The nature of benefit finding in multiple sclerosis (MS)

An Examination of Positive and Negative Outcomes During the COVID-19 Pandemic Among Persons With Multiple Sclerosis

IMPORTANCE

This study provides information to clinicians about how persons with MS coped in both positive and negative ways during a potentially traumatic experience (the coronavirus disease 2019 [COVID-19] pandemic), which will help clinicians to provide better services to this population in the face of stressful events.

OBJECTIVE

To describe both positive and negative outcomes among persons with multiple sclerosis (MS) and to examine whether resilience and social support were related to positive and negative outcomes during the peak of the pandemic.

DESIGN

An online survey administered during the COVID-19 pandemic.

PARTICIPANTS

Participants were 74 individuals with MS and 104 healthy controls (HCs) recruited through social media and community support groups.

OUTCOMES AND MEASURES

The survey included questionnaires that assessed both positive and negative responses to the pandemic, including benefit finding, loneliness, and distress. Resilience and social support were also assessed.

RESULTS

Differences were noted between persons with MS and HCs on negative but not positive outcomes. Better social support and resilience were related to positive outcomes.

CONCLUSIONS AND RELEVANCE

Both persons with MS and HCs were similar in benefit finding and stress management. However, negative outcomes were worse in the MS group. Our findings shed light on the importance of individuals with MS adopting a positive outlook to help during times of adversity. What This Article Adds: Among persons with disabilities such as multiple sclerosis, finding benefits during stressful times can be a potential coping mechanism. Furthermore, resilience and social support should be taken into account to moderate the effects of adverse events.

Development and Psychometric Assessment of the Benefit Finding Scale for Chinese Older Adults With Chronic Diseases

The current study sought to develop an instrument for measuring benefit finding in Chinese older adults with chronic diseases and establish its psychometric characteristics. Scale items were drafted based on a literature review, theoretical learning, the Benefit Finding Scale (BFS), the Post-Traumatic Growth Inventory, and results of interviews with 24 older adults with chronic diseases. The preliminary scale draft was constructed by performing a Delphi expert consultation and pretest with a small sample. Using the first draft of the scale, we surveyed 380 older adults with chronic diseases. The BFS for older adults with chronic diseases comprised 26 items. Using exploratory factor analysis, we identified six common factors that explained 66.86% of the variance. Item content validity index ranged from 0.818 to 1.000 and scale content validity index was 0.91. Cronbach's alpha of the scale was 0.924 and test-retest reliability was 0.902. The BFS for older adults with chronic diseases showed good validity and reliability and can be used as a measurement tool for benefit finding in the aforementioned population. [Research in Gerontological Nursing, 16(1), 44-52.].

Beyond the Boundaries of Disease—Significant Post-traumatic Growth in Multiple Sclerosis Patients and Caregivers

Despite the negative repercussions of a chronic disease, multiple sclerosis (MS) might also lead to positive consequences. This longitudinal study explored post-traumatic growth in MS patients and attempted to identify possible determinants. Post-traumatic growth of 260 patients and their caregivers was compared. A subset of 209 patients and caregivers were evaluated at baseline. Patients filled in the Posttraumatic Growth Inventory and General Health Questionnaire at three different times over a 36-month follow-up period. Patient post-traumatic growth significantly increased over the follow-up period (p < 0.001) with large effect sizes on almost every subscale. Higher score on the Expanded Disability Status Scale, higher pain severity, female gender, and higher anxiety were positive predictors of post-traumatic growth, while more interference of pain, higher level of education, and more social dysfunction were negative predictors. Post-traumatic growth did not differ significantly between patients and caregivers. Our results showed significant positive intrapsychic changes of MS patients over a 36-month follow-up period up to 12 years from diagnosis. The potential influence of clinical, demographic, and mental health variables underlines the need for a personalized approach to be able to understand and sustain these processes. Comparable post-traumatic growth levels in patient-caregiver dyads at baseline suggest interdependently driven cognitive processes stabilizing well-being. Future research is recommended for further insight into the underlying cognitive processes.

Biopsychosocial implications of living with multiple sclerosis: a qualitative study using interpretative phenomenological analysis

BACKGROUND

Multiple sclerosis (MS) is estimated to affect 2.8 million people worldwide, with increasing prevalence in all world regions (Walton et al). While there is no cure for MS, medication and lifestyle modifications can slow disease progression and enhance patients' quality of life. The biopsychosocial model of health recognises important interactions among biological, psychological and social factors in illness, including those relating to illness management, which contribute to the experience of those diagnosed with MS.

