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Quality of Life Research

, Volume 26, Issue 3, pp 727–736 | Cite as

Affective disorders and Health-Related Quality of Life (HRQoL) in adolescents and young adults with Multiple Sclerosis (MS): the moderating role of resilience

  • Nunzia RainoneEmail author
  • Alessandro Chiodi
  • Roberta Lanzillo
  • Valeria Magri
  • Anna Napolitano
  • Vincenzo Brescia Morra
  • Paolo Valerio
  • Maria Francesca Freda
Article

Abstract

Purpose

To investigate the moderating role of resilience in the relationship between affective disorders and Health-Related Quality of Life (HRQoL) for adolescents and young adults with multiple sclerosis (MS).

Methods

A quantitative methodology was adopted. Fifty-three adolescents and young adults were interviewed to assess resilience as a personality trait (Ego-Resiliency Scale) and resilience as an interactive competence (CYRM-28), Health-Related Quality of Life (PedsQL 4.0), depression and anxiety (BDI-II and STAI-Y).

Results

Affective disorders, both depression (β = −.38, p < .001) and anxiety (State β = –.35, p < .001; Trait β = −.41, p < .001), were negatively associated with HRQoL. Data also showed that the resilience competencies using Individual (β = .22, p < .001) and relational resources (β = .12, p < .05) are significantly associated HRQoL. According to the regression analyses, we tested the moderating role of resilience competence using individual resources on the relationship between the Depression Cognitive Factor and Emotional Functioning. Data show that in step 2 of the regression analysis, we obtained a variation of β = −.45 (p < .001) to β = −.30 (p < .001) in the dimension for the Depression Cognitive Factor. The Sobel test showed that the moderating effect of resilience was significant regarding the increase in R2 (p < .01).

Conclusions

Resilience competence using individual resources moderates the relationship between the Depression Cognitive Factor and Emotional Functioning in adolescents with MS. Our study suggests that to improve well-being for adolescents with MS resilience could play a key role.

Keywords

Health-Related Quality of Life Resilience Affective disorders Adolescence and young adulthood Multiple sclerosis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The University of Naples Federico II Ethics board also approved the study.

Informed consent

Written informed consent was obtained from all individuals included in the study or their parents as appropriate.

