|Year : 2019 | Volume
| Issue : 3 | Page : 132-135
A pilot study of fear of disease consequences and its relationship with quality of life, depression and anxiety in patients with multiple sclerosis
, Morteza Ghojazadeh2, Mohammad Naghavi-Behzad3, Naser Derakhshani4
, Vida Poudratchi Asl5, Behrouz Samei6
1 Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
2 Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
3 Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
4 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
5 Ardabil Azad University, Ardabil, Iran
6 Department of Health Services Management, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
|Date of Submission||01-Mar-2019|
|Date of Decision||11-May-2019|
|Date of Acceptance||13-Jul-2019|
|Date of Web Publication||26-Aug-2019|
Dr. Naser Derakhshani
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
Aims: This study aims to determine the relationship between fear of disease consequences and its relationship with quality of life, symptoms of depression, and anxiety in patients with multiple sclerosis (MS). Materials and Methods: This cross-sectional study was conducted at Tabriz University of Medical Sciences. Seventy patients suffering from MS were selected using the convinced sampling method. Data collection tools were included: Fear of Progression Questionnaire-Short Form, World Health Organizations Quality of Life-Brief, Beck Depression Inventory, and Beck Anxiety Inventory. Descriptive statistical methods, independent sample t-test, one-way ANOVA, Spearman's correlation coefficient test, and linear regression model were used to analyze data by SPSS.22 software. Results: In this study, 38 (54.3%) of patients were male. Mean score of fear of the disease, quality of life, depression, and anxiety was 28.68 ± 9.18, 86.47 ± 14.11, 15.22 ± 4.86, and 15.85 ± 5.55, respectively. Results of Spearman's test indicated a significant relationship between fear of disease consequences on the one hand and quality of life (rs= −0.53), symptoms of depression (rs= −0.52), and anxiety (rs= −0.48) on the other hand (P < 0.001). Results of linear regression analysis demonstrated that there is a strength correlation between depression – as the predictive variable – and quality of life (P = 0.018, standard error [SE] = 0.793, β = −0.283 R2 = 0.57), and anxiety – as the predictive variable – and quality of life (P = 0.005, SE = 0.681, β = 0.332 R2 = 0.64). Conclusion: Considering negative effects of fear of the disease consequences on quality of life, symptoms of depression and anxiety, the patients should be informed about their own conditions, and appropriate mental and health cares should be provided, and effective interventions should be done to alleviate the fear of the patients.
Keywords: Anxiety, depression, fear of the disease, multiple sclerosis, quality of life
|How to cite this article:|
Azami-Aghdash S, Ghojazadeh M, Naghavi-Behzad M, Derakhshani N, Asl VP, Samei B. A pilot study of fear of disease consequences and its relationship with quality of life, depression and anxiety in patients with multiple sclerosis. Int Arch Health Sci 2019;6:132-5
|How to cite this URL:|
Azami-Aghdash S, Ghojazadeh M, Naghavi-Behzad M, Derakhshani N, Asl VP, Samei B. A pilot study of fear of disease consequences and its relationship with quality of life, depression and anxiety in patients with multiple sclerosis. Int Arch Health Sci [serial online] 2019 [cited 2022 Jan 23];6:132-5. Available from: http://www.iahs.kaums.ac.ir/text.asp?2019/6/3/132/265447
| Introduction|| |
Multiple sclerosis (MS) is a chronic disease destroying the myelin membrane. It is associated with physical, cognitive, and psychiatric deficiencies. The disease may negatively affect every part of the central neural system, including brain hemispheres, optic nerves, cerebellum, brain stem, and spinal cord.,, In addition, psychological symptoms and related disorders are highly prevalent among patients. There are 2 million MS patients worldwide and about 500,000 in the USA. Often, the disease occurs during 20–40 years of age and is regarded as the third cause of disability in the USA., In addition, the average age of onset MS in the Eastern Mediterranean region was 26.9 years and in Europe 29.2 years. According to the MS Association, there are about 50,000 MS patients in Iran.,,,, In Iran it's estimated the incident of MS 51.52 per 100,000 people., Several studies demonstrated that the disease affects patients' quality of life from different aspects, and most MS patients have low quality of life.,,, In addition, the disease leads to disorders in balance and coordination, perceiving different senses, depression, anxiety, pain (moderate-to-severe), cognitive disorder, amnesia, deficiencies in focus, and sexual function of the patient. The incidence period of the disease usually coincides with occasions such as marriage, job findings, and supplying financial security resulting in symptoms of depression and anxiety in these patients. On the other hand, prognosis and its unpredictable periods significantly affect quality of life and mental health of the patients. The mentioned factors result in unusual and illogical fear of the disease which may affect caring the patients negatively and intensify the disease complications. Reviewing the texts makes it clear that there are limited studies about effects of fear of disease consequences on treating and intensifying complications as well as quality of life, depression, anxiety, and other aspects., Therefore, the present study aims at determining the relationship between fear of disease consequences and its effect on quality of life, symptoms of depression, and anxiety of MS patients. It is hoped that results of the study lead to appropriate management and sufficient focus on the patients' problems.
