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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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Mei Y, Yang X, Gui J, Li Y, Zhang X, Wang Y, Chen W, Chen M, Liu C, Zhang L. The relationship between psychological resilience and depression among the diabetes patients under the background of "dynamic zero COVID-19": the mediating role of stigma and the moderating role of medication burden. Front Public Health 2023; 11:1124570. [PMID: 37680269 PMCID: PMC10481163 DOI: 10.3389/fpubh.2023.1124570] [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: 12/15/2022] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
Objective Depression in diabetes patients is caused by their own disease or the surrounding social environment. How to cope with changes in mentality and adjust psychological stress responses, especially under China's dynamic zero COVID-19 policy, is worth further discussion. The researchers constructed a moderated mediation model to test the effect of psychological resilience during dynamic zero COVID-19 on depression in diabetes patients and the mediating role of stigma and the moderating effect of medication burden. Method From June to September, 2022, data were collected in Jinghu District, Wuhu City, Anhui Province, by multi-stage stratified sampling. Firstly, we selected a tertiary hospital randomly in Jinghu District. Secondly, departments are randomly chosen from the hospital. Finally, we set up survey points in each department and randomly select diabetes patients. In addition, we used the Connor-Davidson Elasticity Scale (CD-RISC) to measure psychological resilience of patients, and used the Stigma Scale for Chronic Illness (SSCI) to measure stigma, medication burden was measured by the Diabetes Treatment Burden Scale (DTBQ), and depression was assessed by the Patient Health Questionnaire-9 (PHQ-9). We used SPSS (version 23.0) and PROCESS (version 4.1) for data analysis. Results (1) Psychological resilience was negatively correlated with stigma, medication burden, and depression. Stigma was positively associated with medication burden and depression. Medication burden and depression are positively correlated, (2) The mediation analysis showed that psychological resilience had a direct predictive effect on depression, and stigma partially mediated the relationship, and (3) Medication burden moderates the direct pathway by which psychological resilience predicts depression; Medication burden moderates the first half of "psychological resilience → stigma → depression." Conclusion Under the mediating effect of stigma, psychological resilience can improve depression. Medication burden has a moderating effect on the relationship between psychological resilience and depression, and it also has a moderating effect on the relationship between psychological resilience and stigma. These results facilitate the understanding of the relationship mechanisms between psychological resilience and depression.
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Affiliation(s)
- Yujin Mei
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - Xue Yang
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - JiaoFeng Gui
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - YuQing Li
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - XiaoYun Zhang
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - Ying Wang
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - Wenyue Chen
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - Mingjia Chen
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - Changjun Liu
- School of Marxism, Jinzhou Medical University, Jinzhou City, Liaoning Province, China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
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Sainz de la Maza S, Maurino J, Castillo-Triviño T, Borges M, Sebastián Torres B, Sotoca J, Alonso Torres AM, Caminero AB, Borrega L, Sánchez-Menoyo JL, Barrero-Hernández FJ, Calles C, Brieva L, Blasco MR, Dotor García-Soto J, Rodríguez-Regal A, Navarro-Cantó L, Agüera-Morales E, Garcés M, Carmona O, Gabaldón-Torres L, Forero L, Hervás M, Gómez-Ballesteros R. Hopelessness in Patients with Early-Stage Relapsing-Remitting Multiple Sclerosis. Patient Prefer Adherence 2023; 17:1431-1439. [PMID: 37337517 PMCID: PMC10277026 DOI: 10.2147/ppa.s411069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/25/2023] [Indexed: 06/21/2023] Open
Abstract
Background Hopelessness is a risk factor for depression and suicide. There is little information on this phenomenon among patients with relapsing-remitting multiple sclerosis (RRMS), one of the most common causes of disability and loss of autonomy in young adults. The aim of this study was to assess state hopelessness and its associated factors in early-stage RRMS. Methods A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. The State-Trait Hopelessness Scale (STHS) was used to measure patients´ hopelessness. A battery of patient-reported and clinician-rated measurements was used to assess clinical status. A multivariate logistic regression analysis was conducted to determine the association between patients' characteristics and state hopelessness. Results A total of 189 patients were included. Mean age (standard deviation-SD) was 36.1 (9.4) years and 71.4% were female. Median disease duration (interquartile range-IQR) was 1.4 (0.7, 2.1) years. Symptom severity and disability were low with a median EDSS (IQR) score of 1.0 (0, 2.0). A proportion of 65.6% (n=124) of patients reported moderate-to-severe hopelessness. Hopelessness was associated with older age (p=0.035), depressive symptoms (p=<0.001), a threatening illness perception (p=0.001), and psychological and cognitive barriers to workplace performance (p=0.029) in the multivariate analysis after adjustment for confounders. Conclusion Hopelessness was a common phenomenon in early-stage RRMS, even in a population with low physical disability. Identifying factors associated with hopelessness may be critical for implementing preventive strategies helping patients to adapt to the new situation and cope with the disease in the long term.
