Skip to main content

Advertisement

SpringerLink
Log in

Treatment for depression and its relationship to improvement in quality of life and psychological well-being in multiple sclerosis patients

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Depression, a common problem in multiple sclerosis (MS), is generally associated with poorer quality of life (QOL). However, it is unclear whether treating depression also extends to better perceived QOL. Understanding QOL in MS has been limited by narrow definitions and exclusive focus on symptomology, with little emphasis on positive aspects of QOL. This study examined the impact of treating depression on QOL in 60 patients with a relapsing form of MS and moderate to severe depression, who were randomly assigned to one of three validated 16-week treatments for depression: individual cognitive-behavioral therapy, group psychotherapy, or sertraline. QOL was measured by the MSQOL-54, a version of the SF-36 adapted for MS, and Ryff’s scales of psychological well-being, which measure positive attitudes and functioning. Depression and QOL were measured at baseline and immediately following treatment completion. Controlling for baseline neurological impairment and baseline QOL scores, regression analyses showed treating depression was significantly associated with improvements in the MSQOL-54 scales (R2s = 0.19–0.55, p < 0.001) and in four of the six scales of psychological well-being: environmental mastery (R2 = 0.13, p < 0.001), positive relations (R2 = 0.08, p < 0.001), purpose in life (R2 = 0.16, p < 0.001), and self-acceptance (R2 = 0.26, p < 0.001). Findings suggest treating depression influences both the negative and positive aspects of QOL and underscore the importance of examining QOL with two complementary approaches.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • DW Anderson et al. (1992) ArticleTitleRevised estimate of the prevalence of multiple sclerosis in the United States. Ann Neurol 31 333–336

    Google Scholar 

  • DE Goodkin (1992) The natural history of multiple sclerosis DE Goodkin (Eds) Treatment of Multiple Sclerosis: Trial Design, Results and Future Perspectives. Springer-Verlag New York 17–46

    Google Scholar 

  • S Fruehwald et al. (2001) ArticleTitleDepression and quality of life in multiple sclerosis. Acta Neurol Scand 104 IssueID5 257–261

    Google Scholar 

  • MP McCabe S McKern (2002) ArticleTitleQuality of life and multiple sclerosis: Comparison between people with multiple sclerosis and people from the general population. J Clin Psychol Med Settings 9 IssueID4 287–295

    Google Scholar 

  • F Patti et al. (2003) ArticleTitleEffects of a short outpatient rehabilitation treatment on disability of multiple sclerosis patients–a randomised controlled trial. J Neurol 250 IssueID7 861–866

    Google Scholar 

  • RA Rudick et al. (1992) ArticleTitleQuality of life in multiple sclerosis. Arch Neurol 49 1237–1242 Occurrence Handle1:STN:280:ByyD1c%2Fks10%3D Occurrence Handle1449401

    CAS  PubMed  Google Scholar 

  • AC Janssens et al. (2003) ArticleTitleImpact of recently diagnosed multiple sclerosis on quality of life, anxiety, depression and distress of patients and partners. Acta Neurol Scand 108 IssueID6 389–395 Occurrence Handle1:STN:280:DC%2BD3srjs1agtw%3D%3D Occurrence Handle14616290

    CAS  PubMed  Google Scholar 

  • BP Hermann et al. (1996) ArticleTitleA comparison of health-related quality of life in patients with epilepsy, diabetes, and multiple sclerosis. Epilepsy Res 25 113–118 Occurrence Handle10.1016/0920-1211(96)00024-1 Occurrence Handle1:STN:280:ByiD3sflvVw%3D Occurrence Handle8884169

    Article  CAS  PubMed  Google Scholar 

  • J Benito-Leon JM Morales J Rivera-Navarro (2002) ArticleTitleHealth-related quality of life and its relationship to cognitive and emotional functioning in multiple sclerosis patients. Eur J Neurol 9 IssueID5 497–502 Occurrence Handle10.1046/j.1468-1331.2002.00450.x Occurrence Handle1:STN:280:DC%2BD38vmtFyqtw%3D%3D Occurrence Handle12220381

