Perceived social support and depression among Veterans with multiple sclerosis

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.

The association between perceived social support and cognition in older adults with and without multiple sclerosis

BACKGROUND

Advances in treatments for Multiple Sclerosis (MS) have resulted in a growing number of aging individuals with MS. Research has shown that perceived social support has protective effects against age-related cognitive decline but no study to date has examined the relationship between perceived social support and cognition in older adults with MS. The current study addressed this gap in knowledge examining the association between perceived social support and cognition in older adults with and without MS.

METHODS

Participants were older adults with MS (n = 67, mean age = 64.75 years;%female =  64.2) and controls (n = 71, mean age = 68.25 years;%female = 57.7) Linear regression models examined the associations of total and domain scores of perceived social support with cognition in the entire sample, and then stratified by group status.

RESULTS

Analyses revealed that total perceived social support, emotional/informational support, and positive social interaction were associated with cognition in the total sample. In stratified analyses, emotional/informational support was significantly associated with cognition in the MS group; however, this association became insignificant when analyses adjusted for depressive symptoms. Positive social interaction was significantly associated with cognition in the control group. Notably, this association remained significant even after adjusting for depressive symptoms.

CONCLUSION

These findings suggest that distinct dimensions of perceived social support may have differential relationships with cognitive function in older adults with MS and healthy controls.

[Relationship between social support and depression among older people from elderly care social organizations in Anhui Province, China]

OBJECTIVE

To examine the relationship between absent social support and depression among older adults from elderly care social organizations in Anhui Province, China.

METHODS

A cross-sectional study using a multi-stage stratified random sampling method was conducted in six selected cities of Anhui Province, China. A linear regression model was employed to estimate the association between absent social support and depression.

RESULTS

All in all, 1167 older people were included. Social support and the three dimensions studied were all negatively correlated with depression. These findings suggest that older people from elderly care organizations, who reported higher social support, were less likely to develop depression. This association also existed after stratified analysis in different areas: household (urban/rural), age and gender.

DISCUSSION

A higher level of social support was correlated with lower chances of experiencing depression. These findings are consistent with the majority of previous literature having reported on social support among elderly populations. However, some of our findings differ from those of other studies.

CONCLUSIONS

Our study suggests that improved social support could help to prevent depression among older adults.

Understanding quality of life across different clinical subtypes of multiple sclerosis: a thematic analysis

PURPOSE

Multiple sclerosis (MS) is a neurological disease that has different clinical presentations and illness trajectories. The aim of this study was to explore factors that are important for quality of life (QoL) of people with MS (pwMS), and to understand how they may differ across three subtypes.

METHODS

Both convenience and purposive sampling were employed. Semi-structured interviews were conducted with people with relapsing-remitting MS (n = 16), secondary progressive MS (n = 14), and primary progressive MS (n = 13). All interviews were audio recorded and then transcribed verbatim for thematic analysis involving both inductive and deductive processes. A separate analysis for each subtype was made during the inductive process before examining for similarities and differences across the three subtypes in the deductive process.

FINDINGS

Four factors were identified to have an important influence on QoL of pwMS: restricted and disrupted enjoyment, disturbed future, challenged sense of self, and well-being of significant others. The themes reflect how pwMS commonly perceived enjoyment as a purpose of life, while also illustrating how their QoL may be questioned because of new perspectives going forward with MS, challenges to their sense of self, and increased concerns for their significant others as a result of MS. Subtype differences were attributed to different illness trajectories: relapsing or progressive.

CONCLUSIONS

There are subtype differences in the negative impact of MS on QoL. Clinicians are encouraged to understand the challenges of different illness trajectories, in particular the traumatic nature of relapses and steady worsening of symptoms among those with progressive subtypes of MS.

Depression and Inflammatory Markers in Veterans With Multiple Sclerosis

Multiple sclerosis (MS), an inflammatory neurodegenerative disease of the central nervous system (CNS), afflicts over one per thousand people in the United States. The pathology of MS typically involves lesions in several regions, including the brain and spinal cord. The manifestation of MS is variable and carries great potential to negatively impact quality of life (QOL). Evidence that inflammatory markers are related to depression in MS is accumulating. However, there are barriers in precisely identifying the biological mechanisms underlying depression and inflammation. Analysis of cytokines provides one promising approach for understanding the mechanisms that may contribute to MS symptoms.