OBJECTIVE

This qualitative, idiographic study aimed to explore the lived experiences of patients in the United Arab Emirates (UAE) diagnosed with S.

METHODS

Semistructured interviews were conducted with a purposive sample of eight patients with MS ranging in age from 25 to 56 years. All participants were residing in the UAE at the time of data collection. Interpretative phenomenological analysis was used to analyse the data.

RESULTS

Three superordinate themes were identified from patients' candid accounts of their lives with MS, highlighting issues of illness management, acceptance and gratitude, and adaptive coping. These themes broadly illustrate biological, psychological and social aspects of patients' MS experiences.

CONCLUSION

The study emphasised the importance of adopting the biopsychosocial model to treat and manage MS. Additionally, it highlights the need for routine assessment and early, multidimensional approach with multidisciplinary team efforts to improve patients' quality of life.

Corporeal Posttraumatic Growth As a Result of Breast Cancer: An Interpretative Phenomenological Analysis

Women’s traumatic experience of breast cancer (BC) can result in posttraumatic growth (PTG). Women’s embodied experiences of BC seem particularly pertinent to their experiences of both difficulty and growth. While PTG is usually conceptualized as having five domains, it seems that BC survivors experience a sixth domain—corporeal PTG (CPTG). CPTG was recently defined as a “reclaiming” and renewed connection to the body through increased appreciation of the physical self, a new sense of bodily responsibility, positive health changes, and a new sense of positive identification with the body. This study’s aim was to explore how women experience CPTG due to BC. In-depth interviews were conducted with female BC survivors. Interpretative phenomenological analysis extracted three themes: losing, regaining, and relinquishing ultimate control over the body, reconstructing embodied identity, and a newfound appreciation for the body. Participants spoke of a complicated journey from distress, loss, and fragmentation to a reshaping of their assumptions about their bodies. The findings suggest that the body plays a vital role in women’s traumatic and growth-related experiences of BC. Future research on the embodied experience of BC is recommended as it forms a crucial part of BC recovery.

"If You Can't Control the Wind, Adjust Your Sail": Tips for Post-Pandemic Benefit Finding from Young Adults Living with Multiple Sclerosis. A Qualitative Study

The COVID-19 outbreak has impacted the wellbeing of people worldwide, potentially increasing maladaptive psychological responses of vulnerable populations. Although young adults with multiple sclerosis (yawMS) might be at greater risk of developing psychological distress linked to the pandemic, they might also be able to adapt to stress and find meaning in adverse life events. The aim of the present study was to explore benefit finding in response to the pandemic in a sample of yawMS. As part of a larger project, data were collected using a cross-sectional, web-based survey. Benefit finding was analysed using a qualitative thematic approach; descriptive and inferential statistics were performed to describe the sample and compare sub-groups. Out of 247 respondents with mostly relapsing-remitting MS, 199 (31.9 ± 6.97 years) reported at least one benefit. Qualitative analysis showed that during the pandemic yawMS found benefits related to three themes: personal growth, relational growth, and existential growth. No differences in benefit finding were found between age sub-groups (18–30 vs. 31–45). Participants reported a wide range of benefits, some of which seem to be specific to MS or the pandemic. Results have been transformed into tips to be introduced in clinical practice to promote resilience in yawMS through meaning making.

The Benefit Finding Questionnaire (BFQ): Scale Development, Validation, and Its Psychometric Properties Among People with Mental Illness

Benefit finding has been defined as positive life changes that result from a stressful event, such as the diagnosis of chronic illness. The present study aimed to develop a benefit finding questionnaire (BFQ) and examine its psychometric property among people with chronic mental illness in Japan. This study adopted a mixed method composed of three phases, including Phase 1: To draft the item pool and design the BFQ based on literature review and discussion among the authors, Phase 2: To revise and refine the drafted items through feedback from focus group interviews and further consideration, and Phase 3: To examine the psychometric properties of the BFQ following the questionnaire survey for people with chronic mental illness and validation of the questionnaire. In Phase 3, a cross-sectional, self-administered questionnaire survey was conducted for mental health service users. Among the 373 eligible participants, we used data from 265 respondents for the analyses (valid response rate = 71.0%). About 65% were male, and the average age was 45.3 years (SD = 12.9). Around 70% were diagnosed with schizophrenia. Factorial, concurrent, and divergent validities, as well as reliability were explored. The 21-item BFQ demonstrated good factorial validity, concurrent and divergent validities, and sufficient internal consistency reliability among people with chronic mental illness. It appears to be a useful scale to assess experience of benefit finding among people with chronic mental illness. Further large-scale research will ensure verification of the scale among people with other illnesses or difficulties.