    Article  CAS  PubMed  Google Scholar 

  • MW Nortvedt et al. (2001) ArticleTitleReduced quality of life among multiple sclerosis patients with sexual disturbance and bladder dysfunction. Mult Scler 7 IssueID4 231–235 Occurrence Handle10.1191/135245801680209330 Occurrence Handle1:STN:280:DC%2BD3MvpvFCjsw%3D%3D Occurrence Handle11548982

    Article  CAS  PubMed  Google Scholar 

  • AC Janssens et al. (2003) ArticleTitleAnxiety and depression influence the relation between disability status and quality of life in multiple sclerosis. Mult Scler 9 IssueID4 397–403 Occurrence Handle10.1191/1352458503ms930oa Occurrence Handle1:STN:280:DC%2BD3szovFGqtQ%3D%3D Occurrence Handle12926846

    Article  CAS  PubMed  Google Scholar 

  • L Pfennings et al. (1999) ArticleTitleExploring differences between subgroups of multiple sclerosis patients in health-related quality of life. J Neurol 246 IssueID7 587–591 Occurrence Handle10.1007/s004150050408 Occurrence Handle1:STN:280:DyaK1MzptFSjsA%3D%3D Occurrence Handle10463361

    Article  CAS  PubMed  Google Scholar 

  • JA Dock M Ravnborg (1996) ArticleTitleQuality of life as a measure of rehabilitation outcome in patients with multiple sclerosis. Acta Neurol Scand 93 229–235 Occurrence Handle1:STN:280:BymA3MritVM%3D Occurrence Handle8739430

    CAS  PubMed  Google Scholar 

  • JL Wang et al. (2000) ArticleTitleMajor depression and quality of life in individuals with multiple sclerosis. Int J Psychiatry Med 30 IssueID4 309–317 Occurrence Handle1:STN:280:DC%2BD3Mvit1aktA%3D%3D Occurrence Handle11308035

    CAS  PubMed  Google Scholar 

  • MP Amato et al. (2001) ArticleTitleQuality of life in multiple sclerosis: The impact of depression, fatigue and disability. Mult Scler 7 IssueID5 340–344 Occurrence Handle10.1191/135245801681138059 Occurrence Handle1:STN:280:DC%2BD3MnnvVGmsw%3D%3D Occurrence Handle11724451

    Article  CAS  PubMed  Google Scholar 

  • F Patti et al. (2003) ArticleTitleHealth-related quality of life and depression in an Italian sample of multiple sclerosis patients. J Neurol Sci 211 IssueID1–2 55–62

    Google Scholar 

  • M Somerset et al. (2003) ArticleTitleFactors that contribute to quality of life outcomes prioritised by people with multiple sclerosis. Qual Life Res 12 IssueID1 21–29 Occurrence Handle10.1023/A:1022088203586 Occurrence Handle12625515

    Article  PubMed  Google Scholar 

  • L Chwastiak et al. (2002) ArticleTitleDepressive symptoms and severity of illness in multiple sclerosis: Epidemiologic study of a large community sample. Am J Psychiatry 159 IssueID11 1862–1868 Occurrence Handle10.1176/appi.ajp.159.11.1862 Occurrence Handle12411220

    Article  PubMed  Google Scholar 

  • DM Wingerchuk BG Weinshenker (2000) ArticleTitleMultiple sclerosis: Epidemiology, genetics, classification, natural history, and clinical outcome measures. Neuroimaging Clin N Am 10 IssueID4 611–624

    Google Scholar 

  • V Janardhan R Bakshi (2002) ArticleTitleQuality of life in patients with multiple sclerosis: The impact of fatigue and depression. J Neurol Sci 205 IssueID1 51–58 Occurrence Handle10.1016/S0022-510X(02)00312-X Occurrence Handle12409184