METHODS

In this pilot study, we measured salivary levels of interleukin (IL)-6, IL-1beta (β), and IL-10 in 24 veterans with MS. Descriptive statistics were reported and Pearson correlation coefficients were obtained between cytokines and depression.

RESULTS

The anti-inflammatory cytokine IL-10 was significantly negatively associated with depression in veterans with MS (r = -0.47, p = .024).

CONCLUSION

Cytokines may be useful for elucidating biological mechanisms associated with the depression and a measure for nurses caring for veterans with MS.

Impact of perceived social support on depression in Chinese rural-to-urban migrants: The mediating effects of loneliness and resilience

The present study aimed to examine whether loneliness and resilience played the roles of mediators on the relationship between perceived social support and depression. A total of 712 Chinese rural-to-urban migrants from Nanjing, who were measured with perceived social support, resilience, loneliness, and depression, participated in the study. Results indicated that perceived social support and resilience were negatively associated with depression. Loneliness was a significant and negative predictor for depression. In addition, we also revealed that resilience and loneliness partially mediated the relationship between perceived social support and depression. These findings might develop a better understanding of depression in the course of migration.

Depression and perceived social support among Saudi patients with multiple sclerosis

PURPOSE

To examine the association between depression level and perceived social support among patients with multiple sclerosis (MS) in Saudi Arabia.

DESIGN AND METHODS

A cross-sectional, descriptive, correlational design was used with 140 patients. A self-reporting questionnaires were used.

FINDINGS

The age range of the participants was 18-59 years (mean 34.3 years, SD 7.69). The mean score for reported depression was 27.5 which is considered as moderate level of depression. The mean score of the Multidimensional Scale of Perceived Social Support (MSPSS) was 45.3 (SD = 16.2). Patients with MS who received higher level of social support exhibits lower level of depression.

PRACTICE IMPLICATIONS

Aside from addressing physiological needs, healthcare providers must ensure that patients with MS receive positive social support to decrease level of depression.

Subjective and psychological well-being in Parkinson's Disease: A systematic review

OBJECTIVES

The aim of this review is to summarize studies investigating subjective and psychological well-being in patients with Parkinson's disease (PD).

MATERIALS AND METHODS

A systematic and integrative review according to PRISMA criteria was performed with a literature search from inception up to September 2017 in multidisciplinary databases (PubMED, Scopus, Web of Knowledge) by combining together key words related to PD and well-being. Studies were included if: their full-text was available; they involved PD patients; focused on the selected positive dimensions; written in English. Case studies, conference proceedings, abstract, dissertations, book chapters, validation studies and reviews were excluded. Data extracted from the studies included sample characteristics, the positive dimension investigated, type of measure, study aims, design and results. One reviewer extracted details and commented results with other reviewers. The studies' quality was assessed following Kmet, Lee, and Cook.

RESULTS

Out of 1425 studies extracted, 12 studies (9 quantitative, 2 qualitative, 1 mixed methods) involving 2204 patients with PD were included. Most of the studies had a cross-sectional design and/or evaluated the effect of physical rehabilitation on well-being. Articles documented that the illness could impair well-being for its progressive impact on patients' motor autonomy. Preserving motor and musculoskeletal functioning facilitate patients' experience of well-being, social contribution and the maintenance of their job.

CONCLUSIONS

Research on positive resources in PD is still scarce compared to other chronic illnesses. The few available investigations suggest the need of preserving motor abilities by proper rehabilitation programs for maintaining and/or promoting patients' well-being and life engagement.

Mental Health Comorbidity in MS: Depression, Anxiety, and Bipolar Disorder

Among individuals with multiple sclerosis (MS), mental health comorbidities play a significant role in contributing to secondary disability and detracting from quality of life. This review examines current evidence surrounding three mental health issues of particular relevance to MS: depression, anxiety, and bipolar disorder. We review what is known of the prevalence, correlates, screening mechanisms, and current treatment of each issue and provide recommendations for future areas of research.

Social relationships, mental health and wellbeing in physical disability: a systematic review

BACKGROUND

Research has consistently found that favourable exchange with one's proximal social environment has positive effects on both mental health and wellbeing. Adults with physical disabilities may have fewer opportunities of favourable exchange, and therefore the effects on mental health and wellbeing may be less advantageous. The aim of this study is to systematically review quantitative studies exploring associations of social relationships with mental health and wellbeing in persons with physical disabilities.