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Affiliation(s)
| | | | | | - Mónica Borges
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Javier Sotoca
- Department of Neurology, Hospital Universitari Vall d´Hebrón, Barcelona, Spain
| | | | - Ana B Caminero
- Department of Neurology, Complejo Asistencial de Ávila, Ávila, Spain
| | - Laura Borrega
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | | | | | - Carmen Calles
- Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | | | - Ana Rodríguez-Regal
- Department of Neurology, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Laura Navarro-Cantó
- Department of Neurology, Hospital General Universitario de Elche, Elche, Spain
| | | | - Moisés Garcés
- Department of Neurology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Olga Carmona
- Department of Neurology, Fundació Salut Empordà, Figueres, Spain
| | | | - Lucía Forero
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Mariona Hervás
- Department of Neurology, Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
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Ashager K, Feleke MG, Degefu S, Elfios E, Getnet A, Ezo E, Sintayehu M. Psychological distress and associated factors among asthmatic patients in Southern, Ethiopia, 2021. Asthma Res Pract 2023; 9:4. [PMID: 37271820 DOI: 10.1186/s40733-023-00093-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND There is an increased prevalence of psychological distress in adults with asthma. Psychological distress describes unpleasant feelings or emotions that impact the level of functioning. It is a significant exacerbating factor in asthma control. Addressing factors that contribute to psychological distress in those asthma patients improves asthma outcomes. So, this study aimed to assess the prevalence of psychological distress and associated factors among asthmatic patients at Hawassa public hospitals, Ethiopia, 2021. METHODS Institution-based cross-sectional study design was used to select 394 asthma patients. Proportional allocation and systematic sampling techniques were used to select study participants. A logistic regression model was used to assess the predictors and psychological distress of the asthmatic patient. The association was interpreted using the odds ratio and 95% confidence interval. RESULT A total of 394 asthma patients participated in the study, giving a response rate of 93.4%. The prevalence of psychological distress among asthmatic patients was 51% [95%CI: 46%-56%]. Participants who had comorbid medical illness [AOR: 6.049, 95% CI (3.131-11.684)], experienced stigma [AOR: 3.587, 95%CI (1.914-6.723)], chewed khat [AOR: 7.268, 95%CI (3.468-15.231)], had poor social support and had uncontrolled asthma were significantly associated with psychological distress in asthmatic patients. CONCLUSION This study demonstrated that the prevalence of psychological distress was found to be high among asthmatic patients. Social support, stigma, chewing khat, comorbid medical illness, and poor asthmatic control had significantly associated with psychological distress in asthmatic patients.
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Affiliation(s)
- Kidist Ashager
- Department of Nursing, School of Nursing, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia.
| | - Mulualem Gete Feleke
- Department of Nursing, School of Nursing, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia.
| | - Sindu Degefu
- Department of Nursing, School of Nursing, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia
| | - Eshetu Elfios
- Department of Nursing, School of Nursing, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia
| | - Asmamaw Getnet
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Elias Ezo
- Department of Nursing, College of Medicine and Health Sciences, Wachamo University, Hosaena, Ethiopia
| | - Mezinew Sintayehu
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Tworek G, Thompson NR, Kane A, Sullivan AB. The impact of stigma on perceived quality of life and experience of anxiety and depression in individuals diagnosed with MS. Mult Scler Relat Disord 2023; 72:104591. [PMID: 36913825 DOI: 10.1016/j.msard.2023.104591] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/13/2023] [Accepted: 02/23/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Stigma experienced by persons living with multiple sclerosis (PwMS) is underrepresented in the literature. Discovering how the experience of stigma impacts quality of life and mood symptoms in PwMS may guide future care considerations with the goal of improving overall quality of life. METHODS A retrospective review of data from the Quality of Life in Neurological Disorders (Neuro-QoL) set of measures and PROMIS Global Health (PROMIS-GH) scale was conducted. Multivariable linear regression was used to assess relationships between baseline (first visit) Neuro-QoL Stigma, Anxiety, Depression, and PROMIS-GH. Mediation analyses examined whether mood symptoms mediated the relationship between stigma and quality of life (PROMIS-GH). RESULTS 6,760 patients (mean age 60.2 ± 8.9 years, 27.7% male, 74.2% white) were included. Neuro-QoL Stigma was significantly related to PROMIS-GH Physical Health (beta=-0.390, 95% CI [-0.411, -0.368]; p < 0.001) and PROMIS-GH Mental Health (beta=-0.595, 95% CI [-0.624, -0.566]; p < 0.001). Neuro-QoL Stigma was also significantly related to Neuro-QoL Anxiety (beta=0.721, 95% CI [0.696, 0.746]; p < 0.001) and Neuro-QoL Depression (beta=0.673, 95% CI [0.654, 0.693]; p < 0.001). Mediation analyses revealed that both Neuro-QoL Anxiety and Depression partially mediated the relationship between Neuro-QoL Stigma and PROMIS-GH Physical and Mental Health. CONCLUSION Results demonstrate stigma is associated with decreased quality of life in both physical and mental health domains in PwMS. Stigma was also associated with more significant symptoms of anxiety and depression. Finally, anxiety and depression play a mediating role in the relationship between stigma and both physical and mental health in PwMS. Therefore, tailoring interventions to effectively reduce symptoms of anxiety and depression in PwMS may be warranted, as it will likely improve overall quality of life and reduce negative impacts of stigma.