    Article  PubMed  Google Scholar 

  • L Provinciali et al. (1999) ArticleTitleA multidimensional assessment of multiple sclerosis: Relationships between disability domains. Acta Neurol Scand 100 156–162

    Google Scholar 

  • BJ Vickery et al. (1997) ArticleTitleComparison of a generic to targeted health-related quality of life measures for multiple sclerosis. J Clin Epidemiol 50 557–569 Occurrence Handle10.1016/S0895-4356(97)00001-2 Occurrence Handle1:STN:280:ByiA38vlsVc%3D Occurrence Handle9180648

    Article  CAS  PubMed  Google Scholar 

  • KW Smith NE Avis SF Assmann (1999) ArticleTitleDistinguishing between quality of life and health status in quality of life research: A meta-analysis. Qual Life Res 8 IssueID5 447–459

    Google Scholar 

  • MM Gladis et al. (1999) ArticleTitleQuality of life: Expanding the scope of clinical significance. J Consult Clin Psychol 67 IssueID3 320–331

    Google Scholar 

  • CD Ryff (1989) ArticleTitleHappiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 57 1069–1081

    Google Scholar 

  • CL Keyes D Shmotkin CD Ryff (2002) ArticleTitleOptimizing well-being: The empirical encounter of two traditions. J Pers Soc Psychol 82 IssueID6 1007–1022

    Google Scholar 

  • CD Ryff B Singer (1996) ArticleTitlePsychological well-being: Meaning, measurement, and implications for psychotherapy research. Psychother Psychosom 65 14–23

    Google Scholar 

  • GJ Kafka A Kozma (2002) ArticleTitleThe construct validity of Ryff’s scales of psychological well-being (SPWB) and their relationship to measures of subjective well-being. Soc Indic Res 57 171–190

    Google Scholar 

  • CD Ryff CLM Keyes (1995) ArticleTitleThe structure of psychological well-being. J Pers Soc Psychol 69 719–727

    Google Scholar 

  • BG Vickrey et al. (1995) ArticleTitleA health-related quality of life measure for multiple sclerosis. Qual Life Res 4 187–206 Occurrence Handle1:STN:280:ByqA3sfhvFA%3D Occurrence Handle7613530

    CAS  PubMed  Google Scholar 

  • DC Mohr et al. (2001) ArticleTitleComparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. J Consult Clin Psychol 69 IssueID6 942–949 Occurrence Handle10.1037//0022-006X.69.6.942 Occurrence Handle1:STN:280:DC%2BD38%2FkvFOrtQ%3D%3D Occurrence Handle11777121

    Article  CAS  PubMed  Google Scholar 

  • DC Mohr SL Hart A Goldberg (2003) ArticleTitleEffects of treatment for depression on fatigue in multiple sclerosis. Psychosom Med 65 IssueID4 542–547

    Google Scholar 

  • DC Mohr C Classen M Barrera (2004) ArticleTitleThe relationship between social support, depression, and treatment for depression in people with multiple sclerosis. Psychol Med 34 533–541

    Google Scholar 

  • CM Poser et al. (1983) ArticleTitleNew diagnostic criteria for multiple sclerosis. Ann Neurol 13 227–231 Occurrence Handle1:STN:280:BiyB3c3ntlM%3D Occurrence Handle6847134

    CAS  PubMed  Google Scholar 

  • FD Lublin SC Reingold (1996) ArticleTitleDefining the clinical course of multiple sclerosis: Results of an international survey. Neurol 46 907–911

    Google Scholar 

  • AT Beck RA Steer GK Brown (1996) Beck Depression Inventory, 2nd edn.: Manual. Psychological Corporation San Antonio TX

    Google Scholar 

  • M Hamilton (1960) ArticleTitleA rating scale for depression. J Neurol Neurosurg Psych 23 56–62 Occurrence Handle1:STN:280:CC%2BC2M7oslU%3D Occurrence Handle14399272