METHODS

The databases PubMed, PsycINFO and Scopus were searched for relevant studies published between 1995 and 2016. Data was extracted on study and participants' characteristics, independent and dependent variables, used measures and effects sizes of associations between social relationships and mental health or wellbeing. A narrative review was performed to synthesize findings along the constructs social support, social networks, negative social interactions, family functioning and relationship quality.

RESULTS

Of the 63 included studies, 47 were cross-sectional and 16 longitudinal. Most studies included a measure of social support (n = 58), while other concepts were less often studied (social networks n = 6; negative social interaction n = 3; family functioning n = 2; relationship quality n = 1). Over half of studies included depression as outcome (n = 33), followed by wellbeing (n = 14), composite mental health measures (n = 10), anxiety (n = 8), psychological distress (n = 7), posttraumatic stress disorder (n = 3), and hopelessness (n = 1). Although trends for associations of social support with mental health and wellbeing were consistent, around a quarter of studies failed to report significant associations. Social networks were related to depression, but not to other mental health or wellbeing measures. Family functioning, negative social interactions and relationship quality showed consistent associations with mental health and wellbeing, however, only few studies were available.

CONCLUSIONS

This review indicates that social relationships play an important role in mental health and wellbeing in persons with disabilities, although findings are less consistent than in general populations and strength of associations vary between constructs. Integrating persons with disabilities into social networks seems not sufficient and rehabilitation professionals together with affected persons and their peers should ensure that high quality relationships and tailored support are available.

Resilience Mediates the Longitudinal Relationships Between Social Support and Mental Health Outcomes in Multiple Sclerosis

OBJECTIVES

To investigate the longitudinal relationships between social support and subsequent mental health outcomes in individuals with multiple sclerosis (MS), and to examine resilience as a mediator between social support and subsequent mental health outcomes in this population.

DESIGN

Observational, longitudinal cohort study. Participants were assessed at 4 time points over 12 months in the context of a previously reported randomized controlled trial.

SETTING

Telephone-based measures administered to community-based participants.

PARTICIPANTS

Individuals (N=163) with MS and 1 or more of the following symptoms: depression, fatigue, and pain.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Mental health outcomes included (1) depressive symptomatology, assessed using the Patient Health Questionnaire-9; (2) anxious symptomatology, assessed using the short form of the Emotional Distress-Anxiety Scale from the Patient-Reported Outcomes Measurement Information System; and (3) general mental health status, assessed using the Mental Component Summary score from the Short Form-8 Health Survey. Resilience was assessed using the Connor-Davidson Resilience Scale.

RESULTS

At any given time, social support from significant others, family members, and friends was significantly associated with subsequent mental health outcomes for all 3 measures assessed (all P values <.05). Resilience measured concomitantly with social support significantly mediated the relationships between social support and subsequent mental health outcomes. After controlling for resilience, most of the direct relationships between social support and mental health outcomes were no longer significant.

CONCLUSIONS

There are significant longitudinal relationships between social support, resilience, and mental health outcomes for people with MS. Given the mediating role of resilience in supporting better mental health outcomes, future clinical research and practice may benefit from an emphasis on resilience-focused psychological interventions.

Comorbid trajectories of postpartum depression and PTSD among mothers with childhood trauma history: Course, predictors, processes and child adjustment

BACKGROUND

Both postpartum depression and posttraumatic stress disorder (PTSD) have been identified as unique risk factors for poor maternal psychopathology. Little is known, however, regarding the longitudinal processes of co-occurring depression and PTSD among mothers with childhood adversity. The present study addressed this research gap by examining co-occurring postpartum depression and PTSD trajectories among mothers with childhood trauma history.

METHODS

177 mothers with childhood trauma history reported depression and PTSD symptoms at 4, 6, 12, 15 and 18 months postpartum, as well as individual (shame, posttraumatic cognitions, dissociation) and contextual (social support, childhood and postpartum trauma experiences) factors.

RESULTS

Growth mixture modeling (GMM) identified three comorbid change patterns: The Resilient group (64%) showed the lowest levels of depression and PTSD that remained stable over time; the Vulnerable group (23%) displayed moderately high levels of comorbid depression and PTSD; and the Chronic High-Risk group (14%) showed the highest level of comorbid depression and PTSD. Further, a path model revealed that postpartum dissociation, negative posttraumatic cognitions, shame, as well as social support, and childhood and postpartum trauma experiences differentiated membership in the Chronic High-Risk and Vulnerable. Finally, we found that children of mothers in the Vulnerable group were reported as having more externalizing and total problem behaviors.