| Materials and Methods|| |
This cross-sectional study was conducted at Tabriz University of Medical Sciences. All 70 patients who participated at annual meeting of MS patients hold by MS Association at Tabriz University of Medical Sciences were sampled using convinced sampling method. Data collection tools were included four valid and reliable questionnaires: Fear of Progression Questionnaire-Short Form (FoPQ-SF), World Health Organizations Quality of Life-Brief (WHOQOL-BREF), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI).
There are seven questions, including some demographic data – (sex, age, marital status, income, occupation, level of education, and area of residence) – about participants.
The fear of progression was evaluated by the Persian translation of FoPQ-SF. There are 12 questions about fear of disease consequences with Likert 5-point – (1 never and 5 very often) – scale with 60 and 12 as the highest and lowest scores. This study was conducted by Kwakkenbos et al., in 2012, the results of the confirmatory factor analysis confirmed the construct validity of the Persian version of the FoPQ-SF. In addition, the reliability of FoPQ-SF tool was also reported (r = 0.87).
Qualities of life of participants were measured using the WHOQOL, 26-item version. The highest and lowest scores were 130 and 26, respectively. This tool involving four dimensions: physical health, psychological health, social health, and environmental. Scoring was conducted with a 5-point Likert scale (1 = very little and 5 = very good). In a study was conducted by Nedjat et al., in 2008, the reliability of the Persian translation of the WHOQOL-BREF was greater than (Cronbach's α = 0.70). In addition, the internal correlation coefficient was calculated using the test-retest. For both, the quality of life and quality of life related to health were calculated 0.7.
To assessing the anxiety of participant, the BAI tool with 21 items was apply. The score of this tool was ranging from 0 (not at all) to 3 (severely, I could barely stand it). The minimum score has 0 and maximum score was 63. In the Persian version of BAI reliability was reported (Cronbach's α = 0.89) and test-retest reliability was 0.75.
Depression symptoms of participants were evaluated by BDI with 21 items, each item of this tool rated with a set of four possible answers (0–3) The BDI reliability was reported (Cronbach's α = 0.96), and test-retest reliability was 0.82. In addition, in the Persian version of BDI, internal consistency was demonstrated (Cronbach's α = 0.84).
The questionnaire was filled out using two-trained questionnaire through interview with the patients. Descriptive statistics (frequency, percentage, mean ± standard deviation [SD]), independent samples t-test, Spearman's correlation coefficient, and linear regression model are used to data analysis by SPSS.16 software package (SPSS Inc, Chicago, United State of America). A P = 5% was statistically considered statistically significant.
| Results|| |
Of 70 participants, 38 (54.3%) were male. The mean age of the patients was 51.50 ± 14.80 years of age. Fifty-five (78.6%) of patients were living in cities, and most of them, i.e. 29 patients (41.4%) were homemakers. Income of 25 (35.7%) patients was less than their costs. Mean ± SD of the disease duration was 5.65 ± 2.95 years.
