disease severity in future research may further enrich our understanding of MS outcomes.

Personality Traits and Fatigue in Multiple Sclerosis: A Narrative Review

(1) Background: Multiple sclerosis (MS) is a chronic neurodegenerative autoimmune disease. Fatigue is a prevalent and debilitating symptom that significantly impacts the quality of life of these patients. A relationship between personality traits and fatigue in MS has been hypothesized but not clearly defined. (2) Methods: A literature search was carried out from databases up to April 2023 for studies correlating personality traits and fatigue in patients suffering from MS. (3) Results: A total of ten articles was included; most of the studies depict a neuroticism-fatigue correlation; however, they were not consistent in terms of the fatigue, personality, and covariate assessments. (4) Conclusions: The clinical and methodological heterogeneity of the included studies prevented us from drawing any firm conclusion on the link between personality traits and fatigue in MS. Several models of personality and different fatigue assessments have been found. Despite this, a common pathway shows that the neuroticism trait or similar personality patterns has a role in fatigue diagnosis. This may be a useful target to improve the quality of life and enhance the modification of the disease treatment results. Further homogeneous and longitudinal studies are needed.

Personality as a Predictor of Disability in Multiple Sclerosis

OBJECTIVE

As personality changes and personality disorders are frequently observed in multiple sclerosis (MS), personality may be a prognostic factor for this disease. The present study investigated the influence of personality on disability, progression, and treatment adherence in MS.

METHOD

Personality was assessed in 41 patients with Relapsing-Remitting MS (30 females; mean age = 42.63 years) using the NEO Personality Inventory-3rd edition. Disability was measured with the Expanded Disability Status Scale, and treatment adherence information was collected from the Swiss MS Cohort. Correlation, multiple linear and partial least square regressions were performed to examine relations between personality, disability, and treatment adherence in MS.

RESULTS

After accounting for age and time since disease onset, our analysis revealed that Neuroticism (β = 0.32, p = 0.01) and its Vulnerability facet (β = 0.28, p < 0.05) predicted greater disability, whereas Extraversion (β = -0.25, p = 0.04) and its Activity facet (β = -0.23, p < 0.05) predicted milder disability. Regarding disability progression, correlational analysis revealed that it was negatively correlated with Extraversion (r = -0.44, p = 0.02) and the Feelings facet of Openness (r = -0.41, p = 0.03), but regressions failed to highlight any predictive links. No significant results could be demonstrated for treatment adherence.

CONCLUSIONS

Overall, our study showed that some personality traits can impact disability in MS, indicating that these should be considered in clinical practice, as they could be used to adapt and improve patients' clinical support.

Personality Traits Predict 7-Year Risk of Diagnosis of Multiple Sclerosis: A Prospective Study

Objective: The objective of the current study is to investigate how Big Five personality traits could predict the risk of multiple sclerosis (MS) diagnosis in 7 years. Methods: A binary logistic regression was used to analyze data from 17,791 participants who responded to questions at Wave 3 (collected between 2011 to 2012) and Wave 10 (collected between 2018 to 2019) using a binary logistic regression from UKHLS with a mean age of 47.01 (S.D. = 16.31) years old with 42.62% males. Results: The current study found that Openness (OR = 0.68, p < 0.01, 95% C.I. (0.51, 0.89)) and Conscientiousness (OR = 0.70, p < 0.05, 95% C.I. (0.52, 0.93)) are positively associated with a reduced risk of MS diagnosis in 7 years. Conclusion: Health professionals can use findings from the current study as evidence for developing tools for assessing the risk of MS, and providing interventions for people who may be at high risk of MS based on their personality traits.

Clinical correlates of state and trait anxiety in multiple sclerosis

BACKGROUND

Anxiety represents one of the most prevalent psychiatric symptoms in multiple sclerosis (MS), impacting the overall disease burden and quality of life. This psychopathological feature can be expressed as state (S-ANX) and trait (T-ANX) anxiety, but few studies specifically evaluated these two components in MS. The present study was aimed at investigating the prevalence and specific correlates of S-ANX and T-ANX in a cohort of people with MS (PwMS).

METHODS

88 in- and out-patients with MS were consecutively recruited. S-ANX and T-ANX were evaluated with the two subscales of the State and Trait Anxiety Inventory. Bivariate analyses were performed to compare PwMS who displayed clinically significant S-ANX and T-ANX and those who did not. Two logistic regression models were run in order to identify variables significantly associated with S-ANX and T-ANX.