'I want to be with you, but I have MS': Challenges of interpersonal relationships from the MS patients' point of view

Interpersonal relationships play an important role in adjustment to disease, coping and improving life quality after onset of Multiple sclerosis (MS). However, considering its specific nature, MS has a considerable effect on interpersonal relationships. Thus, this study was conducted to identify and describe effects of disease on interpersonal relationships through investigating lived experiences of patients. In this research, a total of 24 MS patients were selected through purposive sampling from individuals referred to the MS Clinic of Kashani Hospital in Isfahan, Iran, during 2016-2017, and then in-depth interviews were done with participants. After analysing interviews by Giorgi Descriptive Phenomenological Psychological Method, five main themes were obtained including 'Who is guilty?', 'The need for informed care', 'living with a secret', 'Change in relationships' and 'The Reality slap'. Content of experience for some of these themes was more influenced by nature of the disease, whereas some other themes were influenced more by patient's cultural context.

Perceived benefits of the disease: A qualitative study of patients' experiences of heart failure

Heart failure may bring about positive outcomes, which have not been adequately addressed in the literature. Therefore, this qualitative study sought to scrutinize the experiences of patients and the perceived positive effects of heart failure. The opinions of 19 patients with heart failure in Mashhad city (Iran) were collected via semistructured interviews from December 2017 to November 2018. After analyzing the data, six themes were identified by framework analysis: healthy lifestyle, effective interactions, appreciation of life, spirituality, reappraisal of life and priorities, and endurance. Such positive effects may lead to empowerment and better coping of patients with the disease. Therefore, nurses should consider the patients' perception of illness in addition to the disease manifestations and offer training focusing on the possibilities instead of limitations.

Relapsing-remitting multiple sclerosis: an interpretative phenomenological analysis of dyadic dynamics

BACKGROUND

Multiple sclerosis, a chronic degenerative disease, impacts persons with the disease and their caregivers, usually the spouse. Few studies have considered the dyadic adjustment to the disease, and even fewer have considered the type of multiple sclerosis. This study aimed to explore the experiences and strategies of couples in which one spouse had relapsing-remitting multiple sclerosis using dyadic interpretative phenomenological analysis.

METHODS

Six couples agreed to participate in the study. Semi-structured interviews were conducted with both spouses together to observe their interactions.

RESULTS

Three higher-order themes emerged from the analyses. First, "each is stuck in its own bubble" represents a situation in which each spouse fights on his or her own side to avoid the disease or to avoid the suffering associated with it. Second, "the breakdown of communication" highlights disconnected emotional communication that protects each person but weakens the couple. Third, "the alienated couple" indicates that the two spouses are both emotionally distant and physically united, which prevents them from talking about difficult things.

CONCLUSION

These results demonstrate the importance of supporting the couple before avoidance strategies for fighting the disease are put in place and become entrenched. Implications for rehabilitation The persons with relapsing-remitting multiple sclerosis and their partner struggle with the disease in their own anti-depressive bubble using avoidance individual strategies, and leading to a breakdown in the emotional communication between the two partners. Individual intervention centered on acceptance would allow each of the partners to experience psychological events and to limit strategies of avoidance. Dyadic support would allow the two partners to maintain emotional communication to preserve their relationship. These two complementary interventions could be provided as early as possible for the couples before the avoidance strategies and the distance between the two partners become entrenched.

Taking active steps: Changes made by partners of people with multiple sclerosis who undertake lifestyle modification

Background

Multiple sclerosis (MS), a demyelinating condition of the central nervous system with an unpredictable course, has a major impact on the lives of people with MS. Partners of people with MS may be significantly affected by the diagnosis, management and uncertainty around disease progression and may provide substantial support and care. Modification of lifestyle risk factors in conjunction with standard medical management has been associated with improved physical and mental quality of life. Adopting major lifestyle modification may have a multi-faceted impact on the person with MS and their partner. Experiences of partners of people with MS have been previously explored, but the experiences of partners of people with MS who adopt this strategy have not. As part of a larger study that aimed to explore partners’ lived experiences of and attitudes towards MS and lifestyle modification, this study reports the active steps and significant changes partners undertook to assist the person with MS and, at times, to also modify their own lives.