Mean score of fear of disease consequences was 28.68 ± 9.18 (Min 12 and Max 60) in the patients, which shows that about half of the patients fear of the disease consequences. The total mean of MS patients' quality of life is 86.47 ± 14.11 (Min 26 and Max 130). Mean and SD scores of symptoms of depression and anxiety are 15.22 ± 4.86 (Min 0 and Max 63) and 15.85 ± 5.55 (Min 0 and Max 63), respectively.
Results of Spearman's correlation coefficient indicated a statistically significant relationship between fear of disease consequences and quality of life, depression, and anxiety in patients with multiple sclerosis [Table 1].
|Table 1: Results of spearman's correlation coefficient between fear of disease consequences and quality of life, depression, and anxiety (n=70)|
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Results of the linear regression test demonstrated that there is a strength correlation between fear of the disease and quality of life, direct relation between fear of the disease and anxiety and depression [Table 2].
|Table 2: Results of linear regression between fear of disease consequences and quality of life, depression, and anxiety (n=70)|
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Furthermore, results of linear regression analysis demonstrated that there is a strength correlation between depression – as the predictive variable – and quality of life (P = 0.018, standard error [SE] = 0.793, β = −0.283 R2 = 0.57), and anxiety – as the predictive variable – and quality of life (P = 0.005, SE = 0.681, β = 0.332 R2 = 0.64).
Results of evaluating fear of disease consequences with some demographic variables of the participants showed that among evaluated variables with items above, only sex has a significant relationship with fear of disease and it was higher in woman than that of men (P = 0.021).
| Discussion|| |
Results of statistical tests showed a meaningful relationship between fear of diseases complications and quality of life, depression, and anxiety.
Mean score of quality of life of the patients was measured as 86.47 ± 14.11. This level of quality of life is almost similar to that of patients of Nagaraj et al.'s study., The study conducted by Patti et al., in Italy also showed the similar results. Results of studies conducted at other parts of the world are almost similar to the results obtained from this research.,, However, some studies conducted in Iran, for example, Sureshjani et al., Hazrati et al., and Taraghi and Eleiae refer to low quality of life of MS patients. High quality of life of participants of the present study may be attributed to the applied tools which are different from those used by the above-mentioned studies. Furthermore, another reason for the high quality of life of the participants in this study is compared with other studies. In addition, another reason for the high quality of life of the participants in this study in compared with other studies could be a relatively long time to get sick from the disease among the participants in the study and the possibility of choosing the confronting approaches. On the other hand, the samples of this study were members of the MS Association which can be a quality of life promoting factor for these patients. According to the linear regression model used in this study, there is a statistically significant correlation between fear of the disease consequences – as a predicting factor – and quality of life such that the higher the fear, the lower the quality of life. In their study, Handschel et al. demonstrated that fear of symptoms recurrence significantly affected patients' quality of life. Therefore, considering negative effects of fear of the disease on quality of life as well as low quality of life of our patients in comparison with that of patients in other countries, appropriate planning and practical measures should be implemented and the patients' knowledge of their own conditions should be promoted to alleviate fear of the patients.
The present study results showed that fear of the disease consequences significantly increased the incidence rate of symptoms of depression and anxiety. The results of Patti et al.'s in 2003, study revealed that anxiety and depression were increased due to fear of the disease and alleviated less during the next 6 months, In addition, this study demonstrated that depression and anxiety significantly related to quality of life. In the study conducted by Janssens et al., the researchers concluded that less-supported patients feel fear which result in the development of symptoms of depression and anxiety, and therefore, low quality of life, which may be true for the present study. Therefore, fear of the disease, and finally, low quality of life of the patients should be prevented through highly supporting patients and offering appropriate mental, hygienic, and therapeutic services.
