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Winston-Khan SI, Healy BC, Kehoe SB, Zurawski JD, Singhal T, Glanz BI. Stigma in Multiple Sclerosis: A Narrative Review of Current Concepts, Measures, and Findings. Int J MS Care 2024; 26:125-133. [PMID: 38765301 PMCID: PMC11096853 DOI: 10.7224/1537-2073.2023-047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Stigma is an undesired differentness associated with a particular characteristic or condition that distinguishes a person as being outside the norm and cueing stereotypes. Stigma is common in people with multiple sclerosis (MS) and is associated with several disease variables including disease duration, age, age of onset, and disease course. Stigma is also associated with psychological and psychosocial variables such as depression, anxiety, and quality of life. This article reviews our current understanding of stigma in people with MS with a focus on the various stigma types including anticipated, experienced, and internalized stigma, and the lack of consistent definitions across studies. It also describes the 7 instruments that are most commonly used to measure stigma in people with MS, and the limitations of each measure. We conclude that a better understanding of stigma that includes standard definitions of stigma types could lead to more direct intervention strategies aimed at reducing particular stigma concepts and resulting in improved health-related quality of life in people with MS.
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Affiliation(s)
| | - Brian C. Healy
- From the Brigham MS Center, Brigham and Women's Hospital, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Sydney B. Kehoe
- From the Brigham MS Center, Brigham and Women's Hospital, Boston, MA
| | - Jonathan D. Zurawski
- From the Brigham MS Center, Brigham and Women's Hospital, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
| | - Tarun Singhal
- From the Brigham MS Center, Brigham and Women's Hospital, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
| | - Bonnie I. Glanz
- From the Brigham MS Center, Brigham and Women's Hospital, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
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Dervish J, Arfuch VM, Murley C, McKay KA, Machado A, Wennman-Larsen A, Friberg E. Disclosing or concealing multiple sclerosis in the workplace: two sides of the same coin-insights from a Swedish population-based survey. Front Public Health 2024; 12:1331746. [PMID: 38469271 PMCID: PMC10925750 DOI: 10.3389/fpubh.2024.1331746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/16/2024] [Indexed: 03/13/2024] Open
Abstract
Background People with multiple sclerosis (PwMS) face health and social challenges of living with a chronic and potentially disabling condition. To disclose or conceal MS at work may critically affect individuals' work situation, career opportunities, and health. PwMS may experience a dilemma when assessing if the possible benefits of disclosing the diagnosis outweigh the possible risks. However, concealing in the long-term may have health implications and prevent opportunities for support and work adjustments. Few studies have examined what drives PwMS to disclose or conceal MS at work and the consequences of these ways of managing MS. Objectives To explore the reasons PwMS report for disclosing and/or concealing their MS diagnosis in the workplace, as well as the consequences they have experienced. Methods A web-based survey of PwMS was conducted in 2021. All individuals aged 20-50 listed in the Swedish MS registry were invited to participate. The response rate was 52% and among these participants, 3,810 (86%) completed questions regarding workplace disclosure and/or concealment of MS. Free-text responses on these topics were analyzed using inductive content analysis. Results It was common to disclose MS in the workplace (85%). Identified drivers for disclosure and concealment related to four categories: Work-related, Social, Personal and Circumstantial. Work-related drivers focused on employment or protecting one's career, and changing one's work situation versus maintaining it. Social drivers included the need for support, addressing or preventing stigma, and being considerate of others. Personal drivers were linked to moral values/personal beliefs and processing of the diagnosis. Circumstantial drivers related to involuntary or unforeseen events, timing factors, one's medical condition and external opinion/advice. Identified consequences for disclosure and concealment related to three categories: Work-life, Social, and Personal. Work-life consequences included work arrangements, and career opportunities. Social consequences were linked to MS awareness, stigma, interactions and social support, as well as dynamics of work relationships. Personal consequences involved levels of disease acceptance, and attitudes toward managing MS. Conclusion PwMS often described the question of disclosure as challenging and navigated it with caution, as both disclosure and concealment can yield favorable and unfavorable outcomes.
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Affiliation(s)
- Jessica Dervish
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Victoria Mailen Arfuch
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Chantelle Murley
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kyla A. McKay
- Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Alejandra Machado
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Wennman-Larsen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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3
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Liković M, Buljevac M. ‶You look really good, I don't know why you came here″: persons with multiple sclerosis´ perspectives on social support. Home Health Care Serv Q 2023:1-22. [PMID: 36913915 DOI: 10.1080/01621424.2023.2189645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
The aim of this qualitative study is to gain insight into the perspectives of persons with multiple sclerosis on social support. Semi-structured interviews were conducted with eleven persons with multiple sclerosis. The results on informal support for persons with multiple sclerosis reveal perceived support and the lack of support from different persons. The results on formal support for persons with multiple sclerosis show perceived support from healthcare professionals, professionals working outside healthcare and social care systems, and associations of persons with MS, but also inadequate support from healthcare professionals and social workers. Close emotional relationship, empathy, knowledge and understanding are the basis for provision of all types of support from informal support system, while perceived support from formal support system is based on professionals´ empathy, their professionalism and knowledge. Persons with multiple sclerosis need accurate and timely emotional, informational, practical and financial support.
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Affiliation(s)
- Maja Liković
- Department of Social Work, Faculty of Law, University of Zagreb, Zagreb, Croatia
| | - Marko Buljevac
- Department of Social Work, Faculty of Law, University of Zagreb, Zagreb, Croatia
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4
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The Mediating Role of Stigma, Internalized Shame, and Autonomous Motivation in the Relationship Between Depression, Anxiety, and Psychological Help-Seeking Attitudes in Multiple Sclerosis. Int J Behav Med 2023; 30:133-145. [PMID: 35325406 PMCID: PMC9879833 DOI: 10.1007/s12529-022-10078-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Depression and anxiety are commonly experienced in individuals with multiple sclerosis (MS) yet little is known about factors associated with psychological help-seeking attitudes in those with MS. METHOD The current study investigated whether increased stigma related to chronic illness, internalized shame, and autonomous motivation mediated the relationship between depressive and anxiety symptoms and psychological help-seeking attitudes in individuals with MS. Two hundred fifty-four participants with MS completed an online questionnaire assessing depressive and anxiety symptoms, stigma related to chronic illness, internalized shame, autonomous motivation, and psychological help-seeking attitudes. RESULTS Stigma related to chronic illness, internalized shame, and autonomous motivation mediated the relationships between increased depressive symptoms and anxiety symptoms and psychological help-seeking attitudes. The study also found that higher levels of chronic illness-related stigma and internalized shame were associated with more negative psychological help-seeking attitudes and higher autonomous motivation was associated with more positive psychological help-seeking attitudes. There were no direct effects of depressive or anxiety symptoms on psychological help-seeking attitudes. CONCLUSION The significant mediating roles of stigma-related chronic illness, internalized shame, and autonomous motivation indicate that these factors may be useful to include in future depression and anxiety intervention studies targeting MS populations.