Design

Within an interpretive framework, using Heidegger’s phenomenological philosophy, a qualitative study of semi-structured interviews was conducted.

Participants

Aged greater than 18 years and in a spousal relationship with a person with MS who had undertaken an intensive residential lifestyle educational intervention promoting healthy lifestyle.

Results

Themes identified were: adjusting to lifestyle modification, understanding motivations and practical aspects of adjustment; seeking knowledge and support, exploring the ways partners sought positive support for themselves and the person with MS and abandoned negative influences; and embracing well-being, commitment and change, describing the major changes that partners made to their lives professionally and personally.

Conclusions

The experiences of these partners provide clinicians with insight into potential motivations and outcomes of lifestyle modification and suggest potentially positive aspects for those directly and indirectly affected by MS.

Beyond Disease: Happiness, Goals, and Meanings among Persons with Multiple Sclerosis and Their Caregivers

The experience of persons with multiple sclerosis (MS) and their caregivers is usually investigated in terms of emotional distress and health-related quality of life, while well-being indicators remain largely underexplored. In addition, findings are often interpreted from the clinical perspective, neglecting socio-cultural aspects that may crucially contribute to individuals' functioning. At the methodological level, most studies rely on scaled instruments, not allowing participants to freely express their needs and resources. Based on the bio-psycho-social perspective endorsed by the International Classification of Functioning, well-being indicators were investigated among 62 persons with MS (PwMS), their 62 caregivers and two control groups, matched by age and gender. Participants completed the Positive Affect Negative Affect Schedule (PANAS), the Satisfaction with Life Scale (SWLS), and the Eudaimonic and Hedonic Happiness Investigation instrument (EHHI). EHHI provides information on participants' happiness, goals and meanings through scaled and open-ended questions, contextualized within major life domains. No relevant differences emerged among PwMS and caregivers, compared with the respective control groups, as concerns life domains associated with happiness, goals and meaning. Participants across groups prominently mentioned family, highlighting its intrinsic value and its relevance as a sharing context; health did not represent a major theme for PwMS; community, society and religion/spirituality issues were substantially neglected by all participants. PwMS and caregivers reported lower levels of positive affect than their control groups, while no substantial differences emerged for negative affect, happiness and meaningfulness levels in life and across most domains. Results suggest that the experience of MS is associated with well-being in relevant life domains, such as family and close relationships. Although PwMS and caregivers identified a lower number of goals and meaning-related opportunities compared to control groups, they showed a positive adjustment to disease through the development of personal and family resources. These assets are often undervalued by health professionals and social institutions, while they could be fruitfully exploited through the active involvement of PwMS and their families as expert and exemplary informants in initiatives aimed at promoting the well-being of individuals and communities

Perceptions of coping with non-disease-related life stress for women with osteoarthritis: a qualitative analysis

OBJECTIVE

Coping with arthritis-related stress has been extensively studied. However, limited evidence exists regarding coping with stress extraneous to the disease (life stress). This study explored life stress and coping in a subset of older women with osteoarthritis from a larger longitudinal study.

SETTING

An Australian regional university.

DESIGN

This qualitative study involved semistructured telephone interviews. Potential participants were mailed a letter of invitation/participant information statement by the Australian Longitudinal Study on Women's Health (ALSWH). Invitations were sent out in small batches (primarily 10). Interviews were conducted until data saturation was achieved using a systematic process (n=19). Digitally recorded interviews were transcribed verbatim and deidentified. Data were thematically analysed.

PARTICIPANTS

Women who indicated being diagnosed or treated for arthritis in the previous 3 years in the fifth survey of the ALSWH (conducted in 2007) provided the sampling frame. Potential participants were randomly sampled by a blinded data manager using a random number generator.

RESULTS

Coping with life stress involved both attitudinal coping processes developed early in life (ie, stoicism) and transient cognitive and support-based responses. Women also described a dualistic process involving a reduction in the ability to cope with ongoing stress over time, coupled with personal growth.

CONCLUSIONS

This is the first study to examine how individuals cope with non-arthritis-related stress. The findings add to the current understanding of stress and coping, and have implications regarding the prevention of arthritis in women. Importantly, this study highlighted the potential detrimental impact of persistent coping patterns developed early in life. Public health campaigns aimed at stress mitigation and facilitation of adaptive coping mechanisms in childhood and adolescence may assist with arthritis prevention.

