Illness perceptions and psychological adjustment among persons with multiple sclerosis: the mediating role of coping strategies and social support

Abstract

Purpose: The aim of this study was to test the Common Sense Model of Self-Regulation among persons with multiple sclerosis (MS), hypothesizing direct relations between illness beliefs and psychological adjustment, and indirect relations through coping strategies and social support.

Materials and methods: Questionnaires were administered cross-sectionally to 680 participants (M_age =40.1; 64.4% women) recruited in eight MS units to assess illness beliefs, coping strategies, social support, and adjustment indicators including life satisfaction, psychological well-being, mental health, and depression. Multiple mediational analyses were conducted to identify direct and indirect paths connecting illness beliefs to psychological outcomes.

Results: Controlling for disability level, significant direct and indirect relationships were observed: Beliefs on illness coherence, personal and treatment control were associated with better adjustment; emotion representations and cyclic timeline with worse adjustment; illness identity, consequences, psychological and chance/bad luck causes with mixed positive and negative outcomes. Notably, findings identified recurrent and unique pathways connecting illness beliefs to the different indicators through meaning- and problem-focused coping strategies, avoidance and social support.

Conclusions: The Common Sense Model can represent a useful framework to be tested in rehabilitation programs, jointly addressing illness beliefs and coping resources for the promotion of psychological adjustment among persons with MS.

IMPLICATIONS FOR REHABILITATION

• Based on the Common Sense Model, the beliefs held by persons with MS about their illness are related to various aspects of psychological adjustment in multiple ways, both directly and indirectly through engagement in specific coping strategies and perception of social support.

• Clinicians supporting patients’ adjustment may take into account that some illness beliefs were consistently associated with positive adjustment, some with poor adjustment, and some yielded mixed positive and negative results.

• Some ways in which coping strategies and social support connected illness beliefs to psychological adjustment were specific to the adjustment indicator under consideration including satisfaction with life, psychological well-being, mental health and depression.

• It may be worth testing comprehensive psychological interventions with the aim of raising awareness of one’s illness beliefs, the strategies enacted in response to these beliefs, and the positive and negative relations of these processes with psychological adjustment, encompassing broad areas of individuals’ lives and not only health-related issues or depression.

Keywords:

• Multiple sclerosis
• Common Sense Model
• illness perceptions
• coping
• well-being
• depression

Acknowledgements

The authors gratefully acknowledge the following colleagues for their help in participants’ recruitment, neuropsychological evaluation, questionnaire administration, data coding and storage: Raffaela Sartori, Luca Negri and Cecilia Rassiga (Department of Biomedical and Clinical Sciences L. Sacco, University of Milan), Clara Grazia Chisari (University Polyclinic Hospital G. Rodolico, Catania), Manuela Valsecchi, Samuela Turati (Lab of Clinical Neuropsychology – Psychology Unit, ASST Lariana, Como), Enrico Montanari, Ilaria Pesci, Letizia Manneschi, Angelica Guareschi (Multiple Sclerosis Center – Neurology Unit – Hospital of Vaio, Fidenza), Marco Onofrj (Department of Neurosciences, Imaging and Clinical Sciences – University G. d’Annunzio, Chieti). We further thank Annalisa Pelosi (University of Parma) and Cecilia Rizzi (Polytechnic University of Milan) for statistical advice.

Disclosure statement

Marta Bassi, Sabina Cilia, Monica Falautano, Monica Grobberio, Claudia Niccolai, Marianna Pattini, Erika Pietrolongo, Maria Esmeralda Quartuccio, Beatrice Allegri, Miriam Benin, Giovanna De Luca, Claudio Gasperini, Eleonora Minacapelli, and Antonella Delle Fave report no conflicts of interest. Maria Pia Amato received research grants and honoraria as a speaker and member of advisory boards by: Bayer, Biogen, Merck, Novartis, Sanofi Genzyme, Teva, Almirall, Roche.

Rosa Gemma Viterbo received speaker honoraria from Biogen, Merck Serono and Sanofi.

Francesco Patti received personal compensation for speaking activities and serving on advisor board by Almirall, Bayer, Biogen, Celgene, Merck, Myalin, Novartis, Roche, Sanofi and TEVA. He also received unrestricted research grants by Biogen, Merck and University of Catania.

Maria Trojano has served on scientific advisory boards for Biogen, Merck Serono, and Novartis; received speaker honoraria from Biogen, Merck Serono, Novartis, Sanofi, and Teva; and received research grants from Biogen, Merck Serono, and Novartis.

Notes

1 Three questionnaires are most commonly used to assess illness beliefs. The first to be developed was the Illness Perception Questionnaire [15] measuring cognitive beliefs about illness identity, controllability/curability, timeline, consequences and causes. The Revised Illness Perception Questionnaire (IPQ-R) [16] divided IPQ timeline into chronic and cyclical dimensions, and controllability/curability into personal and treatment control. It further included new items to measure illness coherence and emotional representations. IPQ-R is the instrument used in the present study (see methods). Finally, the Brief Illness Perception Questionnaire [17] relies on single items to assess each dimension: identity, consequences, timeline, personal and treatment control, concern, understanding, and emotional response.

2 Full PROCESS bootstrap output for all outcome variables is available from the corresponding author upon request.

Additional information

Funding

This work was supported by Fondazione Italiana Sclerosi Multipla [Grant No. 2014/R/4].