RESULTS

S-ANX and T-ANX presented a prevalence of 42% and 45.5%, respectively. S-ANX was more frequent in subjects hospitalized due to recent MS onset. PwMS and S-ANX more frequently had a recent relapse, as well as evidence of disease activity on brain magnetic resonance imaging. Subjects with T-ANX were more often females and displayed higher severity of fatigue. Depressive features at the Beck Depression Inventory were more severe in both S-ANX and T-ANX subjects. PwMS with S-ANX reported a higher prevalence of T-ANX and vice versa. At the logistic regressions, depression severity displayed a significant association with S-ANX and T-ANX. We also detected positive associations between S-ANX and inpatient status, as well as between T-ANX and female sex.

CONCLUSION

Both S-ANX and T-ANX are highly prevalent features in PwMS. These two components of anxiety should be adequately identified and discriminated in the clinical practice. The higher severity of depression in PwMS with clinically significant anxiety should not be neglected.

Limb apraxia in individuals with multiple sclerosis: Is there a role of semi-immersive virtual reality in treating the Cinderella of neuropsychology?

BACKGROUND

Limb apraxia is an acquired cognitive-motor disorder characterized by spatial and temporal disorganization of limb movements, negatively affecting the quality of life of patients, including those with multiple sclerosis (MS). Although recent studies have shown the potential role of VR in increasing cognitive and motor functions, only a few studies have been carried out on the rehabilitation of upper limb apraxia. Hence, our study aims to evaluate the potential efficacy of VR training to improve upper limb ideomotor apraxia in patients with MS.

METHODS

One hundred and six patients, affected by secondary progressive MS, who attended our Robotic and Behavioral Neurorehabilitation Service from March 2019 to February 2020, were enrolled in this study and randomly divided into two groups: the control group (CG: 53 patients) performed traditional therapy whereas the experimental group (EG:53 patients) received training using semi-immersive VR. All patients underwent the same amount of cognitive training, 3 times a week for 8 weeks. They were submitted to a specific neuropsychological assessment before (T0) and after the rehabilitation treatment (T1).

RESULTS

The VR training led to a significant improvement in global cognitive functions, with regard to constructive and ideomotor apraxia. On the contrary, the CG achieved significant improvements only in ideomotor apraxia. Moreover, only in the EG, we observed an improvement in the mood at the end of training.

CONCLUSION

The present study demonstrates that VR rehabilitation can be an effective tool for the treatment of apraxia, which is a neuropsychological problem often underestimated in MS patients. Further studies with long-term follow-up periods are needed to confirm the effect of this promising approach.

Personality and fatigue: meta-analysis of seven prospective studies

The present study examined the cross-sectional and longitudinal associations between the five major personality traits and fatigue. Participants were adults aged 16-104 years old (N > 40,000 at baseline) from the Health and Retirement Study, the National Social Life, Health, and Aging Project, the Wisconsin Longitudinal Study graduate and sibling samples, the National Health and Aging Trends Survey, the Longitudinal Internet Studies for the Social Sciences and the English Longitudinal Study of Ageing. Personality traits, fatigue, demographic factors, and other covariates were assessed at baseline, and fatigue was assessed again 5-20 years later. Across all samples, higher neuroticism was related to a higher risk of concurrent (meta-analytic OR = 1.73, 95% CI 1.62-1.86) and incident (OR = 1.38, 95% CI 1.29-1.48) fatigue. Higher extraversion, openness, agreeableness, and conscientiousness were associated with a lower likelihood of concurrent (meta-analytic OR range 0.67-0.86) and incident (meta-analytic OR range 0.80-0.92) fatigue. Self-rated health and physical inactivity partially accounted for these associations. There was little evidence that age or gender moderated these associations. This study provides consistent evidence that personality is related to fatigue. Higher neuroticism and lower extraversion, openness, agreeableness, and conscientiousness are risk factors for fatigue.

The Big Five Personality Traits and Positive Orientation in Polish Adults with Multiple Sclerosis: The Role of Meaning in Life

Scientific achievements concerning the direct relation between personality traits and positive orientation among patients with multiple sclerosis do not explain the role of potential mediators. In fact, some researchers argue that the traits–positivity association is much more complex than it seems to be. For this reason, we made an attempt to analyze the indirect relationship between the above-mentioned variables, including meaning in life as a mediator. In total, 618 patients with MS took part in the study. The NEO Five-Factor Inventory, the Positive Orientation Scale, and the Meaning in Life Questionnaire were used. The results showed that positive orientation/the presence of meaning/searching for meaning correlated positively with extraversion, openness to experience, agreeableness, and conscientiousness, and were negatively associated with neuroticism. Moreover, meaning in life in both its dimensions acted as a mediator in 9 of 10 models. It can be assumed that a propensity to establish interpersonal relationships (extraversion), use active imagination (openness), inspire confidence among others (agreeableness), and take responsibility (conscientiousness) can have an impact on someone’s positive attitude toward oneself and the surrounding world (positive orientation) when people have meaning in life and when they are seeking it.

