Abstract
BackgroundMastery is the extent to which an individual perceives their life circumstances as being under their control and not predominantly influenced by external factors. The relationship of mastery with clinical outcomes in people with multiple sclerosis (pwMS) has not been well-researched. We assessed the relationships of mastery with fatigue, disability, relapse number, and depression risk among pwMS over 2.5 years’ follow-up.MethodsData from the Health Outcomes and Lifestyle in a Sample of people with Multiple sclerosis study, among 839 participants who completed the 2.5 and 5-year reviews, were analysed. Mastery was measured by the Pearlin Mastery Scale, fatigue by Fatigue Severity Scale, depression risk by Patient Health Questionnaire-9, and disability by Patient-Determined Disease Steps, and diagnosed relapse number in the previous 12 months was queried. Cross-sectional and prospective analyses were undertaken by log-binomial, log-multinomial, and Poisson regression, as appropriate, adjusted for relevant confounders.ResultsCross-sectionally, pwMS with the highest quartile mastery (> 25/28) had 90% lower frequency of depression risk, 60% lower frequency of clinically significant fatigue, and 77% fewer had severe disability, all largely robust to adjustment. Prospectively, those in the top two quartiles of mastery (> 21–25, > 25/28) had 66% and 74% lower subsequent depression risk, robust to adjustment. No significant associations were seen prospectively for change in fatigue, disability, or relapse number, however, and no robust associations of mastery with relapse number were evident.ConclusionsProspectively, a protective relationship of mastery with subsequent risk of depression was observed, suggesting this may be a point of intervention to improve wellbeing in pwMS.
Highlights
Multiple sclerosis (MS) is an autoimmune neurodegenerative disease that affects the central nervous system
We have shown that higher mastery is cross-sectionally associated with lower frequencies of depression risk, clinically significant fatigue, and severe disability, robust to adjustment, and prospectively with a lower risk of developing depression risk over 2.5 years’ follow-up
No prospective associations were seen for loss of depression risk, nor with any change in fatigue or disability, and no robust associations were seen for relapse number, either cross-sectionally or prospectively
Summary
Multiple sclerosis (MS) is an autoimmune neurodegenerative disease that affects the central nervous system. The multiple physical, emotional, and social challenges faced by people with MS (pwMS) have a significant impact on feelings of control over their lives. Mastery has been associated with a dosedependent improvement in both mental and physical healthrelated quality of life in pwMS [8]. With respect to specific health outcomes in MS, an improved sense of mastery has been demonstrated to ameliorate fatigue, the distress associated with fatigue, and the subsequent inability to perform tasks [9]. The treatment of depression in MS has been shown to improve the individual’s sense of mastery, sense of purpose in life, and their level of self-acceptance [10]. This study assessed the cross-sectional and prospective relationships of mastery with fatigue, level of disability, relapse number, and depression risk over 2.5 years in an international cohort of pwMS
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