[Stress-buffering effects of benefit finding on the psychological stress' response in mothers of children with developmental disorders]

This study describes the development and evaluation of the Benefit Finding Scale in Developmental Disorder Parenting (BFS-DDP). Using this scale, we examined the stress-buffering effects of identifying positive implications and benefits of having a child with developmental disorders in parents of such children. The BFS- DDP was developed from a questionnaire survey of mothers (N = 265) of children with developmental disorders. Exploratory and confirmatory analysis identified four factors: (a) "deepened relationships," (b) "changed life," (c) "changed life philosophy," and (d) "personal strength." These factors had high degrees of internal consistency. Furthermore, BFS-DDP scores significantly correlated with measuring optimism and meaningfulness, indicating good convergent validity. Hierarchical regression analysis showed that benefit finding significantly decreased stress response in the presence of high stressors. These results suggest that benefit finding may have a stress-buffering effect.

The efficacy of optimism: benefit finding in the treatment of diabetes in Iranian patients

The incidence of diabetes mellitus is on the rise around the world. Middle Eastern countries will be facing a vast increase in the number of diabetes mellitus cases by 2030. Diagnosis of a chronic disease such as diabetes mellitus can be a shocking and life-altering event. Conversely, a diagnosis of a chronic illness can also offer the patient opportunities to change unhealthy behaviors such as poor diet, smoking, and lack of exercise, making them healthier than before their diagnosis. This is referred to as “benefit finding”. This study reveals the many benefit findings of Iranian patients who have been diagnosed with diabetes mellitus and illustrates how benefit finding can be an integral part of long-term patient care.

Impact of organ transplantation in heart, lung and liver recipients: assessment of positive life changes

OBJECTIVE

The majority of psychological studies with organ transplant recipients have examined negative psychological effects. This study aimed to further investigate the positive effects of organ transplantation and to construct a specific measurement instrument.

DESIGN

The initial pool of 14 items for the Positive Effects of Transplant Scale (PETS) was derived from organ recipient interviews. A cross-sectional postal study included 87 heart, 46 lung and 193 liver transplant recipients. The PETS was subjected to principal components analysis (PCA) using varimax rotation, and associations with other measures investigated.

MAIN OUTCOME MEASURES

PETS and an open-ended item about positive effects.

RESULTS

Coding of the open-ended item revealed that the majority of recipients attributed positive life changes to the transplant experience. PCA of the PETS indicated three factors that accounted for 58.82% of the variance. The 12-item questionnaire assesses improvements in: (1) life philosophy, (2) gratitude and (3) health. The total PETS scores exhibited adequate internal consistency and validity.

DISCUSSION

Most transplant patients report positive psychological effects, which suggests this may be an understudied area. The initial development of an assessment tool provides researchers and clinicians a way to assess the degree and nature of these life changes.

The concept of "benefit finding" for people at different stages of recovery from mental illness; a Japanese study

BACKGROUND

Benefit finding is defined as finding benefits through the struggle with adversity.

AIM

This study explored benefit finding at different stages of recovery among people with severe mental illness in Japan.

METHODS

A cross-sectional questionnaire survey, which contained both open-ended questions regarding benefit finding and the Recovery Assessment Scale (RAS), was conducted. Of the responses received from 193 (61%) of 319 individuals with mental illness, responses about benefit finding from 94 questionnaires was analyzed using content analysis (males: 57%; females: 43%; average age: 45 years). Each response about benefit finding was classified into one of three groups according to the stages of recovery by their RAS score (i.e. low, middle or high).

RESULTS

The group with higher recovery scores provided more examples of benefit finding, although almost a quarter of examples of benefit finding were provided by the low-RAS group. Different benefit finding characteristics were found between groups of people at different stages of recovery.

CONCLUSION

While individuals with higher recovery scores are likely to find a variety of benefits, even individuals with lower recovery scores are capable of benefit finding.

Concealable Stigmatized Identities and Psychological Well-Being

Many people have concealable stigmatized identities: Identities that can be hidden from others and that are socially devalued and negatively stereotyped. Understanding how these concealable stigmatized identities affect psychological well-being is critical. We present our model of the components of concealable stigmatized identities including valenced content - internalized stigma, experienced discrimination, anticipated stigma, disclosure reactions, and counter-stereotypic/positive information - and magnitude - centrality and salience. Research has shown that negatively valenced content is related to increased psychological distress. However, smaller identity magnitude may buffer this distress. We review the research available and discuss important areas for future work.

MS and me: exploring the impact of multiple sclerosis on perceptions of self

PURPOSE

The aim of this qualitative study was to explore the impact of multiple sclerosis (MS) on perceptions of self as well as the emotional, social and practical implications of any self-reported changes.

