A longitudinal analysis of cognitive dysfunction, coping, and depression in multiple sclerosis.

Open Access
Rabinowitz, Amanda
Graduate Program:
Master of Science
Document Type:
Master Thesis
Date of Defense:
February 15, 2008
Committee Members:
  • Peter Andrew Arnett, Thesis Advisor
  • Peter Andrew Arnett, Dissertation Advisor
  • coping
  • cognitive dysfunction
  • multiple sclerosis
  • depresion
  • moderation
  • mediation
Objective: Patients with cognitive functioning deficits commonly associated with Multiple Sclerosis (MS) may be at greatest risk for depression when they also use maladaptive coping strategies. Furthermore, cognitive difficulties may directly affect an individual’s ability to employ more adaptive active coping strategies, leading to depression. The current study was designed to test whether coping mediated or moderated the relationship between cognitive dysfunction and depression longitudinally in MS. Method: Fifty-five MS patients were assessed at two time points 3 years apart. Cognitive function was assessed at time 1, using a battery of neuropsychological tests. Coping was assessed at time one and time two using the COPE. An index of adaptive coping strategies was obtained by subtracting “Avoidant Coping” subscale scores from “Active Coping” subscale scores. Evaluative and mood symptoms of depression were assessed at time two using the Chicago Multiscale Depression Inventory. Results: With regard to the moderation hypothesis, after accounting for the main effects for the Cognitive Task and Coping index, the interaction term accounted for 15% of the variance in depression (&#916;F = 10.40; p < .005). With regard to the mediation hypothesis, the Sobel statistic suggested a trend towards significance (Z = -1.78; p < .10). According to the bootstrap estimates, the indirect effect of cognitive functioning on depression via coping is different from zero with 95% confidence (-2.16; LL 95% CI: -4.90; UL 95% CI: -0.12). This is consistent with the conclusion drawn from the Baron and Kenny (1986) criteria for mediation. Conclusions: Coping strategies, defined by the difference between active coping and avoidance coping in an individual, moderate the relationship between cognitive functioning and depression in patients with MS longitudinally. Hence, MS patients with low cognitive functioning are most at risk for experiencing depression when they use a maladaptive coping profile. Furthermore, coping partially mediates the relationship between cognitive functioning and depression longitudinally. This suggests that cognitive dysfunction influences an MS patient’s’ ability to employ more active coping strategies , relative to avoidant strategies, which in turn may contribute s to the relationship between cognitive dysfunction and depression in this sample.