    CAS  PubMed  Google Scholar 

  • DC Mohr et al. (2002) ArticleTitleModerating effects of coping on the relationship between stress and the development of new brain lesions in multiple sclerosis. Psychosom Med 64 IssueID5 803–809 Occurrence Handle10.1097/01.PSY.0000024238.11538.EC Occurrence Handle12271111

    Article  PubMed  Google Scholar 

  • DC Mohr et al. (2000) ArticleTitleComparative outcome trial of three treatments for depression in multiple sclerosis. Ann Behav Med 22 IssueIDSuppl S123

    Google Scholar 

  • D Spiegel C Classen (2000) Group Psychotherapy for Cancer Patients. Basic Books New York

    Google Scholar 

  • TF Scott et al. (1996) ArticleTitleCharacterization of major depression symptoms in multiple sclerosis patients. J Neuropsychiatry Clin Neurosci 8 318–323

    Google Scholar 

  • JE Ware CD Sherbourne (1992) ArticleTitleThe MOS 36-Item Short-Form Health Survey (SF-36) I. Conceptual Framework and Item Selection. Med Care 30 473–481 Occurrence Handle1593914

    PubMed  Google Scholar 

  • DC Mohr et al. (1997) ArticleTitleIdentification of beck depression inventory items related to multiple sclerosis. J Behav Med 20 405–412

    Google Scholar 

  • JE Aikens et al. (1999) ArticleTitleAssessing depressive symptoms in multiple sclerosis: Is it necessary to omit items for the original beck depression inventory? J Behav Med 22 127–142

    Google Scholar 

  • Moran PJ, Mohr DC. The validity of Beck Depression Inventory and Hamilton Rating Scale for Depression items in the assessment of depression among patients with multiple sclerosis. J Behav Med, in press.

  • SL Hauser et al. (1983) ArticleTitleIntensive immunosuppression in progressive multiple sclerosis. A randomized, three-arm study of high-dose intravenous cyclophosphamide, plasma exchange, and ACTH. N Engl J Med 308 IssueID4 173–180

    Google Scholar 

  • SPSS 11 Software Program and SPSS Base 11.0 Applications Guide., SPSS, Inc.: Chicago, IL, 2002.

  • MJ Fisch et al. (2003) ArticleTitleFluoxetine versus placebo in advanced cancer outpatients: A double-blinded trial of the Hoosier Oncology Group. J Clin Oncol 21 IssueID10 1937–1943

    Google Scholar 

  • A Molassiotis et al. (2002) ArticleTitleA pilot study of the effects of cognitive-behavioral group therapy and peer support/counseling in decreasing psychologic distress and improving quality of life in Chinese patients with symptomatic HIV disease. AIDS Patient Care STDS 16 IssueID2 83–96 Occurrence Handle10.1089/10872910252806135

    Article  Google Scholar 

  • MW Nortvedt et al. (2000) ArticleTitleQuality of life as a predictor for change in disability in MS. Neurol 55 51–54 Occurrence Handle1:STN:280:DC%2BD3czovVOlsQ%3D%3D Occurrence Handle10891905

    CAS  PubMed  Google Scholar 

  • B Ruo et al. (2003) ArticleTitleDepressive symptoms and health-related quality of life: The Heart and Soul Study. JAMA 290 IssueID2 215–221 Occurrence Handle10.1001/jama.290.2.215 Occurrence Handle12851276

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. San Francisco/San Francisco VA Medical Center, University of California, 4150 Clement Street (116-A), San Francisco, CA, USA, 94121

    Stacey Hart, Irina Fonareva, Natalia Merluzzi & David C. Mohr

Authors
  1. Stacey Hart
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irina Fonareva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Natalia Merluzzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David C. Mohr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stacey Hart.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hart, S., Fonareva, I., Merluzzi, N. et al. Treatment for depression and its relationship to improvement in quality of life and psychological well-being in multiple sclerosis patients. Qual Life Res 14, 695–703 (2005). https://doi.org/10.1007/s11136-004-1364-z

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-004-1364-z

Keywords

Search

Navigation