References

  1. 1.
    Banwell, B., Ghezzi, A., Bar-Or, A., Mikaeloff, Y., & Tardieu, M. (2007). Multiple sclerosis in children: Clinical diagnosis, therapeutic strategies, and future directions. Lancet Neurology, 6, 887–902.CrossRefPubMedGoogle Scholar
  2. 2.
    Luchinetti, C. F., Brück, W., Rodriguez, M., & Lassmann, H. (1996). Distinct patterns of multiple sclerosis pathology indicates heterogeneity on pathogenesis. Brain Pathology, 6(3), 259–274.CrossRefGoogle Scholar
  3. 3.
    Yeh, E. A., & Weinstock-Guttman, B. (2010). Natalizumab in pediatric multiple sclerosis patients. Therapeutic Advances in Neurological Disorders, 3(5), 293–299.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Krupp, L. B., Banwell, B., Tenembaum, S., & International Pediatric MS Study Group. (2007). Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology, 68(16 Suppl 2), S7–S12.CrossRefPubMedGoogle Scholar
  5. 5.
    Absoud, M., Lim, M., Chong, W. K., et al. (2013). Paediatric acquired demyelinating syndromes: Incidence, clinical and magnetic resonance imaging features. Multiple Sclerosis, 19, 76–86.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Goretti, B., Portaccio, B., Ghezzi, A., et al. (2012). Fatigue and its relationships with cognitive functioning and depression in paediatric multiple sclerosis. Multiple Sclerosis, 18, 329–334.CrossRefPubMedGoogle Scholar
  7. 7.
    MacAllister, W. S., Christodoulou, C., Troxell, R., et al. (2009). Fatigue and quality of life in pediatric multiple sclerosis. Multiple Sclerosis, 15, 1502–1508.CrossRefPubMedGoogle Scholar
  8. 8.
    Chwastiak, L., Ehde, D., Gibbons, L., Sullivan, M., Bowen, J. D., & Kraft, G. H. (2002). Depressive symptoms and severity of illness in multiple sclerosis: Epidemiological study of a large community sample. American Journal of Psychiatry, 158, 1862–1868.CrossRefGoogle Scholar
  9. 9.
    Wynia, K., van Wijlen, A. T., Middel, B., Reijneveld, S. A., & Meilof, J. F. (2012). Change in disability profile and quality of life in multiple sclerosis patients: A five-year longitudinal study using the Multiple Sclerosis Impact Profile (MSIP). Multiple Sclerosis, 18(5), 654–661.CrossRefPubMedGoogle Scholar
  10. 10.
    Patten, S. B., Beck, C. A., Williams, J. V., Barbui, C., & Metz, L. M. (2003). Major depression in multiple sclerosis: A population-based perspective. Neurology, 61, 1524–1527.CrossRefPubMedGoogle Scholar
  11. 11.
    Whitlock, F. A., & Siskind, M. M. (1980). Depression as a major symptom of multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry, 43, 861–865.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Patten, S. B., Metz, L. M., & Reimer, M. M. (2000). Biopsychosocial correlates of major depression in a multiple sclerosis population. Multiple Sclerosis, 6, 115–120.CrossRefPubMedGoogle Scholar
  13. 13.
    Lobentanz, I. S., Asenbaum, S., Vass, K., Sauter, C., Klosh, G., Kollegger, H., et al. (2004). Factors influencing quality of life in multiple sclerosis patients: Disability, depressive mood, fatigue and sleep quality. Acta Neurological Scandinavica, 110, 6–13.CrossRefGoogle Scholar
  14. 14.
    Benedict, R. H. B., Wahlig, E., Bakshi, R., Fishman, I., Munschauer, F., Zidadinov, R., et al. (2005). Predicting quality of life in multiple sclerosis: Accounting for physical disability, fatigue, cognition, mood disorder, personality, and behaviour change. Journal of Neurological Sciences, 231, 29–34.CrossRefGoogle Scholar
  15. 15.
    Sadovnik, A. D., Remick, R. A., Allen, J., Swartz, E., Yee, I. M. L., Eisen, K., et al. (1996). Depression and multiple sclerosis. Neurology, 1996(46), 628–632.CrossRefGoogle Scholar
  16. 16.
    Amato, M. P., Goretti, B., Ghezzi, A., et al. (2008). Cognitive and psychosocial features of childhood and juvenile MS. Neurology, 70(20), 1891–1897.CrossRefPubMedGoogle Scholar
  17. 17.
    Till, C., Ghassemi, R., Aubert-Broche, B., et al. (2011). MRI correlates of cognitive impairment in childhood-onset multiple sclerosis. Neuropsychology, 25(3), 319–332.CrossRefPubMedGoogle Scholar
  18. 18.
    Feinstein, A. (2007). The clinical neuropsychiatry of multiple sclerosis (2nd ed., p. 2007). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  19. 19.
    Kalb, R. (2007). The emotional and psychological impact of multiple sclerosis relapses. Journal of Neurology Science, 256(suppl.1), 29–33.CrossRefGoogle Scholar