One of the limitations of the present study is a lack of similar studies and comparison of results with that of other ones. It is one of few studies evaluating the relationship between fear of disease consequences and quality of life and symptoms of depression and anxiety. Another limitation of the present study was the inability to control possible. Confuse variables such as the severity of the disease. Thus, it is recommended to conduct further studies with high sample sizes about other diseases. Considering the efficiency of qualitative studies evaluating similar participants, it is suggested to conduct qualitative studies about experiences and reasons of fear of disease consequences.
| Conclusion|| |
According to results of the current study, depression, and anxiety of the patients should be alleviated and quality of life of the patients should be promoted through increasing the patients' information and knowledge about their own conditions, providing them with more exact information, and offering appropriate mental and health care.
All moral considerations, including confidentiality of information, were observed in this study. Ethical considerations in this study included: permission from the Ethics Committee of the Tabriz University of Medical Sciences, coordinating with the authorities of MS Association at Tabriz University of Medical Sciences, obtaining informed consent from participants and ensuring the confidentiality of the information and profiles of the participants.
The authors bound themselves to appreciate all patients participated in the study as well as authorities of MS Association at Tabriz University of Medical Sciences for their sincere cooperation.
Financial support and sponsorship
This study was supported by Tabriz University of medical sciences, Tabriz, Iran.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Myhr KM, Grytten N, Aarseth JH, Nyland H. The norwegian multiple sclerosis national competence centre and national multiple sclerosis registry – A resource for clinical practice and research. Acta Neurol Scand Suppl 2006;183:37-40.
Myhr KM, Grytten N, Torkildsen Ø, Wergeland S, Bø L, Aarseth JH. The norwegian multiple sclerosis registry and biobank. Acta Neurol Scand 2015;132:24-8.
McKay KA, Tremlett H, Zhu F, Kastrukoff L, Marrie RA, Kingwell E. A population-based study comparing multiple sclerosis clinic users and non-users in British Columbia, Canada. Eur J Neurol 2016;23:1093-100.
Chwastiak LA, Ehde DM. Psychiatric issues in multiple sclerosis. Psychiatr Clin North Am 2007;30:803-17.
Stuifbergen AK, Blozis SA, Harrison TC, Becker HA. Exercise, functional limitations, and quality of life: A longitudinal study of persons with multiple sclerosis. Arch Phys Med Rehabil 2006;87:935-43.
Mandysova P. Knowing the course of multiple sclerosis. Nursing 1998;28:HN12.
World Health Organization. Atlas: Multiple Sclerosis Resources in The World 2008. World Health Organization; 2008.
Hashemilar M, Savadi Ouskui D, Farhoudi M, Ayromlou H, Asadollahi A. Multiple sclerosis in East-Azerbaijan, North West Iran. Neurol Asia 2011;16:127-31.
Payamani F, Nazari A, Noktedan H, Mehran A, Sahraeian M. Investigation of lifestyle in patients with multiple sclerosis have referred to the MS board in Tehran. YAFTEH 2012;13:31-8.
Thornton EW, Tedman S, Rigby S, Bashforth H, Young C. Worries and concerns of patients with multiple sclerosis: Development of an assessment scale. Mult Scler 2006;12:196-203.
Masoudi R, Mohammadi E, Nabavi SM, Ahmadi F. The effect of Orem based self-care program on physical quality of life in multiple sclerosis patients. Journal of Shahrekord Uuniversity of Medical Sciences 2008;10:21-9.
Taraghi Z, Eleiae M. Quality of life of patient member of MS society of mazandaran. Persian Iran J Neurol 2007;20:51-60.
Eskandarieh S, Heydarpour P, Elhami SR, Sahraian MA. Prevalence and incidence of multiple sclerosis in Tehran, Iran. Iran J Public Health 2017;46:699-704.
Heydarpour P, Khoshkish S, Abtahi S, Moradi-Lakeh M, Sahraian MA. Multiple sclerosis epidemiology in middle East and North Africa: A systematic review and meta-analysis. Neuroepidemiology 2015;44:232-44.
Forbes A, While A, Mathes L, Griffiths P. Health problems and health-related quality of life in people with multiple sclerosis. Clin Rehabil 2006;20:67-78.