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5
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Kassie SA, Alia J, Hyland L. Biopsychosocial implications of living with multiple sclerosis: a qualitative study using interpretative phenomenological analysis. BMJ Open 2021; 11:e049041. [PMID: 34404710 PMCID: PMC8372815 DOI: 10.1136/bmjopen-2021-049041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Seada A Kassie
- Shared Clinical Services, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
- Psychology, Middlesex University Dubai, Dubai, UAE
| | - Jannat Alia
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Lynda Hyland
- Psychology, Middlesex University Dubai, Dubai, UAE
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6
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Lakin L, Davis BE, Binns CC, Currie KM, Rensel MR. Comprehensive Approach to Management of Multiple Sclerosis: Addressing Invisible Symptoms-A Narrative Review. Neurol Ther 2021; 10:75-98. [PMID: 33877583 PMCID: PMC8057008 DOI: 10.1007/s40120-021-00239-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system, leading to neurodegeneration and manifesting as a variety of symptoms. These can include "invisible" symptoms, not externally evident to others, such as fatigue, mood disorders, cognitive impairments, pain, bladder/bowel dysfunction, sexual dysfunction, and vision changes. Invisible symptoms are highly prevalent in people living with MS, with multifactorial etiology and potential to impact the disease course. Patient experiences of these symptoms include both physical and psychosocial elements, which when unaddressed negatively influence many aspects of quality of life and perception of health. Despite the high impact on patient lives, gaps persist in awareness and management of these hidden symptoms. The healthcare provider and patient author experiences brought together here serve to raise the profile of invisible symptoms and review strategies for a team-based approach to comprehensive MS care. We summarize the current literature regarding the prevalence and etiology of invisible symptoms to convey the high likelihood that a person living with MS will contend with one or more of these concerns. We then explore how open communication between people living with MS and their care team, stigma mitigation, and shared decision-making are key to comprehensive management of invisible symptoms. We recommend validated screening tools and technological advancements that may be incorporated into MS care to regularly monitor these symptoms, offering insight into how healthcare providers can both educate and listen to patients, with the goal of improved patient quality of life. By pairing clinical knowledge with an understanding and consideration of the patient perspective, providers will be equipped to foster a patient-centered dialogue that encourages shared decision-making. Invisible symptoms of MS.
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Affiliation(s)
- Lynsey Lakin
- The Neurology Group, 9120 Haven Ave, Rancho Cucamonga, CA, USA
- Comprehensive MS Center, The University of California Riverside, 3390 University Ave, Suite 100, Riverside, CA, USA
| | - Bryan E Davis
- Comprehensive MS Center, The University of California Riverside, 3390 University Ave, Suite 100, Riverside, CA, USA
| | - Cherie C Binns
- Accelerated Cure Project/iConquerMS, 187 Robinson Street, Wakefield, RI, USA
| | - Keisha M Currie
- Currie Consultancy Agency LLC., 11 M. R. Watson Court, Eastover, SC, USA
| | - Mary R Rensel
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
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Donisi V, Gajofatto A, Mazzi MA, Gobbin F, Busch IM, Ghellere A, Klonova A, Rudi D, Vitali F, Schena F, Del Piccolo L, Rimondini M. A Bio-Psycho-Social Co-created Intervention for Young Adults With Multiple Sclerosis (ESPRIMO): Rationale and Study Protocol for a Feasibility Study. Front Psychol 2021; 12:598726. [PMID: 33708157 PMCID: PMC7940381 DOI: 10.3389/fpsyg.2021.598726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS), the most common neurological disease that causes disability in youth, does not only affect physical functions but is also associated with cognitive impairment, fatigue, depression, and anxiety and can significantly impact health-related quality of life (HRQoL). Since MS is generally diagnosed at a young age-a period of great significance for personal, relational, and professional development-adaptation can become highly challenging. Therefore, enhancing the competence of young people to adaptively cope with these potential challenges is of utmost importance in order to promote their potentialities and talents. It has been shown that psychological interventions targeting MS patients can enhance resilience and HRQoL and that regular physical activity (PA) and social engagement can improve psychological well-being. However, literature on the development of global interventions based on the bio-psycho-social model of the disease is missing. Even less attention has been paid to interventions dedicated to young adults with MS (YawMS) and to the involvement of patients in the development of such programs. AIMS In collaboration with MS patients, this study aims to develop a bio-psycho-social intervention (ESPRIMO) for YawMS, aiming to improve their HRQoL and to explore its feasibility, acceptability, and effects. METHODS To tailor the intervention to the specific needs of YawMS, "patient engagement principles" will be adopted in the co-creation phase, performing a web survey and focus groups with patients and healthcare professionals. In the intervention phase, a pilot sample of 60 young adults with MS will be enrolled. The co-created intervention, composed of group sessions over a 12-week period, will cover psycho-social strategies and include physical activities. Adopting a longitudinal, pre-post evaluation design, self-report questionnaires measuring HRQoL and other bio-psycho-social features (e.g., resilience, well-being, mindfulness traits, self-efficacy, perceived social support, psychological symptoms, illness perception, committed action, fatigue, attitudes, subjective norms, perceived behavioral control, motivation, perception of autonomy support for PA, barriers and intentions to PA) will be administered, the quantity and quality of PA will be measured, and a questionnaire developed by the authors will be used to evaluate the feasibility and acceptability of the ESPRIMO intervention.