  20. 20.
    Schubert, D. S. (1993). Increased depression in multiple sclerosis patients. A meta-analysis. Psychosomatics, 34, 124–130.CrossRefPubMedGoogle Scholar
  21. 21.
    Boyd, J. R., & MacMillan, L. J. (2005). Experiences of children and adolescents living with multiple sclerosis. Journal of Neuroscience Nursing, 37(6), 334–342.CrossRefPubMedGoogle Scholar
  22. 22.
    Varni, J. W., Seid, M., & Kurtin, P. S. (2001). PedsQL™ 4.0: Reliability and validity of the Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales in healthy and patient populations. Medical Care, 39(8), 800–812.CrossRefPubMedGoogle Scholar
  23. 23.
    Cieza, A., & Stucki, G. (2005). Content comparison of health-related quality of life (HRQOL) instruments based on the international classification of functioning, disability and health (ICF). Quality of Life Research, 14(5), 1225–1237.CrossRefPubMedGoogle Scholar
  24. 24.
    Varni, J. W., Limbers, C. A., & Burwinkle, T. M. (2007). Impaired health-related quality of Life in children and adolescents with chronic conditions: A comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQLTM 4.0 Generic Core Scales. Health and Quality of Life. doi: 10.1186/1477-7525-5-43.Google Scholar
  25. 25.
    Uzark, K., Jones, K., Slusher, J., Limbers, C. A., Burwinkle, T. M., & Varni, J. W. (2008). Quality of life in children with heart disease as perceived by children and parents. Pediatrics, 121(5), 1060–1067.CrossRefGoogle Scholar
  26. 26.
    Varni, J. W., Limbers, C. A., & Burwinkle, T. M. (2007). Impaired health-related quality of Life in children and adolescents with chronic conditions: A comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQLTM 4.0 Generic Core Scales. Health and Quality of Life. doi: 10.1186/1477-7525-5-43.Google Scholar
  27. 27.
    Nelson, T. D., Kidwell, K. M., Hoffman, S., Trout, A. L., Epstein, M. H., & Thompson, R. W. (2014). Health-related quality of life among adolescents in residential care: Description and correlates. American Journal of Orthopsychiatry, 84(3), 226–233.CrossRefPubMedGoogle Scholar
  28. 28.
    Gay, M. C., Vrignaud, P., Garitte, C., et al. (2010). Predictors of depression in multiple sclerosis patients. Acta Neurologica Scandinavica, 121(3), 161–170.CrossRefPubMedGoogle Scholar
  29. 29.
    Janardhan, V., & Bakshi, R. (2002). Quality of life in patients with multiple sclerosis: The impact of fatigue and depression. Journal of the Neurological Sciences, 205(1), 51–58.CrossRefPubMedGoogle Scholar
  30. 30.
    Lanzillo, R., Chiodi, A., Carotenuto, A., Magri, V., Napolitano, A., Liuzzi, R., et al. (2015). Quality of life and cognitive functions in early onset multiple sclerosis. European Journal of Paediatric Neurology. doi: 10.1016/j.ejpn.2015.08.005.PubMedGoogle Scholar
  31. 31.
    Ferrans, C. E., Zerwic, J. J., Wilbur, J. E., & Larson, J. L. (2005). Conceptual model of health-related quality of Life. Journal of Nursing Scholarship, 37, 336–342.CrossRefPubMedGoogle Scholar
  32. 32.
    Freda, M. F., Rainone, N., Striano, M., Valerio, P. Theoretical issues about reflexivity and its role in fostering academic inclusion. In M. F. Freda, G. Esposito, J Gonzalez Monteagudo (Ed.) Working with Underachieving Students in Higher Education. Fostering inclusion through narration and reflexivity. Routledge: London. ISBN: 978-1-138-96291-0 (hbk); 978-1-315-65912-1 (ebk) (in press).Google Scholar
  33. 33.
    Ungar, M. (Ed.). (2012). The social ecology of resilience: A handbook of theory and practice. New York: Springer.Google Scholar
  34. 34.
    Goldstein, S., & Brooks, R. (2012). Handbook of resilience (2nd ed.). New York: Springer.Google Scholar
  35. 35.
    Olsson, C. A., Bond, L., Burns, J. M., Vella-Brodrick, D. A., & Sawyer, S. M. (2003). Adolescent resilience: A concept analysis. Journal of Adolescence, 26(1), 1–11.CrossRefPubMedGoogle Scholar
  36. 36.
    Coleman, J., & Hagnell, A. (Eds.). (2007). Adolescence, risk and resilience: Against the odds. Chichester: Wiley.Google Scholar
  37. 37.
    Block, J. H., & Block, J. (1980). The role of ego-control and Ego-resiliency in the origination of behavior. In W. A. Collings (Ed.), The Minnesota symposia on child psychology (Vol. 13, pp. 39–101). Hillsdale: Erlbaum.Google Scholar
  38. 38.