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Affiliation(s)
- Grace Tworek
- Cleveland Clinic Mellen Center for Multiple Sclerosis, 9500 Euclid Ave/ U10, Cleveland, OH 44195, USA.
| | - Nicolas R Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA; Center for Outcomes Research & Evaluation, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Alexa Kane
- Cleveland Clinic Mellen Center for Multiple Sclerosis, 9500 Euclid Ave/ U10, Cleveland, OH 44195, USA
| | - Amy B Sullivan
- Cleveland Clinic Mellen Center for Multiple Sclerosis, 9500 Euclid Ave/ U10, Cleveland, OH 44195, USA
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Desalegn GT, Zeleke TA, Shumet S, Mirkena Y, Kassew T, Angaw DA, Salelew E. Coping strategies and associated factors among people with physical disabilities for psychological distress in Ethiopia. BMC Public Health 2023; 23:20. [PMID: 36600278 DOI: 10.1186/s12889-022-14877-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Coping strategies are frequently used among individuals with physical disabilities when they face adversities. Low- and middle-income countries are not investigated coping styles among psychological distress persons with disabilities despite the high prevalence of psychological distress. The aim of this study was to identify coping strategies among people with physical disabilities for their psychological distress in Ethiopia has a crucial role to improve the health status of persons with physical disabilities. METHODS An institution-based cross-sectional study was employed among individuals living with physical disabilities at the University of Gondar staff and students from May to June 2021. All staff and students with physical disabilities were screened for psychological distress (n = 269). The census sampling technique was used to select the study participants for psychological distress. The Brief Cope with Problems Experienced (COPE-28) was used to assess coping strategies. Bivariate and multivariate linear regression analyses were used to identify factors associated with coping strategies. An odd ratio (OR) with a 95% confidence interval (CI) at P < 0.05 was computed to assess the strength of the association. RESULTS The emotional-focused coping strategy was the most frequently used when dealing with psychological distress among participants with physical disabilities. The most commonly used emotional-focused coping strategy was spirituality. In the multivariate analyses; urban residence (β = 3.05, 95% CI: 0.98, 5.12), and stigma (β = 3.10, 95% CI: 0.61, 2.83) were factors positively associated with emotion-focused coping strategy, and World Health Organization Quality of Life (WHO QOL) (β = 0.18, 95% CI: 0.13, 0.22), and stigma (β = 1.11, 95% CI: 0.61, 2.83) were factors significantly associated with problem-focused coping. Urban residence (β= -0.96, 95% CI: -1.69, -0.22) was negatively associated with dysfunctional coping strategy, but WHO QOL (β = 0.35, 95% CI: 0.32, 0.38) was positively correlated with dysfunctional coping. CONCLUSION In this study revealed that spirituality is the most frequently used coping strategy among the study participants. Urban residents, stigma, and WHO QOL significantly correlated with coping strategies among such patients. The Ministry of Health, Ministry of Education, and other concerned organizations may find the present findings useful to strengthen the coping styles to minimize psychological distress among people with physical disabilities.
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Affiliation(s)
- Getachew Tesfaw Desalegn
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, P. O. Box: 196, Northwest Gondar, Ethiopia.