METHOD

Twelve participants were interviewed and interpretative phenomenological analysis used to analyse the data. Participants were recruited from a MS hospital clinic in the north-west of England.

RESULTS

Four themes were identified although for reasons of space and novelty three were discussed, (i) 'my body didn't belong to me': the changing relationship to body, (ii) 'I miss the way I feel about myself': the changing relationship to self and (iii) 'let's just try and live with it': incorporating yet separating MS from self.

CONCLUSIONS

The onset of MS was seen to impact upon self yet impact did not necessarily equate with a loss of self but rather a changed self. Self-related changes did, however, carry the potential to impact negatively upon a person's mood and psychological functioning and consequently, clinicians are encouraged to consider issues relating to self as standard.

Functioning and disability in multiple sclerosis from the patient perspective

Multiple sclerosis (MS) has a great impact on functioning and disability. The perspective of those who experience the health problem has to be taken into account to obtain an in-depth understanding of functioning and disability. The objective was to describe the areas of functioning and disability and relevant contextual factors in MS from the patient perspective. A qualitative study using focus group methodology was performed. The sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for data analysis. Identified concepts were linked to International Classification of Functioning, Disability and Health (ICF) categories according to established linking rules. Six focus groups with a total of 27 participants were performed. In total, 1327 concepts were identified and linked to 106 ICF categories of the ICF components Body Functions, Activities and Participation and Environmental Factors. This qualitative study reports on the impact of MS on functioning and disability from the patient perspective. The participants in this study provided information about all physical aspects and areas of daily life affected by the disease, as well as the environmental factors influencing their lives.

Posttraumatic growth after cancer: the importance of health-related benefits and newfound compassion for others

PURPOSE

There is growing evidence in psycho-oncology that people can experience posttraumatic growth (PTG), or positive life change, in addition to the distress that may occur after a cancer diagnosis. Many studies utilise existing PTG measures that were designed for general trauma experiences, such as the Posttraumatic Growth Inventory. However, such inventories may not take into account life changes associated with a crisis specifically in a health-related context.

METHOD

The current study presents a mixed method exploration of the post-diagnosis experience of cancer survivors (N = 209) approximately 3 years after diagnosis.

RESULTS

Quantitative and qualitative assessment of PTG showed that appreciating life was the most salient area of positive life change for cancer survivors. The results also revealed that in addition to several PTG domains captured by existing quantitative PTG measures, further positive life changes were reported, including compassion for others and health-related life changes.

CONCLUSIONS

These domains of PTG highlight the unique context of a cancer diagnosis and the potential underestimation of positive life change by existing inventories. Further research is warranted that is directed towards designing a context-specific PTG measure for cancer survivors.

Quantitative relationship between recovery and benefit-finding among persons with chronic mental illness in Japan

This study quantitatively examined the association between recovery and benefit-finding among persons with a chronic mental illness in Japan. A cross-sectional questionnaire survey was conducted, with responses from 237 (74%) of 319 individuals (≥ 20 years old) with a chronic mental illness in community and inpatient ward settings. The data of 120 questionnaires were analyzed (men, 64%; average age, 41 years). The questionnaire included the Recovery Assessment Scale (RAS) and Self-identified Stage of Recovery Parts A and B (SISR-A and SISR-B) for assessing recovery and the Perceived Positive Change Scale (PPCS) for assessing benefit-finding. The total RAS and SISR-B scores strongly and positively correlated with the PPCS score. The PPCS score significantly differed among the recovery stages, as classified by the SISR-A, with higher scores at higher stages; the association was almost linear. The study confirmed the theoretically expected relationship between recovery and benefit-finding among these individuals. Benefit-finding might be associated not only with a higher stage of recovery but also with each step from one stage to another.