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Affiliation(s)
- Valeria Donisi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alberto Gajofatto
- Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Angela Mazzi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Gobbin
- Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Isolde Martina Busch
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Annamaria Ghellere
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alina Klonova
- Section of Movement Sciences, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Latvian Academy of Sport Education, Riga, Latvia
| | - Doriana Rudi
- Section of Movement Sciences, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Vitali
- Section of Movement Sciences, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Schena
- Section of Movement Sciences, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michela Rimondini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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8
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Giovannetti AM, Barabasch A, Giordano A, Quintas R, Barello S, Graffigna G, Alfieri S, Schiffmann I, Muche-Borowski C, Borreani C, Heesen C, Solari A. Construction of a User-Led Resource for People Transitioning to Secondary Progressive Multiple Sclerosis: Results of an International Nominal Group Study. Front Neurol 2020; 11:798. [PMID: 33013615 PMCID: PMC7461961 DOI: 10.3389/fneur.2020.00798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022] Open
Abstract
Background: ManTra is a mixed-methods, co-production research project for developing an intervention (resource) for people with newly diagnosed secondary progressive multiple sclerosis (pwSPMS) in Italy and Germany. In previous project actions, six resources were outlined, meeting the needs prioritized by pwSPMS. Aims: This study aims to achieve multiple-stakeholder consensus on the most suitable resource and to refine the consensus resource. Methods: Two nominal group technique (NGT) meetings were held, one in Milan and one in Hamburg. Participants were pwSPMS (five in Italy/six in Germany), pwSPMS significant others (SOs, four/five), healthcare professionals (HPs, seven/four), and health service researchers/patient and citizen organizations representatives (HPCORs, five/five). Two of the four resources discussed in each meeting were the same in Italy and Germany: “Promoting the engagement of pwSPMS: a program for the patients and the HPs” and “Enriched physiotherapy program for pwSPMS.” The other two were “A personalized care plan for pwSPMS” and “Roadmap for social and economic benefits” in Italy and “Metacognitive and everyday life training for pwSPMS” and “Psychological support for pwSPMS” in Germany. Each meeting consisted of two plenary sessions and a parallel group session (four stakeholder groups: pwSPMS, SOs, HPs, and HPCORs) in between. Meetings' narratives were analyzed thematically. Results: The two meetings were rich in participation and discussion. In Italy, the consensus resource was “A personalized care plan for pwSPMS.” Refinements included enrichment with pwSPMS engagement, inclusion of additional HPs, improved definition of the MS nurse's role within the interdisciplinary panel, and community care integration. In Germany, the consensus resource was “Psychological support for pwSPMS.” Refinements included reshaping this resource into a more comprehensive and adaptive rehabilitation intervention and training the psychologist in recognizing client's rehabilitative needs and enhancing his/her autonomy. Conclusions: The NGT eased multiple-stakeholder deliberation and resource fine-tuning in both countries.
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Affiliation(s)
- Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Unit of Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Barabasch
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Psychology, University of Turin, Turin, Italy
| | - Rui Quintas
- Unit of Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Serena Barello
- EngageMinds Hub-Consumer, Food & Health Engagement Research Center, Department of Psychology, Università Cattolica del Sacro Cuore, Cremona, Italy
| | - Guendalina Graffigna
- EngageMinds Hub-Consumer, Food & Health Engagement Research Center, Department of Psychology, Università Cattolica del Sacro Cuore, Cremona, Italy
| | - Sara Alfieri
- Unit of Clinical Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Milan, Italy
| | - Insa Schiffmann
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Cathleen Muche-Borowski
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Borreani
- Unit of Clinical Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Milan, Italy
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Reyes S, Suarez S, Allen‐Philbey K, Thomson A, Giovannoni G. The impact of social capital on patients with multiple sclerosis. Acta Neurol Scand 2020; 142:58-65. [PMID: 32189325 DOI: 10.1111/ane.13244] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/27/2020] [Accepted: 03/16/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the association between social capital (SC) and the physical and psychological impact of multiple sclerosis (MS). MATERIALS & METHODS A cross-sectional study was conducted among people with MS (pwMS) at The Royal London Hospital, London, UK. Participants completed a survey including the Multiple Sclerosis Impact Scale-29 (MSIS-29), the Hospital Anxiety and Depression Scale (HADS), the self-reported EDSS and a SC questionnaire (SCQ). The SCQ assessed personal relationships, social support networks, civic engagement, and trust and cooperative norms. Kendall's tau correlation test was performed to measure the correlation between SC and MSIS-29 scores, and multiple linear regressions were conducted to find the best outcome prediction model. RESULTS 236 pwMS participated in the study. Median age was 43.5 years (IQR 35-52). Of the total, 168 (71.2%) were female and 180 (76.3%) had relapsing-remitting MS. Median MSIS-29 scores were 23.7 (IQR 8.8-57.5) for the physical scale and 38.9 (IQR 16.7-55.6) for the psychological scales. Total SC scores were significantly correlated with the MSIS-29 physical (τb = -0.09, P = .02) and psychological scores (τb = -0.23, P < .001). After adjusting for possible confounders, the "personal relationships" domain had a significant effect on the MSIS-29 physical scores (β = -2.70, SE = 1.34; P = .045). Total SC (β = -1.08, SE = 0.33; P = .001) and the "personal relationships" (β = -2.60, SE = 1.20; P = .031) and "trust and cooperative norms" (β = -1.40, SE = 0.61; P = .024) domains had a significant effect on the MSIS-29 psychological scores. CONCLUSIONS Higher levels of SC were associated with lower physical and psychological impact of MS. Emerging evidence on SC and its effects on MS should be translated into interventions designed to promote the health and well-being of pwMS.