| | - Tadele Amare Zeleke
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, P. O. Box: 196, Northwest Gondar, Ethiopia
| | - Shegaye Shumet
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, P. O. Box: 196, Northwest Gondar, Ethiopia
| | - Yohannes Mirkena
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, P. O. Box: 196, Northwest Gondar, Ethiopia
| | - Tilahun Kassew
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, P. O. Box: 196, Northwest Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatics Institute of Public Health, College of Medicine and Health Science, University of Gondar, Northwest Gondar, Ethiopia
| | - Endalamaw Salelew
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, P. O. Box: 196, Northwest Gondar, Ethiopia
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Long-term prognosis communication preferences in early-stage relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2022; 64:103969. [PMID: 35728432 DOI: 10.1016/j.msard.2022.103969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/23/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Multiple sclerosis is one of the most common causes of neurological disability in young adults with major consequences for their future lives. Improving communication strategies on prognosis may help patients deal with the disease and adjust their long-term life goals. However, there is limited information on patients' preferences of long-term prognosis (LTP) communication and associated factors. OBJECTIVE The aim of this study was to describe patients' preferences and assess the factors associated with LTP communication preferences in early-stage relapsing-remitting multiple sclerosis (RRMS) patients. METHODS A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration from first attack ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. The Prognosis in MS questionnaire was used to assess how much patients want to know about their LTP. Different patient-reported measures were administered to gather information on symptom severity, pain, fatigue, mood/anxiety, quality of life, stigma, illness perception, feeling of hopelessness, self-efficacy, information avoidance and coping strategies. Cognition was assessed using the Symbol Digit Modalities Test (SDMT). A multivariate logistic regression analysis was performed to assess the association between LTP information preference and demographic and clinical characteristics, as well as patients' perspectives. RESULTS A total of 189 patients were included (mean age: 36.1 ± 9.4 years, 71.4% female, mean disease duration: 1.2 ± 0.8 years). Median EDSS score was 1.0 (IQR = 0.0-2.0). A proportion of 68.5% (n = 126) of patients had never discussed LTP with their neurologists, whereas 69.2% (n = 126) reported interest in knowing it (73.5% at diagnosis). Bivariate analyses suggested that patients were significantly more likely to have higher LTP information preferences if they were male and had a lower SDMT score. Male gender and a lower SDMT score were predictors of LTP information preferences. CONCLUSIONS Patients with early-stage RRMS want to discuss their LTP shortly after diagnosis. Understanding the factors involved may be useful to design individualized communication strategies.
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Meca-Lallana JE, Gómez-Ballesteros R, Pérez-Miralles F, Forero L, Sepúlveda M, Calles C, Martínez-Ginés ML, González-Suárez I, Boyero S, Romero-Pinel L, Sempere ÁP, Meca-Lallana V, Querol L, Costa-Frossard L, Prefasi D, Maurino J. Impact of Neuromyelitis Optica Spectrum Disorder on Quality of Life from the Patients' Perspective: An Observational Cross-Sectional Study. Neurol Ther 2022; 11:1101-1116. [PMID: 35524037 PMCID: PMC9075919 DOI: 10.1007/s40120-022-00356-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Neuromyelitis optica spectrum disorder (NMOSD) is associated with a reduced health-related quality of life (HRQoL). The purpose of this study was to describe the impact of NMOSD on HRQoL from the patients’ perspective and its relationship with other disease factors. Methods An observational, cross-sectional study was conducted at 13 neuroimmunology clinics in Spain. Patients with NMOSD diagnosis (2015 Wingerchuk criteria) were included. The 29-item Multiple Sclerosis Impact Scale (MSIS-29) was used to assess the HRQoL. Different questionnaires were used to measure symptom severity, stigma, mood disorders, pain, fatigue, and difficulties in the workplace. Factors that impact HRQoL were identified by Spearman’s correlation and multivariate linear regression analysis. Results Seventy-one patients were included (mean age 47.4 ± 14.9 years, 80.3% female, mean time since disease onset 9.9 ± 8.1 years). The median Expanded Disability Status Scale score was 3.0 (1.5–4.5). The mean (± SD) physical and psychological MSIS-29 sub-scores were 41.9 ± 16.8 and 20.9 ± 8.3, respectively. Fatigue and body pain were the most prevalent symptoms. Depressive symptoms were found in 44.3% (n = 31) of patients. The physical MSIS-29 dimension showed the highest correlation with symptom severity (ρ = 0.85584, p < 0.0001), whereas the highest correlations for psychological MSIS-29 dimension were pain, MSIS-29 physical dimension, and depression (ρ = 0.76487, 0.72779, 0.71380; p < 0.0001, respectively). Pain was a predictor of both dimensions of MSIS-29. Conclusion Fatigue, pain, and depressive symptoms are frequent problems among patients with NMOSD, impacting on their quality of life. Assessment of patient-oriented outcomes may be useful to achieve a holistic approach, allowing early specific interventions.