Informal caregivers assisting people with multiple sclerosis: factors associated with the strength of the caregiver/care recipient relationship

The objective of this study was to identify characteristics of informal caregivers, caregiving, and people with multiple sclerosis (MS) receiving this assistance that are associated with the strength of the care-giver/care recipient relationship. Data were collected in a national survey of informal caregivers and analyzed using an ordered logistic regression model to identify factors associated with caregiver perceptions of the strength of the relationship with the person with MS. The overall health of the person with MS was significantly associated with caregiver perceptions that providing assistance strengthened the caregiver/care recipient relationship, with poor health having a negative impact on the relationship. A spousal relationship between the caregiver and the person with MS was associated with significantly lower perceptions of a strengthened relationship. Conversely, caregiver perceptions that MS symptoms interfered with the independence of the person with MS in daily life were associated with caregiver perceptions of a strengthened relationship. Longer duration of caregiving and more hours per week spent providing assistance also were associated with a stronger relationship. In contrast, we found a significant negative association between caregiver perceptions that assisting the person with MS was burdensome and the strength of the relationship. Similarly, higher levels of education among caregivers tended to have a significantly negative impact on the caregiver/care recipient relationship. Our findings highlight the importance of addressing the needs and concerns of spousal caregivers. Health professionals who treat informal caregivers, as well as those treating people with MS, should be sensitive to the impact caregiving has on caregivers, especially spouses providing assistance.

Suicidal thinking in multiple sclerosis

PURPOSE

Studies demonstrate that suicidal ideation (SI) is greater in persons with multiple sclerosis (MS) than in the general population. SI may offer some MS patients a mechanism for feeling in control of their lives, in the face of a daunting, unpredictable disease. In this study, we determined what specific mental constructs or perceptual themes occur for MS patients experiencing SI, while also examining the construct of 'control' as a central theme.

METHODS

Individual interviews (N = 16) were audiotaped, transcribed and qualitatively analysed by two independent raters to test for key themes in MS patients reporting SI.

RESULTS

In relation to SI, eight key themes were identified by both raters as having been expressed in interviews: perceived loss of control, increased family tension, loneliness, hopelessness and frustration, physical and psychological impact of MS, loss of perceived masculinity or femininity, regaining control and failure to achieve desired or expected role functioning. We created a model to explain the emergence of these themes as they contribute to SI among patients with MS. All participants indicated that perceived loss of control elicited thoughts of suicide.

CONCLUSION

Perceived loss of control appears to be a major disease related burden associated with SI in MS patients.

The dimensional structure of benefit finding in multiple sclerosis and relations with positive and negative adjustment: A longitudinal study

Benefit finding is a meaning making construct that has been shown to be related to adjustment in people with MS and their carers. This study investigated the dimensions, stability and potency of benefit finding in predicting adjustment over a 12 month interval using a newly developed Benefit Finding in Multiple Sclerosis Scale (BFiMSS). Usable data from 388 persons with MS and 232 carers was obtained from questionnaires completed at Time 1 and 12 months later (Time 2). Factor analysis of the BFiMSS revealed seven psychometrically sound factors: Compassion/Empathy, Spiritual Growth, Mindfulness, Family Relations Growth, Lifestyle Gains, Personal Growth, New Opportunities. BFiMSS total and factors showed satisfactory internal and retest reliability coefficients, and convergent, criterion and external validity. Results of regression analyses indicated that the Time 1 BFiMSS factors accounted for significant amounts of variance in each of the Time 2 adjustment outcomes (positive states of mind, positive affect, anxiety, depression) after controlling for Time 1 adjustment, and relevant demographic and illness variables. Findings delineate the dimensional structure of benefit finding in MS, the differential links between benefit finding dimensions and adjustment and the temporal unfolding of benefit finding in chronic illness.

Sense making and benefit finding among patients with amyotrophic lateral sclerosis and their primary caregivers

The associations of sense making and benefit finding with depressive symptoms were examined among patient and caregiver pairs coping with Amyotrophic Lateral Sclerosis. Benefit finding, but not sense making, was associated with fewer depressive symptoms for both patients and caregivers. Patient and caregiver pairs where neither found benefit had more depressive symptoms compared to pairs where at least one member found benefit. Patients cited benefits related to relationships and caregivers were more likely to cite finding personal strength as a benefit. Results suggest situational constraints to making sense and on the kinds of benefit that can be found.

Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: a systematic review

PURPOSE

The diagnosis of a life-threatening illness can be an extremely stressful, traumatic experience. However, many survivors report also various positive changes, referred in empirical literature as post-traumatic growth (PTG). Empirical studies that documented stress disorders and PTG in patients and survivors of life-threatening diseases are reviewed in three areas: Predictors of PTG, relationships between PTG and indicators of mental health and the impact of PTG on the process of convalescence.

METHOD

The literature review was completed by making use of three major databases - PsycINFO, PILOTS and Medline.