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Affiliation(s)
- Saúl Reyes
- Barts and The London School of Medicine and Dentistry Blizard Institute Queen Mary University of London London UK
- Department of Neurology Barts Health NHS Trust Royal London Hospital London UK
| | - Sebastian Suarez
- Department of Internal Medicine Boston Medical Centre Boston MA USA
| | | | - Alison Thomson
- Wolfson Institute Queen Mary University of London London UK
| | - Gavin Giovannoni
- Barts and The London School of Medicine and Dentistry Blizard Institute Queen Mary University of London London UK
- Department of Neurology Barts Health NHS Trust Royal London Hospital London UK
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10
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De la Torre GG, Mato I, Doval S, Espinosa R, Moya M, Cantero R, Gonzalez M, Gonzalez C, Garcia MA, Hermans G, González-Torre S, Mestre JM, Hidalgo V. Neurocognitive and emotional status after one-year of mindfulness-based intervention in patients with relapsing-remitting multiple sclerosis. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:183-192. [DOI: 10.1080/23279095.2020.1732388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
| | - Isabel Mato
- Neuropsychology and Experimental Psychology Lab, University of Cadiz, Cádiz, Spain
| | - Sandra Doval
- Experimental Psychology Department, Complutense University, Madrid, Spain
| | - Raúl Espinosa
- Neurology, University Hospital Puerta del Mar, Cádiz, Spain
| | - Miguel Moya
- Neurology, University Hospital Puerta del Mar, Cádiz, Spain
| | - Rafael Cantero
- Neurology, University Hospital Puerta del Mar, Cádiz, Spain
| | | | - Carmen Gonzalez
- Neuropsychology and Experimental Psychology Lab, University of Cadiz, Cádiz, Spain
| | - Manuel A. Garcia
- Neuropsychology and Experimental Psychology Lab, University of Cadiz, Cádiz, Spain
| | | | - Sara González-Torre
- Neuropsychology and Experimental Psychology Lab, University of Cadiz, Cádiz, Spain
| | - Jose Miguel Mestre
- Neuropsychology and Experimental Psychology Lab, University of Cadiz, Cádiz, Spain
| | - Verónica Hidalgo
- Neuropsychology and Experimental Psychology Lab, University of Cadiz, Cádiz, Spain
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11
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Žiaková K, Čáp J, Miertová M, Gurková E, Kurucová R. An interpretative phenomenological analysis of dignity in people with multiple sclerosis. Nurs Ethics 2020; 27:686-700. [PMID: 31994972 DOI: 10.1177/0969733019897766] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dignity is a fundamental concept in healthcare. The symptoms of multiple sclerosis have a negative effect on dignity. Understanding of lived experience of dignity in people with multiple sclerosis is crucial to support dignity in practice. RESEARCH AIM The aim was to explore the sense of dignity experienced by people with multiple sclerosis. RESEARCH DESIGN AND PARTICIPANTS An interpretative phenomenological analysis design was adopted, using data collected through face-to-face interviews with 14 participants. ETHICAL CONSIDERATIONS The study was approved by the faculty Ethical Committee (No. EC 1828/2016). FINDINGS Four interconnected superordinate themes emerged from analysis: Loss of a fully-fledged life: Violating the dignity-of-self; To accept and fight: Promoting the dignity-of-self; Contempt and rudeness: Indignity-in-relation; and Those who know and see, help: Promoting dignity-in-relation. The loss of former fully-fledged life has a dramatic impact on integrity and impaired dignity-of-self. Accepting illness and changed identity impaired by multiple sclerosis was the step that the participants considered to be important for reacquiring the sense of dignity. The participants encountered misunderstandings, prejudices, embarrassment, insensitive remarks, labelling, unwillingness and impersonal treatment as indignities. Acceptance of their condition, needed support, the feeling of being part of a group, sensitivity and the sharing of problems had a positive effect on their dignity. DISCUSSION Continual changes in functional ability threaten an individual's identity and were experienced as violations of dignity. Based on this, participant's dignity-of-self was not a moral, but much more existential value. Acceptance of changed identity and fighting spirit were important for restoring their dignity-of-self. The misunderstandings, prejudices and unwillingness had a negative impact on their dignity-in-relation. On the other side, support from others in fighting promoted their dignity-in-relation. CONCLUSION Dignity is manifested as a complex phenomenon of lived experience of people with multiple sclerosis and also an umbrella concept for providing good quality of person-centred care.
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Adaptation to the disease – the psychological resources of families struggling with multiple sclerosis. HEALTH PSYCHOLOGY REPORT 2020. [DOI: 10.5114/hpr.2020.94722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Yamaguchi S, Yatsushiro R. Significance and potential of self-management research for HTLV-1 associated myelopathy: review of self-management for people with multiple sclerosis. J Rural Med 2019; 14:7-25. [PMID: 31191762 PMCID: PMC6545424 DOI: 10.2185/jrm.2996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/13/2018] [Indexed: 11/27/2022] Open
Abstract
Objective and Methods: A total of 21 published studies on self-management for people with multiple sclerosis (MS) were reviewed to explore the significance and potential of self-management for people with HTLV-1 associated myelopathy (HAM). These studies were classified based on three concepts: self-management regimen and preferences, context of self-management, and outcomes of self-management. Results: Self-management regimens for people with MS include medical, role, and emotional management. Moreover, self-management regimens are closely associated with the context of self-management, emphasizing the importance of investigating contextual factors and regimens concurrently. Quality of life (QOL) has been evaluated as an outcome of self-management, and self-management has been shown to have both positive and negative effects on the QOL of people with MS. However, insufficient studies focus on self-management regimens and patient preferences; further investigation is necessary to develop effective self-management interventions that reflect the often unique nature of the disease for each individual. The characteristics of HAM are also unique to individual patients. Therefore, investigation of people with HAM in particular is required. Conclusion: This literature review examined the significance of investigating self-management for people with HAM.
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Affiliation(s)
- Saori Yamaguchi
- Department of Fundamental and Clinical Nursing, School of Health Sciences, Faculty of Medicine, Kagoshima University, Japan
| | - Rika Yatsushiro
- Department of Fundamental and Clinical Nursing, School of Health Sciences, Faculty of Medicine, Kagoshima University, Japan
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Thorley EM, Iyer RG, Wicks P, Curran C, Gandhi SK, Abler V, Anderson KE, Carlozzi NE. Understanding How Chorea Affects Health-Related Quality of Life in Huntington Disease: An Online Survey of Patients and Caregivers in the United States. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 11:547-559. [PMID: 29750428 PMCID: PMC6132452 DOI: 10.1007/s40271-018-0312-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Chorea is the hallmark motor feature of Huntington disease (HD) and can negatively impact daily functioning and health-related quality of life (HRQoL). OBJECTIVE The objective of this study was to evaluate how chorea impacts HRQoL and overall functioning among HD patients participating on the PatientsLikeMe website ( www.PatientsLikeMe.com ). METHODS A survey was provided to HD participants and/or their caregivers via PatientsLikeMe (9 February 2017-22 March 2017), comprising multiple-choice and open-ended questions designed to assess how chorea impacts HRQoL and overall functioning, and the importance of treating chorea. The HDQLIFE measurement system was used to evaluate patient-reported outcomes of chorea and compare Anxiety and Stigma scores in participants with high chorea versus those with low chorea [HDQLIFE Chorea scores ≥ 60 (n = 45) vs. < 60 (n = 38)]. RESULTS A total of 115 participants (n = 35 caregivers; n = 80 individuals with HD) were included in this study. Among those experiencing chorea (n = 83, 74% of respondents), 66% indicated it was 'Very Important' to manage chorea; however, only 47% agreed that their current medication regimen helped manage their movements. In general, respondents reported that chorea negatively affected HRQoL [HDQLIFE Chorea mean score (standard deviation): 59.3 (6.1)]. Consistent with this, significantly higher Anxiety (P = 0.0423) and stigma (P < 0.0001) scores were observed among respondents with high chorea than in those with low chorea. CONCLUSIONS These results highlight the negative impact of chorea on HRQoL and overall functioning in individuals with HD. Better chorea treatment options are needed to successfully manage symptoms and to help improve HRQoL in these individuals, and patient experiences of anxiety and stigma should be considered in treatment plans.