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Affiliation(s)
- José E Meca-Lallana
- Clinical Neuroimmunology Unit and Multiple Sclerosis CSUR, Department of Neurology, Hospital Universitario "Virgen de la Arrixaca", IMIB-Arrixaca, Murcia, Spain
| | | | - Francisco Pérez-Miralles
- Unit of Neuroimmunology, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Lucía Forero
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - María Sepúlveda
- Department of Neurology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Carmen Calles
- Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | - Sabas Boyero
- Department of Neurology, Hospital Universitario Cruces, Bilbao, Spain
| | - Lucía Romero-Pinel
- Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ángel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Luis Querol
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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da Graca B, Bennett MM, Powers MB, Gottlieb RL, Waddimba AC, Warren AM. Psychological differences in adults with and without a COVID-19 diagnosis. J Ment Health 2022; 31:560-567. [PMID: 35000538 DOI: 10.1080/09638237.2021.2022617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Substantial evidence is emerging regarding the broad societal and psychological impacts of the COVID-19 pandemic, but little is known about whether infected individuals are differently affected. AIM We evaluated psychological differences between individuals who do vs. do not report testing positive for COVID-19. METHODS An online survey was offered to adults (≥18 years) who were diagnosed with COVID-19 by a provider within a large integrated-delivery healthcare system, enrolled in COVID-19-related clinical trials at the healthcare system, or responded to targeted local distribution. Measures assessed included the 8-item Patient Health Questionnaire depression scale, Generalized Anxiety Disorder 7-item Scale, and Posttraumatic Diagnostic Scale for DSM-5. RESULTS Of 487 respondents, 43% reported testing positive for COVID-19, including 11% requiring hospitalization. Overall rates of general anxiety disorder and posttraumatic stress were 34% and 16%, respectively, with no significant differences between groups. Prevalence of depression was higher among respondents reporting a positive COVID-19 test (52% vs. 31%). This difference persisted after controlling for respondent characteristics (odds ratio = 3.7, p < 0.01). CONCLUSIONS People who report testing positive for COVID-19, even those not requiring hospitalization, have increased risk for depression. Mental health care screening and services should be offered to individuals testing positive, facilitating early intervention.
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Affiliation(s)
| | | | - Mark B Powers
- Baylor University Medical Center, Dallas, TX, USA.,Texas A&M University - College of Medicine, Dallas, TX, USA
| | - Robert L Gottlieb
- Baylor Scott and White Research Institute, Dallas, TX, USA.,Baylor University Medical Center, Dallas, TX, USA.,Texas A&M University - College of Medicine, Dallas, TX, USA
| | - Anthony C Waddimba
- Baylor Scott and White Research Institute, Dallas, TX, USA.,Baylor University Medical Center, Dallas, TX, USA
| | - Ann Marie Warren
- Baylor Scott and White Research Institute, Dallas, TX, USA.,Baylor University Medical Center, Dallas, TX, USA.,Texas A&M University - College of Medicine, Dallas, TX, USA
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Brown R, Coventry L, Sillence E, Blythe J, Stumpf S, Bird J, Durrant AC. Collecting and sharing self-generated health and lifestyle data: Understanding barriers for people living with long-term health conditions - a survey study. Digit Health 2022; 8:20552076221084458. [PMID: 35284085 PMCID: PMC8905063 DOI: 10.1177/20552076221084458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background The growing popularity of collecting self-generated health and lifestyle data presents a valuable opportunity to develop our understanding of long-term health conditions and improve care. Barriers remain to the effective sharing of health and lifestyle data by those living with long-term health conditions which include beliefs around concepts of Trust, Identity, Privacy and Security, experiences of stigma, perceptions of risk and information sensitivity. Method We surveyed 250 UK adults who reported living with a range of long-term health conditions. We recorded data to assess self-reported behaviours, experiences, attitudes and motivations relevant to sharing self-generated health and lifestyle data. We also asked participants about their beliefs about Trust, Identity, Privacy and Security, stigma, and perceptions of risk and information sensitivity regarding their health and lifestyle data. Results Three-quarters of our sample reported recording information about their health and lifestyle on a daily basis. However, two-thirds reported never or rarely sharing this information with others. Trust, Identity, Privacy and Security concerns were considered to be ‘very important’ by those with long-term health conditions when deciding whether or not to share self-generated health and lifestyle data with others, with security concerns considered most important. Of those living with a long-term health condition, 58% reported experiencing stigma associated with their condition. The greatest perceived risk from sharing with others was the potential for future harm to their social relationships. Conclusions Our findings suggest that, in order for health professionals and researchers to benefit from the increased prevalence of self-generated health and lifestyle data, more can be done to address security concerns and to understand perceived risks associated with data sharing. Digital platforms aimed at facilitating the sharing of self-generated health and lifestyle data may look to highlight security features, enable users to control the sharing of certain information types, and emphasise the practical benefits to users of sharing health and lifestyle data with others.
