Depression, Fatigue, Cognitive Function & Uncertainty in Multiple Sclerosis
Background: First discovered in the 19th century, MS is a chronic disease of the central nervous system. While most people are diagnosed between the ages of 20 and 40, disease severity is not age dependent and the lifetime expectancy for this population remains normal. MS is recognized as a leading cause of neurological disability among young adults and is the most prevalent neurological disease among young and middle-aged adults in certain parts of the world. In the United States alone, healthcare costs associated with MS are estimated at over $10 billion annually. While prior research has been undertaken with regards to the common symptoms of MS, uncertainty, enabling skills, self-management and quality of life, there have been no studies undertaken that involved all of them. This cross-sectional descriptive study was the first to explore all of these relationships simultaneously using Braden’s LRCISHM.
Methods: Measurement tools utilized in the study included: 1) Demographic and Illness Characteristics, 2) The Modified Fatigue Impact Scale, 3) Perceived Deficits Questionnaire, 4) Patient Health Questionnaire-9, 5) Mishel’s Uncertainty in Illness Scale-Adult, 6) Rosenbaums’ Self-Control Scale- Modified, 7) COPE Inventory- Brief, and 8) SF-36 Health Status Questionnaire. Data analysis involved descriptive statistics, correlations and linear regression to answer the specific aims.
Results: The major findings for this study were that depression, declines in cognitive function, fatigue and uncertainty, enabling skills and self-management were all associated with each other. Greater uncertainty was associated with lower physical health, lower mental health and poorer quality of life (QOL). Higher depression scores, greater perceived declines in cognitive function and higher fatigue scores were associated with lower physical health, lower mental health and poorer QOL. The study findings also indicate using a modified version of Braden’s LRCISHM is appropriate in a population of women with MS. Furthermore, aspects of stages I, II, III and IV of Braden’s LRCISHM did relate to Stage V, identified in this study as QOL: physical health and QOL: mental health.
Implications: The research findings suggest a symptom cluster for this population: depression, fatigue and declines in cognitive function. Interventions for healthcare providers should be aimed at assessing for all three symptoms. The research findings indicate that use of Braden’s LRCISHM is appropriate for an MS population and successful in showing a relationship between the variables of Stage I and QOL in Stage V. Future research aimed at exploring the relationship between Stage I and Stage V could provide insight on how the disease characteristics may directly impact QOL in other chronic illness populations as well as how to approach and manage these symptoms in the clinical setting.