MS Control, Coping, and Social Support: Relationship to Depression in Multiple Sclerosis

Open Access
Author:
Polen, Dawn M.
Graduate Program:
Psychology
Degree:
Doctor of Philosophy
Document Type:
Dissertation
Date of Defense:
August 25, 2006
Committee Members:
  • Peter Andrew Arnett, Committee Chair
  • Michelle Gayle Newman, Committee Member
  • William Ray, Committee Member
  • Craig R Denegar, Ph D, Committee Member
Keywords:
  • depression
  • Multiple sclerosis
Abstract:
Individuals with Multiple Sclerosis (MS) consistently show high rates of depression, and depression can have profound and negative impacts on the health and well-being of these patients. MS control, coping, and social support may all impact depression in MS. MS control is a construct that is associated with the domains of learned helplessness and attributional style. The MS literature reports relationships between coping and depression, social support and depression, and learned helplessness and depression. However, there is relatively little research examining possible interrelationships among these variables in predicting depression in MS. This study sought to refine and redefine these potentially broad constructs based on an analysis of the content validity and psychometric properties of tests developed to measure them, and to explore their inter-relatedness based on a comparative analysis of five structural equation models comprised of these constructs modeled in theoretically different ways. One-hundred-and-one MS patients were administered a series of questionnaires assessing multiple domains of MS control, coping, social support, and depression. The nature of the relationships among these constructs for individuals with MS was examined with consideration given to demographic and disease-related variables. In all five models, the construct depression was the variable being predicted and was measured as a combination of mood and negative evaluative symptoms of depression. MS control was represented through the measurement of items assessing feelings of control related to MS. Coping comprised measures of active coping—active coping, planning, and suppression of competing activities—and avoidant coping—denial, behavioral disengagement, and mental disengagement. Finally, social support was measured as the number of supports and satisfaction with that support. Each model was tested for goodness of fit to the data via five fit indices: Chi-square, the Chi-square to degrees of freedom ratio (CMIN/df), the Comparative Fit Index (CFI), the Incremental Fit Index (IFI), and the root-mean-square error of approximation (RMSEA). These fit indices were compared among models in order to determine which model best depicted the relationship among these constructs. Finally, a gender discrepancy among these constructs was predicted, such that MS control, coping, and social support were predicted to be more strongly associated with depression for women than for men. All five models displayed adequate goodness of fit to the data via the evaluation of three of the five fit indices. When the avoidant coping measures were removed from the models (based on poor psychometric fit of these measures within the models), all five models displayed adequate goodness of fit to the data via the evaluation of four of the five fit indices. Given that all models displayed some goodness of fit, per standard SEM interpretive approaches, the most parsimonious model (Model 1) was considered the best explanation of the associations among these constructs. Thus, the explanation that MS control, coping (particularly, active coping), and social support all account for significant independent amounts of the variance in depression in this population (specifically, for women) is the best fitting explanation for the current data. According to Model 1 (with data for active coping/ women only), these data suggest that MS control, coping, and social support account for 15%, 14%, and 26% of the variance in depression, respectively. Regression analyses showed that this and the other models were only a good fit for women in the sample. Hence, social support appears to have a significant, independent impact on depression for women with MS, followed by MS control and active coping. Specifically, this study illustrates how poor social support (particularly few social supports), ineffective coping (particularly lack of planning in response to stress), and strong feelings of MS control (particularly a belief that “MS is controlling my life”) may likely lead to depression in women with MS. Psychotherapeutic care for this population may be most effective if consideration for each of these specific domains is targeted as part of a comprehensive treatment protocol.