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Affiliation(s)
- Richard Brown
- Psychology Department, Northumbria University, Newcastle, UK
| | - Lynne Coventry
- Psychology Department, Northumbria University, Newcastle, UK
| | | | | | - Simone Stumpf
- Department of Computer Science, City University of London, UK
| | - Jon Bird
- Department of Computer Science, University of Bristol, UK
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Matías-González Y, Sánchez-Galarza A, Rosario-Hernández E, Flores-Caldera I, Rivera-Segarra E. Stigma and social support and their impact on quality of life and self-esteem among women with endometriosis in Latin-America and the Caribbean. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001329. [PMID: 36962832 PMCID: PMC10022163 DOI: 10.1371/journal.pgph.0001329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 11/04/2022] [Indexed: 12/04/2022]
Abstract
Endometriosis is a complex disease affecting approximately 5-10% individuals worldwide. Prevalence rates in Latin-America and the Caribbean are largely unknown, with published data only from Puerto Rico and Chile. Pain associated with endometriosis negatively affects patients' health and quality of life. However, there is a need to better understand the role played by psychosocial variables such as stigma and social support in diverse cultural contexts. The purpose of this study was to examine the mediating role of endometriosis related stigma (endo-stigma) and the moderating role of social support on the endometriosis QoL and self-esteem among women with endometriosis from Latin America and the Caribbean. A cross-sectional design with online survey techniques was implemented. A total of 169 self-identified cisgender women with endometriosis from 14 Latin-American and Caribbean countries participated in the study. We used partial least squares structural equation modeling (PLS-SEM) to examine the study's hypotheses. Incapacitating pain was positively and significantly related to endometriosis QoL as measured by the EHP-5 (b = .266, p < .01). Endo-stigma was positively and significantly related to endometriosis QoL (b = .340, p< .01) and self-esteem (b = .297, p< .01). In addition, endo-stigma mediated the relationship between incapacitating pain and self-esteem (IE = .073, p = .018). Finally, social support moderated the relationship between stigma stress and endometriosis QoL (b = .060, p = .039). Findings suggest stigma could be one of the mechanisms through which the relationship between incapacitating pain and self-esteem among Latin American and Caribbean women with endometriosis could be partially explained. Furthermore, women who scored high in the need for social support and stigma stress also showed worst endometriosis QoL. These results point towards the need to develop tailored interventions targeting these factors in order to foster a better QoL and wellbeing for this population in the context of Latin America and the Caribbean.
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Affiliation(s)
| | - Astrid Sánchez-Galarza
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | | | - Idhaliz Flores-Caldera
- Department of Basic Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
- Department of Ob-Gyn, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Eliut Rivera-Segarra
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
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Pérez-Miralles F, Prefasi D, García-Merino A, Ara JR, Izquierdo G, Meca-Lallana V, Gascón-Giménez F, Martínez-Ginés ML, Ramió-Torrentà L, Costa-Frossard L, Fernández Ó, Moreno-García S, Medrano N, Maurino J, Casanova B. Short-term data on disease activity, cognition, mood, stigma and employment outcomes in a cohort of patients with primary progressive multiple sclerosis (UPPMS study). Mult Scler Relat Disord 2021; 50:102860. [PMID: 33647591 DOI: 10.1016/j.msard.2021.102860] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/08/2021] [Accepted: 02/20/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Primary progressive multiple sclerosis (PPMS) has long been defined by progressive disability accrual in the absence of initial relapses. However, its underlying neurodegenerative process seems to be accompanied by central nervous system inflammation. A new classification defined multiple sclerosis courses according to clinical/radiological activity and progression. We provide further insight into PPMS activity according to this classification and other daily living aspects. METHODS This was a multicentre, prospective, cohort study including 55 adult patients with PPMS according to 2010 McDonald criteria, within ten years from neurologic symptom onset and not receiving disease-modifying therapies during the past six months, who were followed up for 12 months. The primary study endpoint was the percentage of patients with active disease based on clinical relapses and/or magnetic resonance activity. Disability progression, cognitive function, physical/psychological impact, depression symptoms, stigma and employment were secondary endpoints. RESULTS Eleven (25.6%) patients exhibited multiple sclerosis activity throughout the 12-month study follow-up. Fourteen showed non-active multiple sclerosis without progression, 11 non-active multiple sclerosis with progression, 6 active multiple sclerosis without progression and 4 active multiple sclerosis with progression; one patient with disease activity was not assessable for progression. Cognitive function scores remained unchanged or increased, disease physical impact was maintained and disease psychological impact significantly decreased. The proportion of patients with depression symptoms or stigma remained without significant changes as well as employment outcomes. CONCLUSION This study shows that one-fourth of PPMS patients may exhibit disease activity over one year, with disability progression in approximately one-third but without worsening of cognitive function, disease impact, depression, stigma or employment outcomes.
