Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that affects young individuals during their most productive period of their lives. MS-related stress impinges upon patients’ wellbeing and quality of life. On the other hand, previous research has revealed that low stress, anxiety and depression, along with increased social support and sense making of emerging disease-related adversities herald successful psychological adjustment to the disease. To our knowledge, there is no disease-specific instrument evaluating the degree of psychological adjustment to MS.
To develop and validate the Multidimensional Psychological Adjustment Questionnaire for Multiple Sclerosis (MPAq-MS), a new questionnaire for evaluating the degree of coping in the disease.
A sample of 44 MS patients (mean age 45.5 ± 12.5 years-old, 63.6% females, 95.5% RRMS, mean disease duration 12.8±8.0 years) was selected to investigate the psychometric properties of MPAq-MS. Construct validity was assessed by principal components analysis (PCA) and confirmatory factor analysis (CFA). Convergent validity was assessed by including the Depression Anxiety and Stress-21 questionnaire, physical fatigue (using a 0-10 visual analogue scale) and hair cortisol. Cronbach’s alpha and test-retest correlations (second assessment after 8 weeks) were used to assess reliability.
PCA and CFA confirmed the theoretical four-construct validity of the MPAq-MS tool (stress-anxiety, depression, social support and sense making). The PCA model explained 75.2% of the total observed variance. Higher MPAq-MS scores were moderately correlated with less stress (r=-0.629, p<0.01), anxiety (r=-0.553, p<0.001), depression (r=-0.554, p<0.001) and physical fatigue (r=-0.472, p=0.001) indicating good convergent validity. Interestingly, higher MPAq-MS scores were correlated with less hair cortisol (rho=-0.333, p=0.041). The internal consistency of the tool was found acceptable (Cronbach’s alpha = 0.745). The intraclass correlation coefficient (ICC) was 0.812 (95%CI 0.65-0.90, p<0.001) indicating good reliability.
The MPAq-MS instrument showed good psychometric properties in MS patients. Future studies should confirm these results in larger samples of MS patients and of various MS types. This tool could be considered an additional patient-reported outcome in MS research.