RESULTS

The majority of the studies investigated PTG and its relationships to health indicators after the diagnosis of cancer, HIV/AIDS, cardiac disease, multiple sclerosis and rheumatoid arthritis. The review indicated that quality of social support, patients' coping strategies and several indicators of mental and physical health were consistently associated with post-traumatic growth. Associations between growth and health-related variables (e.g. physical deficits, pain, depression, anxiety) varied depending on different study design (cross-sectional versus longitudinal) and the sample composition (patients versus symptom-free survivors). Several findings are disease-specific.

CONCLUSIONS

The results point to the potential adaptive significance of PTG. More research is needed to investigate specific disease-related profiles of PTG and the complex mechanisms, which underlie the relationships between PTG and the process of convalescence. This knowledge may help to foster the overall positive adjustment of chronically ill patients.

The nature of sense making in caregiving for persons with multiple sclerosis

OBJECTIVE

Sense making refers to the development of explanations for adversity. This study investigated the nature of sense making in multiple sclerosis (MS) carers and relations between it and care recipient illness, caregiving context, carer religious-spiritual beliefs and carer and care recipient adjustment.

SUBJECTS

A total of 232 MS carers and their care recipients completed questionnaires.

METHOD

A questionnaire survey methodology was used to collect qualitative and quantitative data. Variables included: Demographics, caregiving context (caregiving duration, co-residency, carer-care recipient relationship, outside employment), care recipient illness (activities of daily living, number of symptoms, illness duration, course), sense making (anticipated sense making, number of sense making categories), carer and care recipient adjustment (positive states of mind, life satisfaction, anxiety, depression).

RESULTS

Half the carers generated sense making explanations for their caregiving situation and 12 sense making themes emerged from this qualitative data. Over a third of those carers who could not make sense of their situation were able to anticipate comprehending it and the strength of this anticipation was related to greater life satisfaction. Carer sense making was related to having a religious-spiritual belief, fewer care recipient symptoms, marital status and it predicted life satisfaction after controlling for relevant covariates. Carer and care recipient sense making was positively correlated, and the sense making of one partner was positively related to life satisfaction of the other partner.

CONCLUSIONS

Findings chart the nature of sense making in MS caregiving and support the notion of collective sense making within dyads and the proposed beneficial links between sense making and adjustment.

Dyadic benefit finding after myocardial infarction: a qualitative investigation

OBJECTIVE

The aim of this study was to explore the process of dyadic benefit finding after myocardial infarction.

METHODS

For the purposes of the study, a qualitative methodology using intepretative phenomenologic analysis was used. Semistructured interviews were conducted with 11 couples. Patients were predominantly male, aged between 50 and 70 years, and partners were aged between 45 and 64 years. All couples were married.

RESULTS

In terms of the patients, the following themes emerged: a catalyst for change/wake-up call; change of life philosophy; being protected/being invincible; humanistic attitudes. With regard to the spouses, the following themes emerged: active search for benefit/failure to find benefit and improvement of relationship.

CONCLUSION

The study revealed no compatibility in the process of benefit finding between patients and spouses. Clinical implications for cardiac rehabilitation interventions are discussed.

Post-traumatic growth and life threatening physical illness: a systematic review of the qualitative literature

Post-traumatic growth (PTG) is the phenomenon of positive change through the experience of trauma and adversity (O'Leary & Ickovics, 1995). Research suggests that the type of trauma sustained could have differing processes and outcomes from each other (Demark-wahnefried et al., 2000; Sabiston, McDonough, and Crocker, 2007). The aim of this study was to synthesize qualitative data on PTG and illness related trauma. Fifty-seven published journal articles dating from before November 1st, 2007 in PsychINFO, MEDLINE, EMBASE, Web of Knowledge and from the authors own knowledge of the area were reviewed. Key words included PTG; benefit finding; thriving and positive changes. Key themes included: 'reappraisal of life and priorities'; 'trauma equals development of self'; 'existential re-evaluation'; and 'a new awareness of the body'. Findings suggest that there are unique elements to illness related PTG and a need for additional research into the processes and outcomes of physical illness related trauma.

Making Sense of Illness or Disability

This study investigated sense making in multiple sclerosis (MS) and relations with illness, religious-spiritual beliefs and adjustment (life satisfaction, positive states of mind, depression, anxiety). Four hundred and eight persons with MS completed a questionnaire. Half the sample generated sense making explanations for their illness. Content analyses revealed 16 sense making themes. Participants who reported having a religious-spiritual belief were more likely to report sense making than those who did not have such a belief. Sense making was related to lower disability and disease severity and evidenced beneficial direct effects on positive adjustment outcomes and depression after controlling for illness and religious-spiritual belief.