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Affiliation(s)
| | - Ravi G Iyer
- Teva Pharmaceutical Industries, 41 Moores Rd, Frazer, PA, 19355, USA
| | - Paul Wicks
- PatientsLikeMe, 160 2nd Street, Cambridge, MA, 02142, USA
| | - Chris Curran
- PatientsLikeMe, 160 2nd Street, Cambridge, MA, 02142, USA
| | - Sanjay K Gandhi
- Teva Pharmaceutical Industries, 41 Moores Rd, Frazer, PA, 19355, USA
| | - Victor Abler
- Teva Pharmaceutical Industries, 41 Moores Rd, Frazer, PA, 19355, USA
| | - Karen E Anderson
- Department of Psychiatry, Georgetown University, Washington, DC, USA
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, 500 S. State Street, Ann Arbor, MI, 48109, USA
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Turcotte S, Vallée C, Vincent C. [Occupational therapy and community integration of adults with neurological conditions: A scoping review]. The Canadian Journal of Occupational Therapy 2019; 85:365-377. [PMID: 30599776 DOI: 10.1177/0008417418813399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND. Although community integration (CI) is the ultimate goal of rehabilitation, it is rarely achieved in clinical settings. PURPOSE. The purpose of this study was to (a) synthesize the state of occupational therapy knowledge related to CI for people with neurological issues and to (b) illustrate how CI is conceptualized within the literature. METHOD. A scoping review was completed using two reviewers, resulting in the selection of 47 articles pertaining to four study populations. Themes common across all client populations were identified through content analysis, and an iterative synthesis was used to analyse the evolution of knowledge. FINDINGS. The selected articles covered craniocerebral trauma ( n = 21, 9 experimental categories [EXP]), medullar injuries ( n = 11, 4 EXP), cerebrovascular injuries ( n = 9, 4 EXP), and multiple sclerosis ( n = 4, 1 EXP). CI was used interchangeably with the term social participation. Fifty-one percent of the articles defined CI solely as part of a measurement tool, and 10% did not provide a definition of CI. The physical dimension of CI had been studied more frequently than the social and psychological dimensions. IMPLICATIONS. Innovative practices should work to enable community inclusion and full citizenship to support the long-term enablement.
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Blundell Jones J, Walsh S, Isaac C. The Relational Impact of Multiple Sclerosis: An Integrative Review of the Literature Using a Cognitive Analytic Framework. J Clin Psychol Med Settings 2018; 24:316-340. [PMID: 28756504 PMCID: PMC5705738 DOI: 10.1007/s10880-017-9506-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This integrative literature review uses cognitive analytic therapy (CAT) theory to examine the impact of a chronic illness, multiple sclerosis (MS), on relationships and mental health. Electronic searches were conducted in six medical and social science databases. Thirty-eight articles met inclusion criteria, and also satisfied quality criteria. Articles revealed that MS-related demands change care needs and alter relationships. Using a CAT framework, the MS literature was analysed, and five key patterns of relating to oneself and to others were identified. A diagrammatic formulation is proposed that interconnects these patterns with wellbeing and suggests potential “exits” to improve mental health, for example, assisting families to minimise overprotection. Application of CAT analysis to the literature clarifies relational processes that may affect mental health among individuals with MS, which hopefully will inform how services assist in reducing unhelpful patterns and improve coping. Further investigation of the identified patterns is needed.
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Affiliation(s)
- Joanna Blundell Jones
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, S10 2TN UK
| | - Sue Walsh
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, S10 2TN UK
| | - Claire Isaac
- Russell Cairns Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU UK
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Anagnostouli M, Katsavos S, Artemiadis A, Zacharis M, Argyrou P, Theotoka I, Christidi F, Zalonis I, Liappas I. Determinants of stigma in a cohort of hellenic patients suffering from multiple sclerosis: a cross-sectional study. BMC Neurol 2016; 16:101. [PMID: 27411373 PMCID: PMC4944520 DOI: 10.1186/s12883-016-0621-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 06/23/2016] [Indexed: 11/18/2022] Open
Abstract
Background Patients suffering from several neurologic disorders may bear the “stigma” of their disease, being disqualified from full social acceptance. Although stigma is considered to be present in Multiple Sclerosis (MS), the factors that influence its levels are ambiguous. Aim of our study was to examine, for the first time in the literature, the basic determinants of stigma in a Hellenic MS-patients cohort, as well as how stigma affects their Quality-of-Life (QoL) profiles. Methods Three hundred forty two patients were recruited in this study. Data collected concerned sociodemographic and disease-related variables, mental illness assessment, Multiple-Sclerosis-QoL-54 (MSQoL-54) and Stigma-Scale-for-Chronic-Illness-24 (SSCI-24) questionnaires. Potential determinants were evaluated with univariate statistical analyses for their contribution to total, internalized (inner-self derived) and externalized (society derived) stigma. Important findings were further evaluated on hierarchical regression models. Results Disability levels were found to be the most powerful predictor in all stigma categories, followed by the presence of mental illness. Working and caregiving status were also ascertained as determinants of internalized stigma. Stigma levels displayed strong negative correlation with all composites of MSQoL-54. Conclusions Stigma is present in the social environment of MS patients and was confirmed as a barrier (according to the International Classification of Functioning, Disability and Health), with detrimental effects on their QoL levels and functioning performances. Disability and mental illness were shown as the principal determinants of stigma, while financial characteristics were not as equally involved. Further validation of these results in other MS populations may provide safer conclusions, towards more efficacious patient-centered care outcomes.