    Block, J., & Kremen, A. M. (1996). IQ and ego-resiliency: Conceptual and empirical connections and separateness. Journal of Personality and Social Psychology, 70, 349–361.CrossRefPubMedGoogle Scholar
  39. 39.
    Block, J. (2002). Personality as an affect-processing system. Mahwah: Erlbaum.Google Scholar
  40. 40.
    Prince-Embury, S., & Saklofske, D. H. (Eds.). (2013). Resilience in children, adolescents, and adults: Translating research into practice. New York: Springer.Google Scholar
  41. 41.
    Freda, M. F., & Esposito, G. (2016). Promoting reflection and reflexivity through narrative devices: Narrative mediation path qualitative multimodal method. Qualitative Research Journal. doi: 10.1108/QRJ-06-2016-0039. (in press).Google Scholar
  42. 42.
    Rutter, M. (1985). Resilience in the face of adversity: protective factors and resistance to psychiatric disorder. British Journal of Psychiatry, 147, 598–611.CrossRefPubMedGoogle Scholar
  43. 43.
    Palermo, T. M., Long, A. C., Lewandowski, A. S., Drotar, D., Quittner, A. L., & Walker, L. S. (2008). Evidence-based assessment of health-related quality of Life and functional impairment in pediatric psychology. Journal of Pediatric Psychology, 33, 983–996.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Matza, L. S., Rentz, A. M., Secnik, K., Swensen, A. R., Revicki, D. A., Michelson, D., et al. (2004). The link between health-related quality of life and clinical symptoms among children with attention-deficit hyperactivity disorder. Journal of Developmental and Behavioral Pediatrics, 25, 166–174.CrossRefPubMedGoogle Scholar
  45. 45.
    Varni, J., Limbers, C., Neighbors, K., Schulz, K., Lieu, J. C., Heffer, R., et al. (2011). The PedsQL infant scales: Feasibility, internal consistency reliability, and validity in healthy and ill infants. Quality of Life Research, 20, 45–55.CrossRefPubMedGoogle Scholar
  46. 46.
    Varni, J. W., Seid, M., & Rode, C. A. (1999). The PedsQL™: Measurement model for the pediatric quality of life inventory. Medical Care, 37(2), 126–139.CrossRefPubMedGoogle Scholar
  47. 47.
    Varni, J. W., & Limbers, C. A. (2009). The PedsQL™ 4.0 generic core scales young adult version feasibility, reliability and validity in a university student population. Journal of Health Psychology, 14(4), 611–622.CrossRefPubMedGoogle Scholar
  48. 48.
    Leplege, A., & Hunt, S. (1997). The problem of quality of life in medicine. JAMA, 278, 47.CrossRefPubMedGoogle Scholar
  49. 49.
    Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory-II. San Antonio: Psychological Corporation.Google Scholar
  50. 50.
    Vanheule, S., Desmet, M., Groenvynck, H., Rosseel, Y., & Fontaine, J. (2008). The factor structure of the beck depression inventory II: An evaluation. Assessment, 15, 177–187.CrossRefPubMedGoogle Scholar
  51. 51.
    Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto: Consulting Psychologists Press.Google Scholar
  52. 52.
    Liebenberg, L., Ungar, M., & Van de Vijver, F. (2012). Validation of the child and youth resilience measure-28 (CYRM-28) among Canadian youth. Research on Social Work Practice, 22(2), 219–226.CrossRefGoogle Scholar
  53. 53.
    Kurtzke, J. F. (1983). Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology, 33(11), 1444–1452.CrossRefPubMedGoogle Scholar
  54. 54.
    Pachner, A. R., & Steiner, I. (2009). The multiple sclerosis severity score (MSSS) predicts disease severity over time. Journal of Neurological Sciences, 278(1–2), 66–70. doi: 10.1016/j.jns.2008.11.020.CrossRefGoogle Scholar
  55. 55.
    Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.CrossRefPubMedGoogle Scholar
  56. 56.
    Wang, C. W., & Chan, C. L. (2009). Psychosocial adaptation status and health-related quality of life among older Chinese adults with visual disorders. Quality of Life Research, 18, 841–851.CrossRefPubMedGoogle Scholar
  57. 57.
    McNulty, K. (2007). Coping with multiple sclerosis: Considerations and interventions. In E. Martz, H. Livneh, & B. A. Wright (Eds.), Coping with chronic illness and disability: theoretical, empirical, and clinical aspects (pp. 289–311). New York: Springer.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of HumanitiesUniversity of Naples “Federico II”NaplesItaly
  2. 2.Department of Neurosciences, Reproductive Science and OdontostomatologyFederico II UniversityNaplesItaly

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