Haresabadi M, Karimi Monaghi H, Froghipor M, Mazlom S. Quality of life in patients with multiple sclerosis referring to Ghaem hospital, Mashhad in 2009. J North Khorasan Univ Med Sci 2011;2:7-12.
Heidari Sureshjani S, Eslami AA, Hassan Zadeh A. The quality of life among multiple sclerosis patients in Isfahan, Iran. Health Sys Res J 2012;5:571-9.
Taraghi Z, Ilali E, Abedini M, Zarvani A, Khoshnama I, Mohammadpour R, et al
. Quality of life among multiple sclerosis patients. Iran J Nurs 2007;20:51-9.
McGuinness SD, Peters S. The diagnosis of multiple sclerosis: Peplau's interpersonal relations model in practice. Rehabil Nurs 1999;24:30-3.
Bishop M, Stenhoff DM, Shepard L. Psychosocial adaptation and quality of life in multiple sclerosis: Assessment of the disability centrality model. J Rehabil 2007;73:3.
Russell CS, White MB, White CP. Why me? Why now? Why multiple sclerosis?: Making meaning and perceived quality of life in a Midwestern sample of patients with multiple sclerosis. Fam Syst Health 2006;24:65.
Anvar M, Javadpour A, Zadeh SM. Assessing death anxiety and its correlates among severe medically ill in-patients. Shiraz E-Medical Journal 2012;13:122-7.
Adelbratt S, Strang P. Death anxiety in brain tumour patients and their spouses. Palliat Med 2000;14:499-507.
Kwakkenbos L, van den Hoogen FH, Custers J, Prins J, Vonk MC, van Lankveld WG, et al.
Validity of the Fear of Progression Questionnaire-Short Form in patients with systemic sclerosis. Arthritis Care Res (Hoboken) 2012;64:930-4.
Nedjat S, Montazeri A, Holakouie K, Mohammad K, Majdzadeh R. Psychometric properties of the Iranian interview-administered version of the World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF): A population-based study. BMC Health Serv Res 2008;8:61.
Beck AT, Steer RA, Carbin MG. Psychometric properties of the beck depression inventory: Twenty-five years of evaluation. Clin Psychol Rev 1988;8:77-100.
Basker M, Moses PD, Russell S, Russell PS. The psychometric properties of beck depression inventory for adolescent depression in a primary-care paediatric setting in India. Child Adolesc Psychiatry Ment Health 2007;1:8.
Janardhan V, Bakshi R. Quality of life in patients with multiple sclerosis: The impact of fatigue and depression. J Neurol Sci 2002;205:51-8.
Nagaraj K, Taly AB, Gupta A, Prasad C, Christopher R. Prevalence of fatigue in patients with multiple sclerosis and its effect on the quality of life. J Neurosci Rural Pract 2013;4:278-82.
] [Full text]
Patti F, Cacopardo M, Palermo F, Ciancio MR, Lopes R, Restivo D, et al.
Health-related quality of life and depression in an Italian sample of multiple sclerosis patients. J Neurol Sci 2003;211:55-62.
Benito-León J, Morales JM, Rivera-Navarro J. Health-related quality of life and its relationship to cognitive and emotional functioning in multiple sclerosis patients. Eur J Neurol 2002;9:497-502.
Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005;353:2034-41.
Hazrati M, Zahmatkeshan N, Dejbakhsh T, Nikseresht A, Zeyghami B. The effect of rehabilitation process on the quality of life in multiple sclerosis patients. Armaghane Danesh 2005;10:53-65.
Handschel J, Naujoks C, Kübler NR, Krüskemper G. Fear of recurrence significantly influences quality of life in oral cancer patients. Oral Oncol 2012;48:1276-80.
Janssens AC, van Doorn PA, de Boer JB, van der Meché FG, Passchier J, Hintzen RQ. Impact of recently diagnosed multiple sclerosis on quality of life, anxiety, depression and distress of patients and partners. Acta Neurol Scand 2003;108:389-95.
[Table 1], [Table 2]