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Affiliation(s)
- Maria Anagnostouli
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece.
| | - Serafeim Katsavos
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
| | - Artemios Artemiadis
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
| | - Markos Zacharis
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
| | - Paraskevi Argyrou
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
| | - Ilia Theotoka
- 1st Department of Psychiatry, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
| | - Fotini Christidi
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
| | - Ioannis Zalonis
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
| | - Ioannis Liappas
- 1st Department of Psychiatry, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece
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Cook JE, Germano AL, Stadler G. An Exploratory Investigation of Social Stigma and Concealment in Patients with Multiple Sclerosis. Int J MS Care 2016; 18:78-84. [PMID: 27134581 DOI: 10.7224/1537-2073.2015-021] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We conducted a preliminary investigation into dimensions of stigma and their relation to disease concealment in a sample of American adults living with multiple sclerosis (MS). METHODS Fifty-three adults with MS in the United States completed an online survey assessing anticipated, internalized, and isolation stigma, as well as concealment. RESULTS Responses to all the scales were relatively low, on average, but above scale minimums (P < .001). Ratings of isolation stigma and concealment were highest. Anticipated stigma strongly predicted concealment. CONCLUSIONS Many adults living with MS may be concerned that they will be the target of social stigma because of their illness. These concerns are associated with disease concealment. More research is needed to investigate how MS stigma and concealment may be independent contributors to health in patients with MS.
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Affiliation(s)
- Jonathan E Cook
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA (JEC); Department of Psychology, Columbia University, New York, NY, USA (ALG); and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (GS)
| | - Adriana L Germano
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA (JEC); Department of Psychology, Columbia University, New York, NY, USA (ALG); and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (GS)
| | - Gertraud Stadler
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA (JEC); Department of Psychology, Columbia University, New York, NY, USA (ALG); and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (GS)
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Siu JYM. Influence of social experiences in shaping perceptions of the Ebola virus among African residents of Hong Kong during the 2014 outbreak: a qualitative study. Int J Equity Health 2015; 14:88. [PMID: 26437961 PMCID: PMC4595049 DOI: 10.1186/s12939-015-0223-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 09/25/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The outbreak of Ebola virus disease (EVD) in Africa in 2014 attracted worldwide attention. Because of the high mortality rate, marginalised social groups are vulnerable to disease-associated stigmatisation and discrimination, according to the literature. In Hong Kong, ethnic minorities such as Africans are often disadvantaged groups because of their low position in the social hierarchy. In 2011, approximately 1700 Africans were residing in Hong Kong. Their overseas experiences during the EVD outbreak were not well documented. Therefore, this study investigated the EVD-associated stigmatisation experiences of African residents of Hong Kong with chronic illnesses, and how these experiences shaped their perceptions of EVD. METHODS A qualitative design with 30 in-depth semistructured interviews was conducted with chronically ill African residents of Hong Kong. RESULTS The interview data showed that the sampled Africans often experienced stigmatisation in their workplaces and in the community during the EVD outbreak. Their experiences of EVD-associated stigma were correlated to the embedded social and cultural values regarding ethnic minorities in Hong Kong. These experiences of being stigmatised shaped the perceptions of the Africans of EVD, leading them to view EVD as shameful and horrifying. They also perceived EVD as retribution and was introduced by Westerners. The participants' perceptions of EVD influenced their responses to and behaviour towards EVD, which may have posed potential threats to Hong Kong's public health. CONCLUSIONS The EVD outbreak was not the only cause of the participants' stigmatisation; rather, their EVD-associated experiences were a continuation and manifestation of the embedded social and cultural values regarding ethnic minorities in Hong Kong. The experiences of being stigmatised shaped the participants' perceptions of EVD. Because of their marginalised social position and isolation from the main community, the participants had extremely limited access to reliable information about EVD. As a result, they used their own cultural beliefs to understand EVD, which might have ultimately influenced their health behaviours. The experiences of the participants showed that ethnic minorities in Hong Kong were in need of more culturally responsive social and health care support to obtain reliable information about the nature of and preventive measures against EVD.
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Affiliation(s)
- Judy Yuen-man Siu
- David C. Lam Institute for East-West Studies (Environment, Health, and Sustainability working group), Hong Kong Baptist University, Kowloon Tong, Hong Kong.
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20
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Kapella MC, Berger BE, Vern BA, Vispute S, Prasad B, Carley DW. Health-related stigma as a determinant of functioning in young adults with narcolepsy. PLoS One 2015; 10:e0122478. [PMID: 25898361 PMCID: PMC4405359 DOI: 10.1371/journal.pone.0122478] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/11/2015] [Indexed: 12/04/2022] Open
Abstract
Symptoms of narcolepsy tend to arise during adolescence or young adulthood, a formative time in human development during which people are usually completing their education and launching a career. Little is known about the impact of narcolepsy on the social aspects of health-related quality of life in young adults. The purpose of this study was to examine relationships between health-related stigma, mood (anxiety and depression) and daytime functioning in young adults with narcolepsy compared to those without narcolepsy. Young adults (age 18–35) with narcolepsy (N = 122) and without narcolepsy (N = 93) were mailed a packet that included questionnaires and a self-addressed postage paid envelope. The questionnaire included demographic information and a composite of instruments including the SF 36, Functional Outcomes of Sleep Questionnaire (FOSQ), Fife Stigma Scale (FSS), Epworth Sleepiness Scale (ESS) and Hospital Anxiety and Depression Scale (HADS). Variable associations were assessed using descriptive statistics, ANOVA, Mann-Whitney U Test, correlations, stepwise multiple regression and path analysis. Young adults with narcolepsy perceived significantly more stigma and lower mood and health-related quality of life than young adults without narcolepsy (p<0.01). Health-related stigma was directly and indirectly associated with lower functioning through depressed mood. Fifty-two percent of the variance in functioning was explained by the final model in the young adults with narcolepsy. Health-related stigma in young adults with narcolepsy is at a level consistent with other chronic medical illnesses. Health-related stigma may be an important determinant of functioning in young adults with narcolepsy. Future work is indicated toward further characterizing stigma and developing interventions that address various domains of stigma in people with narcolepsy.