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Affiliation(s)
- Francisco Pérez-Miralles
- Neuroimmunology Unit, Neurology Department, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell, 106, 46026 Valencia, Spain.
| | - Daniel Prefasi
- Medical Department, Roche Farma S.A., Calle de la Ribera del Loira, 50, 28042 Madrid, Spain
| | - Antonio García-Merino
- Neurology Department, Hospital Universitario Puerta de Hierro, Calle Manuel de Falla, 1, 28222 Majadahonda Spain
| | - José Ramón Ara
- Neurology Department, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - Guillermo Izquierdo
- Neurology Department, Hospital Universitario Virgen Macarena, Calle Dr Fedriani, 3, 41009 Seville, Spain
| | - Virginia Meca-Lallana
- Neurology Department, Hospital Universitario La Princesa, Calle de Diego de León, 62, 28006 Madrid, Spain
| | - Francisco Gascón-Giménez
- Neurology Department, Hospital Clínico Universitario de Valencia, Avenida de Blasco Ibáñez, 17, 46010 Valencia, Spain
| | - María Luisa Martínez-Ginés
- Neurology Department, Hospital Universitario Gregorio Marañón, Calle del Dr Esquerdo, 46, 28007 Madrid, Spain
| | - Lluis Ramió-Torrentà
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Hospital Universitari Josep Trueta and Hospital Santa Caterina, Avenida de Francia, S/N, 17007 Girona, Spain. IDIBGI Calle Dr. Castany s/n, Salt, 17190 Spain. Medical Sciences Department, Faculty of Medicine, University of Girona, Plaça Sant Domènec, 3 17400 Girona, Spain
| | - Lucienne Costa-Frossard
- Neurology Department, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo km 9.100, 28034 Madrid, Spain
| | - Óscar Fernández
- Neurology Department, Hospital Regional Universitario Carlos Haya, Avenida de Carlos Haya, 84, 29010 Málaga, Spain
| | - Sara Moreno-García
- Neurology Department, Hospital Universitario 12 de Octubre, Avenida de Córdoba, S/N, 28041 Madrid, Spain
| | - Nicolás Medrano
- Medical Department, Roche Farma S.A., Calle de la Ribera del Loira, 50, 28042 Madrid, Spain
| | - Jorge Maurino
- Medical Department, Roche Farma S.A., Calle de la Ribera del Loira, 50, 28042 Madrid, Spain
| | - Bonaventura Casanova
- Neuroimmunology Unit, Neurology Department, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell, 106, 46026 Valencia, Spain
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13
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Meca-Lallana JE, Prefasi D, Pérez-Miralles F, Forero L, Sepúlveda M, Calles C, Martínez-Ginés ML, González-Suárez I, Boyero S, Romero-Pinel L, Sempere ÁP, Meca-Lallana V, Querol L, Costa-Frossard L, de Castro-Trapiello H, Canal N, Maurino J. Perception of Stigma in Patients with Neuromyelitis Optica Spectrum Disorder. Patient Prefer Adherence 2021; 15:713-719. [PMID: 33880015 PMCID: PMC8052114 DOI: 10.2147/ppa.s305707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Perception of stigma was associated with low self-esteem, psychological problems, and decreased health-seeking behavior among patients with different neurological disorders. The purpose of this study was to assess stigmatization and its impact in patients with neuromyelitis optica spectrum disorder (NMOSD). METHODS A non-interventional study was conducted at thirteen neuroimmunology clinics in Spain. Patients with a diagnosis of NMOSD (2015 Wingerchuk criteria) were included. The 8-item Stigma Scale for Chronic Illness (SSCI-8), the Expanded Disability Status Scale (EDSS), the 29-item Multiple Sclerosis Impact Scale (MSIS-29), the Beck Depression Inventory-Fast Screen (BDI-FS), the MOS Pain Effects Scale (MOS-PES) and the Fatigue Impact Scale for Daily Use (D-FIS) were used to assess the perception of stigma, disability, quality of life, mood, pain, and fatigue, respectively. Associations between outcome measures were analyzed using Spearman's rank correlation. RESULTS Seventy-one patients were studied (mean age: 47.4 years ± 14.9, 81.7% female, mean time since disease onset: 9.9 years ± 8.1). The median EDSS score was 3.0 (interquartile range 1.5, 4.5). Stigma prevalence was 61.4% (n=43). Thirty-one patients (43.6%) had depression. The SSCI-8 score showed a significant correlation with both physical (rho=0.576, p<0.0001) and psychological (rho=0.608, p<0.0001) MSIS-29 scales scores, EDSS score (rho=0.349, p=0.0033), BDI-FS score (rho= 0.613, p<0.0001), MOS-PES score (rho= 0.457, p<0.0001), and D-FIS score (rho=0.556, p<0.0001). CONCLUSION Stigma is a common phenomenon affecting over 6 out of 10 patients with NMOSD. Understanding stigma may be useful to develop educational strategies improving NMOSD knowledge.
