Psychosocial and neurological predictors of mental health in multiple sclerosis patients.

Multiple Sclerosis (MS) is a chronic and unpredictable disease, largely uncontrolled by current treatment. Its effects vary from a mild course with minimal disabilities to a rapidly progressing or fluctuating course with devastating disabilities. No reliable indicators exist to assure patients that their status will remain stable or that disabilities will not emerge or progress. Furthermore, patients confront symptoms that frequently and unpredictably vary with respect to form and intensity, sometimes daily. Over the short and long term, the unpredictability and mutability of MS-related disabilities pose particular adjustment problems. For these reasons, there has been increasing interest in studying psychosocial adjustment in MS patients. Unfortunately, many studies of adjustment have suffered from methodological flaws (see, for review, Devins and Seland [l]). In particular, several studies fail to take adequate account of physiological disease factors in the assessment of psychological status. Assessment instruments have been employed that misclassify somatic complaints, often reflecting neurological dysfunction in MS, as evidence of psychopathology. The Minnesota Multiphasic Personality Inventory (MMPI) [2] and General Health Questionnaire (GHQ) [3] are examples of inventories that misclassify neurological impairment in this way, likely overestimating the prevalence of mood and personality disorders in MS patients [4,5]. Certainly, accounting for the effects of physical symptoms on psychological status is of major importance in evaluating factors affecting adjustment. Thus, the search for predictive factors requires multifactorial designs, evaluating theoretically cohesive models of adequately measured physical and psychosocial factors. In this study, we investigated a model that included disease status, physical disability, and psychosocial measures to identify key factors affecting the mental health of MS patients. Our goal was a model of factors that could guide intervention programs assisting psychosocial adjustment. We conceptualized five sets of factors: neurological impairment, disease duration, physical disability, disease-related symptoms, and psychosocial factors. In further specifying variables, in terms of neurological impairment, we considered both the current severity of neurological impairment and the duration of disease (measured from the onset of disease perceived by the patient) as potentially significant contributors to mental health status. Physical disability indices were used to assess whether the sickness-related disruption of physical functioning, affecting ambulation, mobility, and body care, would have