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Affiliation(s)
- Mary C. Kapella
- Department of Biobehavioral Health Science, Center for Narcolepsy, Sleep & Health Research, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - Barbara E. Berger
- Department of Biobehavioral Health Science, Center for Narcolepsy, Sleep & Health Research, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Boris A. Vern
- Department of Biobehavioral Health Science, Center for Narcolepsy, Sleep & Health Research, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Pulmonary, Critical Care, Sleep & Allergy, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Sachin Vispute
- Department of Biobehavioral Health Science, Center for Narcolepsy, Sleep & Health Research, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Bharati Prasad
- Department of Pulmonary, Critical Care, Sleep & Allergy, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - David W. Carley
- Department of Biobehavioral Health Science, Center for Narcolepsy, Sleep & Health Research, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, United States of America
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Steadman J, Pretorius C. The impact of an online Facebook support group for people with multiple sclerosis on non-active users. Afr J Disabil 2014; 3:132. [PMID: 28730005 PMCID: PMC5443048 DOI: 10.4102/ajod.v3i1.132] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 09/17/2014] [Indexed: 11/07/2022] Open
Abstract
Background Multiple sclerosis (MS) is a debilitating disease and there is little research on support networks for people with MS (PwMS). More specifically, most studies on online support groups focus on those who actively participate in the group, whereas the majority of those who utilise online support groups do so in a passive way. Objectives This study therefore aimed to explore the experiences of non-active users of an online Facebook support group for PwMS. Emphasis was placed on the facilitators and the barriers that were associated with membership to this group. Method An exploratory qualitative research design was implemented, whereby thematic analysis was utilised to examine the ten semi-structured interviews that were conducted. Results Several facilitators were acquired through the online support group; namely emotional support (constant source of support, exposure to negative aspects of the disease), informational support (group as a source of knowledge, quality of information) and social companionship (place of belonging). Some barriers were also identified; namely emotional support (emotions lost online, response to messages, exposure to negative aspects of the disease), informational support (information posted on the group, misuse of group) and social companionship (non-active status) Conclusion These findings demonstrate that the non-active members of the online support group for PwMS have valid reasons for their non-active membership status. More important, the findings suggest that the online Facebook support group provided the group members with an important support network in the form of emotional support, informational support and social companionship, despite their non-active membership status or the barriers that have been identified.
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Affiliation(s)
- Jacqui Steadman
- Department of Psychology, Stellenbosch University, South Africa
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Hartley S, McArthur M, Coenen M, Cabello M, Covelli V, Roszczynska-Michta J, Pitkänen T, Bickenbach J, Cieza A. Narratives reflecting the lived experiences of people with brain disorders: common psychosocial difficulties and determinants. PLoS One 2014; 9:e96890. [PMID: 24805128 PMCID: PMC4013080 DOI: 10.1371/journal.pone.0096890] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 04/13/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND People with brain disorders - defined as both, mental disorders and neurological disorders experience a wide range of psychosocial difficulties (PSDs) (e.g., concentrating, maintaining energy levels, and maintaining relationships). Research evidence is required to show that these PSDs are common across brain disorders. OBJECTIVES To explore and gain deeper understanding of the experiences of people with seven brain disorders (alcohol dependency, depression, epilepsy, multiple sclerosis, Parkinson's disease, schizophrenia, stroke). It examines the common PSDs and their influencing factors. METHODS Seventy seven qualitative studies identified in a systematic literature review and qualitative data derived from six focus groups are used to generate first-person narratives representing seven brain disorders. A theory-driven thematic analysis of these narratives identifies the PSDs and their influencing factors for comparison between the seven disorders. RESULTS First-person narratives illustrate realities for people with brain disorders facilitating a deeper understanding of their every-day life experiences. Thematic analysis serves to highlight the commonalities, both of PSDs, such as loneliness, anger, uncertainty about the future and problems with work activities, and their determinants, such as work opportunities, trusting relationships and access to self-help groups. CONCLUSIONS The strength of the methodology and the narratives is that they provide the opportunity for the reader to empathise with people with brain disorders and facilitate deeper levels of understanding of the complexity of the relationship of PSDs, determinants and facilitators. The latter reflect positive aspects of the lives of people with brain disorders. The result that many PSDs and their influencing factors are common to people with different brain disorders opens up the door to the possibility of using cross-cutting interventions involving different sectors. This strengthens the message that 'a great deal can be done' to improve the lived experience of persons with brain disorders when medical interventions are exhausted.
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Affiliation(s)
- Sally Hartley
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maggie McArthur
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Michaela Coenen
- Department of Medical Informatics, Biometry and Epidemiology – IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Maria Cabello
- Instituto de Salud Carlos lll CIBERSAM, Faculty of Medicine, Universidad Autonoma de Madrid, Instituto de investigacion de la Princesa (IIS-IP), Madrid, Spain
| | - Venusia Covelli
- Neurology, Public Health and Disability Unit, Scientific Directorate, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy
| | | | - Tuuli Pitkänen
- A-Clinic Foundation (A-klinikkasäätiö), Helsinki, Finland
| | | | - Alarcos Cieza
- Department of Medical Informatics, Biometry and Epidemiology – IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University (LMU), Munich, Germany
- Swiss Paraplegic Research (SPR), Nottwil, Switzerland
- Faculty of Social and Human Sciences, University of Southampton, Southampton, United Kingdom
- * E-mail:
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Galushko M, Golla H, Strupp J, Karbach U, Kaiser C, Ernstmann N, Pfaff H, Ostgathe C, Voltz R. Unmet needs of patients feeling severely affected by multiple sclerosis in Germany: a qualitative study. J Palliat Med 2014; 17:274-81. [PMID: 24527993 DOI: 10.1089/jpm.2013.0497] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The needs of patients feeling severely affected by multiple sclerosis (MS) have rarely been investigated. However this is essential information to know before care can be improved, including adding palliative care (PC) services where helpful. Since it remains unclear at what point specialized palliative care should begin for this patient group, this study focuses on needs in general. OBJECTIVE The objective was to explore the subjectively unmet needs of patients feeling severely affected by MS. METHODS The study used a qualitative cross-sectional approach for needs assessment. Fifteen patients self-reporting feeling severely affected by MS were recruited and interviewed using a combination of purposive and convenience sampling (five were accompanied by a caregiver relative). Interviews were recorded and transcribed verbatim, followed by qualitative content analysis. RESULTS Unmet needs were identified in the main categories "support of family and friends," "health care services," "managing everyday life," and "maintaining biographical continuity." Patients expressed the desire for more support from their families and to be viewed as distinct individuals. They see a substantial deficit in the physician-patient relationship and in the coordination of services. A decrease in expressed unmet needs was found for patients more severely affected and less socially integrated. CONCLUSIONS To address the unmet needs of severely affected MS patients, health care services need to be improved and linked with existing PC services. Special attention is required to form supporting professional-patient relationships. Multiprofessional services should be accessible for patients, while integrating relatives. All services should have an individual approach to provide needs-tailored support.
