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The Contribution of Illness Beliefs, Coping Strategies, and Social Support to Perceived Physical Health and Fatigue in Multiple Sclerosis


This study investigated the relationship of illness beliefs with perceived physical health and fatigue among persons with multiple sclerosis. Besides direct effects between illness beliefs and outcome measures, the mediational role of coping strategies and social support was examined. Six hundred and eighty persons with multiple sclerosis completed the Revised Illness Perception Questionnaire evaluating illness beliefs; the Brief COPE measuring problem-focused, meaning-focused, and avoidant strategies; the Multidimensional Scale of Perceived Social Support assessing social support; MS Quality of Life-54 investigating perceived physical health; and the Fatigue Severity Scale assessing physical fatigue. Mediation analyses were performed controlling for disability level. Direct effects were identified for both perceived physical health and fatigue, whereas indirect effects were observed only for physical health through avoidant strategies and social support. Based on present findings, psychological intervention may primarily target illness beliefs to address fatigue, and beliefs and coping strategies to improve perceived physical health.

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The authors gratefully acknowledge the following colleagues for their help in participants’ recruitment, neuropsychological evaluation, questionnaire administration, data coding, and storage: Raffaela Sartori, Cecilia Rassiga (Department of Biomedical and Clinical Sciences L. Sacco, University of Milan), Clara Grazia Chisari (University Polyclinic Hospital G. Rodolico, Catania), Manuela Valsecchi, Samuela Turati (Lab of Clinical Neuropsychology – Psychology Unit, ASST Lariana, Como), Enrico Montanari, Ilaria Pesci, Letizia Manneschi, Angelica Guareschi (Multiple Sclerosis Center - Neurology Unit - Hospital of Vaio – Fidenza), Marco Onofrj (Department of Neurosciences, Imaging and Clinical Sciences - University G. d’Annunzio, Chieti).


This study was supported by FISM – Fondazione Italiana Sclerosi Multipla – Grant No. 2014/R/4.

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Correspondence to Marta Bassi.

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Marta Bassi, Monica Grobberio, Luca Negri, Sabina Cilia, Eleonora Minacapelli, Claudia Niccolai, Marianna Pattini, Erika Pietrolongo, Maria Esmeralda Quartuccio, Beatrice Allegri, Miriam Benin, Giovanna De Luca, Monica Falautano, Claudio Gasperini, and Antonella Delle Fave report no conflicts of interest. Maria Pia Amato received research grants and honoraria as a speaker and member of advisory boards by Bayer, Biogen, Merck, Novartis, Sanofi Genzyme, Teva, Almirall, and Roche. Rosa Gemma Viterbo received speaker honoraria from Biogen, Merck Serono, and Sanofi. Francesco Patti received personal compensation for speaking activities and serving on advisor board by Almirall, Bayer, Biogen, Celgene, Merck, Myalin, Novartis, Roche, Sanofi, and TEVA. He also received research grants by Biogen, Merck, Reload onlus, the Italian Ministry of University and Education (MIUR), and University of Catania. Maria Trojano has served on scientific advisory boards for Biogen, Merck Serono, Novartis, and Roche; received speaker honoraria from Biogen, Merck Serono, Novartis, Sanofi, and Roche; and received research grants from Biogen, Merck Serono, Novartis, and Roche.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Bassi, M., Grobberio, M., Negri, L. et al. The Contribution of Illness Beliefs, Coping Strategies, and Social Support to Perceived Physical Health and Fatigue in Multiple Sclerosis. J Clin Psychol Med Settings (2019).

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  • Multiple sclerosis
  • Illness beliefs
  • Coping strategies
  • Fatigue
  • Health-related quality of life