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.
Similar content being viewed by others
References
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.
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.
Yeh, E. A., & Weinstock-Guttman, B. (2010). Natalizumab in pediatric multiple sclerosis patients. Therapeutic Advances in Neurological Disorders, 3(5), 293–299.
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.
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.
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.
MacAllister, W. S., Christodoulou, C., Troxell, R., et al. (2009). Fatigue and quality of life in pediatric multiple sclerosis. Multiple Sclerosis, 15, 1502–1508.
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.
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.
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.
Whitlock, F. A., & Siskind, M. M. (1980). Depression as a major symptom of multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry, 43, 861–865.
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.
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.
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.
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.
Amato, M. P., Goretti, B., Ghezzi, A., et al. (2008). Cognitive and psychosocial features of childhood and juvenile MS. Neurology, 70(20), 1891–1897.
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.
Feinstein, A. (2007). The clinical neuropsychiatry of multiple sclerosis (2nd ed., p. 2007). Cambridge: Cambridge University Press.
Kalb, R. (2007). The emotional and psychological impact of multiple sclerosis relapses. Journal of Neurology Science, 256(suppl.1), 29–33.
Schubert, D. S. (1993). Increased depression in multiple sclerosis patients. A meta-analysis. Psychosomatics, 34, 124–130.
Boyd, J. R., & MacMillan, L. J. (2005). Experiences of children and adolescents living with multiple sclerosis. Journal of Neuroscience Nursing, 37(6), 334–342.
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.
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.
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.
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.
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.
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.
Gay, M. C., Vrignaud, P., Garitte, C., et al. (2010). Predictors of depression in multiple sclerosis patients. Acta Neurologica Scandinavica, 121(3), 161–170.
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.
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.
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.
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).
Ungar, M. (Ed.). (2012). The social ecology of resilience: A handbook of theory and practice. New York: Springer.
Goldstein, S., & Brooks, R. (2012). Handbook of resilience (2nd ed.). New York: Springer.
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.
Coleman, J., & Hagnell, A. (Eds.). (2007). Adolescence, risk and resilience: Against the odds. Chichester: Wiley.
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.
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.
Block, J. (2002). Personality as an affect-processing system. Mahwah: Erlbaum.
Prince-Embury, S., & Saklofske, D. H. (Eds.). (2013). Resilience in children, adolescents, and adults: Translating research into practice. New York: Springer.
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).
Rutter, M. (1985). Resilience in the face of adversity: protective factors and resistance to psychiatric disorder. British Journal of Psychiatry, 147, 598–611.
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.
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.
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.
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.
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.
Leplege, A., & Hunt, S. (1997). The problem of quality of life in medicine. JAMA, 278, 47.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory-II. San Antonio: Psychological Corporation.
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.
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.
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.
Kurtzke, J. F. (1983). Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology, 33(11), 1444–1452.
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.
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.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Rights and permissions
About this article
Cite this article
Rainone, N., Chiodi, A., Lanzillo, R. et al. Affective disorders and Health-Related Quality of Life (HRQoL) in adolescents and young adults with Multiple Sclerosis (MS): the moderating role of resilience. Qual Life Res 26, 727–736 (2017). https://doi.org/10.1007/s11136-016-1466-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-016-1466-4