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Affiliation(s)
- Maren Galushko
- 1 Department of Palliative Medicine, University Hospital , Cologne, Germany
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Burgunder JM, Guttman M, Perlman S, Goodman N, van Kammen DP, Goodman L. An International Survey-based Algorithm for the Pharmacologic Treatment of Chorea in Huntington's Disease. PLOS CURRENTS 2011; 3:RRN1260. [PMID: 21975581 PMCID: PMC3166256 DOI: 10.1371/currents.rrn1260] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/02/2011] [Indexed: 11/21/2022]
Abstract
It is generally believed that treatments are available to manage chorea in Huntington’s disease (HD). However, lack of evidence prevents the establishment of treatment guidelines. The HD chorea research literature fails to address the indications for drug treatment, drug selection, drug dosing and side effect profiles, management of inadequate response to a single drug, and preferred drug when behavioral symptoms comorbid to chorea are present. Because there is lack of an evidence base to inform clinical decision-making, we surveyed an international group of experts to address these points. Survey results showed that patient stigma, physical injury, gait instability, work interference, and disturbed sleep were indications for a drug treatment trial. However, the experts did not agree on first choice of chorea drug, with the majority of experts in Europe favoring an antipsychotic drug (APD), and a near equal split in first choice between an APD and tetrabenazine (TBZ) among experts from North America and Australia. All experts chose an APD when comorbid psychotic or aggressive behaviors were present, or when active depression prevented the use of TBZ. However, there was agreement from all geographic regions that both APDs and TBZ were acceptable as monotherapy in other situations. Perceived efficacy and side effect profiles were similar for APDs and TBZ, except for depression as a significant side effect of TBZ. Experts used a combination of an APD and TBZ when treatment required both drugs for control of chorea and a concurrent comorbid symptom, or when severe chorea was inadequately controlled by either drug alone. The benzodiazepines (BZDs) were judged ineffective as monotherapy but useful as adjunctive therapy, particularly when chorea was exacerbated by anxiety. There was broad disagreement about the use of amantadine for chorea. Experts who had used amantadine described its benefit as small and transient. In addition to survey results, this report reviews available chorea studies, and lastly presents an algorithm for the treatment of chorea in HD which is based on expert preferences obtained through this international survey.
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Affiliation(s)
- Jean-Marc Burgunder
- Department of Neurology, University of Bern, Switzerland; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario Canada; David Geffen School of Medicine at UCLA; Institute for Systems Biology, Seattle, WA; Formerly CHDI Foundation, Inc. Presently independent CNS development consultant and Huntington's Disease Drug Works, Lake Forest Park, WA
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Olsson M, Skär L, Söderberg S. Meanings of being received and met by others as experienced by women with MS. Int J Qual Stud Health Well-being 2011; 6. [PMID: 21394245 PMCID: PMC3052635 DOI: 10.3402/qhw.v6i1.5769] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2011] [Indexed: 11/24/2022] Open
Abstract
In order to elucidate meanings of being received and met by others as experienced by women with multiple sclerosis (MS) we conducted a qualitative inquiry. We interviewed 15 women with MS and analysed the interviews with a phenomenological hermeneutic interpretation. The findings were presented in two themes: experiencing oneself as a valuable person and experiencing oneself as diminished. Meanings of being received and met by others, as experienced by women with MS, can be understood as containing two dimensions where treatment from others can mean recognising oneself through confirmation, as well as being ignored due to missing togetherness with others.
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Affiliation(s)
- Malin Olsson
- Department of Health Science, Division of Nursing, Luleå University of Technology, Luleå, Sweden
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Karnilowicz W. Identity and psychological ownership in chronic illness and disease state. Eur J Cancer Care (Engl) 2011; 20:276-82. [PMID: 20738388 PMCID: PMC3056146 DOI: 10.1111/j.1365-2354.2010.01220.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2010] [Indexed: 11/30/2022]
Abstract
Psychological ownership is rarely considered in health discourse related to chronic illness or disease state. Construction of identity is an important consideration within this framework. This autoethnographic study explores psychological ownership and identity related to prostate cancer and chronic illness. Conclusions about the nature of psychological ownership and identity were gathered from the relevant literature and personal experience. Themes include the patient-healthcare professional relationship and that psychological ownership is personal and grounded in an individual's sense of identity, control and perceived capacity to control illness or disease. Personal reflection through autoethnography guides discussion of psychological ownership and identity.
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Affiliation(s)
- W Karnilowicz
- School of Social Sciences and Psychology, Victoria University, Melbourne, Victoria, Australia.
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Landtblom AM, Lang C, Flensner G. The study circle as a tool in multiple sclerosis patient education in Sweden. Patient Prefer Adherence 2008; 2:225-32. [PMID: 19920967 PMCID: PMC2770404 DOI: 10.2147/ppa.s3315] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Patient education plays an important role in the management of chronic diseases that can cause disability and predictable psychosocial problems. Quality of life assessment in multiple sclerosis (MS) has confirmed that psychosocial complications related to working life, marriage/partnership, and the family often occur. Furthermore, symptoms such as fatigue, pain, and sexual dysfunction have a great impact. We wanted to develop and implement study circles to promote the patients' abilities to meet such common problems and to provide a network where they can be autonomous and develop appropriate strategies in self-care and existential problems. METHODS Together with the MS patient organization and a study association, we have arranged study circles for patients with MS, thus providing structured information according to a pedagogic model. The patients are encouraged to work together in groups to learn about the disease and its key symptoms, to develop strategies to master these symptoms in everyday life, and to make necessary changes, ie, self-care management. The programme also contains handicap policies. RESULTS Fifteen study circles with a total of 105 patients started during the first year. Fifteen circle leaders were approved. A focus interview showed that the patients are highly satisfied but also revealed some problems in interactions with health care professionals. The study circles were included in a wider project from a newly started multidisciplinary centre for health education for a variety of chronic diseases causing disability, which aims at becoming a regional interface between the health care system, patient organizations, and educational services. CONCLUSION The study circles have an important role to play in the management of MS. Good organization is required to make such a project work since health care services do not normally work so closely with patient organizations and educational services. PRACTICE IMPLICATIONS Study circles that are permanently established and function well are of great help for the patients and the work at the MS clinic is substantially facilitated. Health care professionals also gain from the arrangement by learning more about the self-perceived impact of the disease.
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Affiliation(s)
- Anne-Marie Landtblom
- Motala General Hospital, Motala, Sweden
- Department of Clinical and Experimental Medicine, Division of Neurology
- Correspondence: Anne-Marie Landtblom, Department of Clinical and Experimental Medicine, Division of Neurology, University of Linköping, Sweden, Tel +46 70 559 1670, Email
| | | | - Gullvi Flensner
- Department of Medicine and Care, Division of Nursing Science, University of Linköping, Sweden
- Department of Nursing, Health and Culture, University West, Trollhättan, Sweden
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