Title

Understanding the dynamics of coping, psychological well-being and health-related quality of life in persons with relapsing-remitting multiple sclerosis

Date of Completion

January 2006

Keywords

Psychology, Clinical|Sociology, Individual and Family Studies

Degree

Ph.D.

Abstract

Much of the research that has been conducted to date about persons living with relapsing-remitting multiple sclerosis (RRMS) has focused on healthy functioning as a measure of quality of life. While healthy functioning is an important component of well being and quality of life, there is a growing body of evidence that psychological well being is also an important area to consider. In addition, prior studies investigating coping strategies of chronically ill individuals have posited a bifurcation of coping styles; that is one either utilizes problem-focused or emotion-focused strategies, with negative outcomes related to emotion-focused coping. Recent studies have found that positive emotion-focused coping strategies, such as acceptance, or religiosity and spirituality can offer salutary effects. In addition, much of the literature is atheoretical and focuses on intra-individual predictors. The current study is guided by Carver's theory of self-regulation, and by Heckhausen and Schulz's lifespan theory of control. One hundred twenty individuals with a clinical diagnosis of RRMS who were randomly selected from the UMassMemorial Medical Center Neurology Clinic database (mean age 47.9, range 19-83) answered a mail questionnaire. This cross sectional study examined contextual, illness-related factors, as well as intra-individual variables that predict psychological well being and health-related quality of life. Results of regression analysis found that distinct variations of age, gender, marital status, quality of relationship, income, years since diagnosis, employment status, education, children at home, relapse, race, positive emotion focused coping, problem-focused coping, negative emotion focused coping and optimism were significantly predictive of many aspects of psychological well being and health related quality of life. Results point to both an overlap in the predictor variables as well as to those that predict only psychological well being or health-related quality of life. In particular, optimism is strongly related to positive psychological well being and health-related outcomes. Additionally, a high-quality marital/partner relationship, and providing care for children in the home also showed strong relationships to positive outcomes. These social roles were more salient indicators of well being and quality of life than any particular coping strategy, although problem-focused coping and positive emotion-focused coping were significantly related to personal growth. Results also support the inclusion of contextual, illness, and intra-individual factors in models of coping, well being and quality of life in RRMS. ^