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Affiliation(s)
- Jose E Meca-Lallana
- Clinical Neuroimmunology Unit and Multiple Sclerosis CSUR. Department of Neurology. Hospital Universitario “Virgen de la Arrixaca”, IMIB-Arrixaca, Murcia, Spain
| | | | - Francisco Pérez-Miralles
- Unit of Neuroimmunology, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Lucía Forero
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - María Sepúlveda
- Department of Neurology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Carmen Calles
- Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | - Sabas Boyero
- Department of Neurology, Hospital Universitario Cruces, Bilbao, Spain
| | - Lucía Romero-Pinel
- Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ángel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Luis Querol
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Neus Canal
- Department of Statistics, IQVIA, Barcelona, Spain
| | - Jorge Maurino
- Medical Department, Roche Farma, Madrid, Spain
- Correspondence: Jorge Maurino Roche Farma, Ribera Del Loira, 50, Madrid, 28042, SpainTel +34 913 24 81 00 Email
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Maurino J, Martínez-Ginés ML, García-Domínguez JM, Solar MD, Carcelén-Gadea M, Ares-Luque A, Ballabriga J, Navarro-Cantó L, Medrano N, Honan CA. Workplace difficulties, health-related quality of life, and perception of stigma from the perspective of patients with Multiple Sclerosis. Mult Scler Relat Disord 2020; 41:102046. [PMID: 32179482 DOI: 10.1016/j.msard.2020.102046] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/26/2020] [Accepted: 03/06/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION In Multiple Sclerosis (MS), withdrawal from employment is a critical problem. This study explores relationships between disease characteristics, work difficulties, health-related quality of life, depression, and stigma and how these factors affect employment status. METHODS A multicenter, non-interventional, cross-sectional study was conducted in adults with relapsing-remitting MS (RRMS) and primary progressive MS (PPMS). Patient-reported questionnaires included: 23-item Multiple Sclerosis Work Difficulties Questionnaire, 29-item Multiple Sclerosis Impact Scale, Stigma Scale for Chronic Illness, and Beck Depression Inventory-Fast Screen. RESULTS A total of 199 individuals (mean age = 43.9 ± 10.5 years, 60.8% female, 86.4% with RRMS) participated in the study. Mean time from diagnosis was 9.6 ± 7.2 years and median Expanded Disability Status Scale score was 2.0 (interquartile range: 1.0-3.5). Employment rate was 47.2% (n = 94). Mean physical and psychological MSIS-29 impact sub-scores were 40.38 ± 17.1 and 20.24 ± 7.8, respectively. Forty patients (19.9%) had at least one SSCI-8 item with a score of 4 or 5, suggesting the presence of stigma often or always. Eighty-one patients (40.7%) were depressed and 25 (12.6%) had moderate-to-severe depression. Work difficulties were higher in those with worse functional status, a diagnosis of PPMS, and lower educational levels. Employed participants had lower perceptions of stigma and depressive symptoms than those not employed. Higher perceptions of stigma were also strongly linked to higher physical and psychological impact on health-related quality of life and greater work difficulties. Depressive symptoms were also strongly related to work-related problems. CONCLUSIONS Work difficulties, stigma and poor quality of life are common in MS patients, even in a population with low physical disability. Evaluation of these dimensions in clinical practice would allow the development of targeted rehabilitation and specific work plans for MS employers.
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Affiliation(s)
| | | | | | - María D Solar
- Department of Neurology, Hospital Universitario de Cabueñes, Gijón, Spain
| | - María Carcelén-Gadea
- Department of Neurology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Adrián Ares-Luque
- Department of Neurology, Complejo Asistencial Universitario de León, Spain
| | - Jordi Ballabriga
- Department of Neurology, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
| | - Laura Navarro-Cantó
- Department of Neurology, Hospital General Universitario de Elche, Elche, Spain
| | | | - Cynthia A Honan
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
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Abstract
BACKGROUND Most people with multiple sclerosis (MS) experience social stigma at mild-to-moderate levels, with potential implications for their health. However, little is known about how adults adapt to social stigma across their lives, or with respect to MS stigma in particular. Using a large national database and controlling for confounding demographic and health-related variables, this study examined whether longer MS duration was associated with reports of stigma in people with MS. METHODS Data were available from 6771 participants enrolled in the semiannual survey conducted by the North American Research Committee on Multiple Sclerosis (NARCOMS). Participants completed measures of MS stigma and reported on demographic and health-related covariates. RESULTS With disability level, age, and other demographic and health-related covariates taken into account, the longer respondents had lived with MS, the less stigma they felt. Results were similar for people's anticipation of stigma and their feelings of isolation because of stigma. CONCLUSIONS As people gain experience living with MS, their adaptations to the social aspects of their illness may allow them to structure their lives so that they can mitigate the impact of stigma. Doctors, therapists, and other health care personnel should consider that patients with MS might be especially concerned and distressed by stigma earlier in the course of their illness.
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