LIMITATIONS

Generalizability is limited, given this is a sample of mothers with childhood trauma history and demographic risk.

CONCLUSIONS

The results highlight the strong comorbidity of postpartum depression and PTSD among mothers with childhood trauma history, and also emphasize its aversive impact on the offspring.

The impact of social support on psychological distress for U.S. Afghanistan/Iraq era veterans with PTSD and other psychiatric diagnoses

This study aimed to examine the degree to which posttraumatic stress disorder (PTSD) affects the relationship between social support and psychological distress for U.S. Afghanistan/Iraq era veterans with and without co-occurring psychiatric disorders. Veterans (N=1825) were administered self-report questionnaires and a structured diagnostic interview as part of a multi-site study of post-deployment mental health through the Department of Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC). Main and interaction effects models assessed the association between psychological distress and social support for three comparisons conditions (Controls vs. PTSD-only, non-PTSD, and PTSD plus co-morbid diagnoses). Having PTSD was a critical factor in attenuating the strength of this association, more so than other diagnoses. Furthermore, those with PTSD plus co-morbid diagnoses did not demonstrate significantly larger attenuation in that association compared to the PTSD-only group, indicating that psychiatric comorbidity may be less important in considering the role of social support in PTSD. By understanding this relationship, new avenues for engaging and enhancing treatment outcomes related to social support for veterans of this cohort may be identified. Additional longitudinal research could help evaluate the effect of PTSD symptom clusters, social support type, and trauma exposure type on these relationships.

Psychological distress and comorbid physical conditions: disease or disability?

BACKGROUND

The relationship between comorbidity and psychological distress is well documented, however the mechanism of this association is unclear. We aim to assess the extent to which the association between common chronic conditions and high scores on the Kessler Psychological Distress Scale (K10) measure of psychological distress vary according to comorbid conditions, disability, and sociodemographic circumstances.

METHODS

Analysis of self-reported cross-sectional data from the New South Wales 45 and Up Study, Australia, for 236,508 participants aged 45 years and over, using logistic regression modeling.

RESULTS

Self-reported heart attack/angina, other heart disease, stroke, and diabetes were all significantly associated with higher risk of high/very high K10 scores. These associations were attenuated, but remained statistically significant, when comorbidity, disability, and sociodemographic factors were added to the model. Men reporting needing help for daily tasks were nine times as likely to report high/very high K10 scores as those without this need, and women reporting needing help were seven times more likely to have high/very high K10 scores.

CONCLUSIONS

Heart attack/angina, other heart disease, stroke, and diabetes are all significantly associated with psychological distress. However, these effects are partly explained by other comorbid conditions, limitations on physical functioning, and sociodemographic factors. These findings highlight the importance of developing public health policies that encompass psychological, physiological, and social domains, and provide crucial insights for clinicians in identifying and supporting those people at risk of psychological distress.

Social support, depression, and physical disability: age and diagnostic group effects

BACKGROUND

Social support is an important resource that may benefit individuals aging with physical disabilities, although its effects may vary depending on age, sex, and type of disability.

OBJECTIVES

To (1) examine differences in social support--and how support might vary as a function of age and sex--in samples of individuals with multiple sclerosis (MS), spinal cord injury (SCI), and muscular dystrophy (MD) and (2) understand the extent that associations between different support domains and depression might be moderated by disability diagnosis, sex and age.

METHODS

A convenience sample (N = 1416) of individuals with MS, SCI, and MD completed surveys that included measures of perceived social support and depressive symptoms.

RESULTS

No significant support differences were found between diagnostic groups. There was a gradual decrease in social support with chronological age, and women reported more support than men, particularly friend support. Levels of perceived friend support were negatively associated with depression, and the associations between social support and depression did not differ as a function of age, sex, or diagnosis.

CONCLUSIONS

Social support is similarly associated with lower levels of depression for men and women, across disability diagnoses and all ages. Being a man and being older may be associated with lower levels of perceived support. Research is needed to determine if interventions that improve support will decrease depression and improve quality of life in persons with disabilities, particularly for men and individuals who are aging.