Well-Being in Highly Hypnotizable Persons

Both hypnotizability and well-being are relevant to health. This study aimed to investigate whether high hypnotizability was positively associated with well-being and whether the latter was related to the activity of the behavioral inhibition/approach system (BIS/BAS). ANOVA revealed significantly higher scores on the General Well-Being Index (PGWBI) in highly hypnotizable (highs, n = 31) compared with low hypnotizable participants (lows, n = 53), with medium hypnotizable participants (mediums, n = 41) exhibiting intermediate values. This finding was discussed in relation to other hypnotizability-related traits, such as morpho-functional brain characteristics, equivalence between imagery and perception, and interoceptive sensitivity. A secondary finding was a nonsignificant gender difference in scores on the PGWBI. The highs' higher well-being could be considered a favorable prognostic factor for physical and mental health.

Association of personality traits with physical function, cognition, and mood in multiple sclerosis

BACKGROUND

Growing literature supports the hypothesis that personality influences health outcomes. Few studies have examined the association between personality traits and key clinical manifestations in persons with multiple sclerosis (pwMS).

OBJECTIVE

To investigate whether personality traits are associated with physical function, cognition, and depression in persons with MS.

METHODS

In this cross-sectional study, we analyzed data from two cohorts (UPMC, n = 365 and CUIMC, n = 129). Participants completed a personality scale (assessing neuroticism, extraversion, openness, agreeableness, and conscientiousness) and validated surveys measuring physical function, cognition, and depression. Stepwise linear regressions were used to evaluate associations between personality traits and outcome measures.

RESULTS

Consistently across cohorts, higher extraversion was associated with better physical function, whereas higher neuroticism was associated with worse depression. In the first cohort, higher extraversion was associated with better cognition, while higher neuroticism was associated with greater risk for memory impairment in the second cohort. Relationships were independent of age and disease duration.

CONCLUSION

Findings suggest a potentially protective role of extraversion, and a harmful role of neuroticism, in MS-specific patient-reported clinical outcomes. Increased understanding of the interplay between personality and health outcomes may inform risk models for physical decline, cognitive impairment, and depression in pwMS.

Prevalence and Related Factors of Depression, Anxiety, Acute Stress, and Insomnia Symptoms Among Medical Staffs Experiencing the Second Wave of COVID-19 Pandemic in Xinjiang, China

The prevalence and related factors of mental health impact among medical staffs who experienced the second wave of the COVID-19 pandemic in China is unknown. Therefore, this survey was conducted to investigate the prevalence and related factors of depressive, anxiety, acute stress, and insomnia symptoms in medical staffs in Kashi, Xinjiang, China during the second wave of the COVID-19 pandemic. A cross-sectional online survey was conducted among medical staffs working in First People's Hospital of Kashi, Xinjiang. The questionnaire collected demographic data and self-design questions related to the COVID-19 pandemic. The Impact of Events Scale-6, the Insomnia Severity Index, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder Scale-7, the Perceived Social Support Scale, the Chinese Big Five Personality Inventory-15, and the Trait Coping Style Questionnaire were used to measure psychological symptoms or characteristics. Binary logistic regression was carried out to examine the associations between socio-demographic factors and symptoms of depression, anxiety, stress, and insomnia. In total, data from 123 participants were finally included, among which the prevalence rate of depressive, anxiety, acute stress, and insomnia symptoms is 60.2, 49.6, 43.1, and 41.1%, respectively. The regression model revealed that minority ethnicity, being worried about infection, spending more time on following pandemic information, and neurotic personality were positively associated with the mental health symptoms, while extraversion personality, higher education level, and better social support were negatively associated. In our study, the prevalence of mental health impact was high among medical staffs in Kashi, China who experienced the second wave of the COVID-19 pandemic. Several factors were found to be associated with mental health conditions. These findings could help identify medical staffs at risk for mental health problems and be helpful for making precise mental health intervention policies during the resurgence. Our study may pave way for more research into Xinjiang during the COVID-19 pandemic.