Health-related quality of life in multiple sclerosis: temperament outweighs EDSS

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Abstract

Background

The influence of personality on health-related quality of life in patients with multiple sclerosis has been the focus of previous studies showing that introversion and neuroticism were related with reduced health related quality of life. However, no data exist on the impact of temperament on quality of life in this patient group.

Methods

Between April 2014 and March 2016 139 multiple sclerosis patients were recruited from a specialized outpatient clinic of the general hospital of Vienna. Health-related quality of life was measured by “The Multiple Sclerosis International Quality of Life Questionnaire (MusiQol)”, temperament by “Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Questionnaire – Münster version” (briefTEMPS-M), and disability by the “Expanded disability status scale”. All patients underwent a diagnostic psychiatric semi-structured interview (MINI).

Results

Known predictors (like disease duration, EDSS, psychiatric co-morbidities, immunomodulatory treatments) explain the proportion of variation in the outcome of MusiQol global index score in 30.9% in multi-variable linear regression analysis. It increased respectively to 40.3, 42.5, and 45.8% if adding the depressive, cyclothymic, or hyperthymic temperament to the list of variables. An increase of depressive and cyclothymic temperament scores significantly reduced global index score of MusiQol ( p = 0.005, p = 0.002, respectively), while the hyperthymic temperament significantly raised it ( p < 0.001).

Conclusion

In MS patients, the depressive and cyclothymic temperament predict a lower and hyperthymic temperament an increased health-related quality of life, independent of current disability status, immunomodulatory treatments, and affective co-morbidities.

Electronic supplementary material

The online version of this article (10.1186/s12888-018-1719-6) contains supplementary material, which is available to authorized users.

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Most cited references 23

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The incidence and prevalence of psychiatric disorders in multiple sclerosis: A systematic review

Stephen C Reingold, Jeffrey Cohen, Olaf Stuve … (2015)

Background: Psychiatric comorbidity is associated with lower quality of life, more fatigue, and reduced adherence to disease-modifying therapy in multiple sclerosis (MS). Objectives: The objectives of this review are to estimate the incidence and prevalence of selected comorbid psychiatric disorders in MS and evaluate the quality of included studies. Methods: We searched the PubMed, PsychInfo, SCOPUS, and Web of Knowledge databases and reference lists of retrieved articles. Abstracts were screened for relevance by two independent reviewers, followed by full-text review. Data were abstracted by one reviewer, and verified by a second reviewer. Study quality was evaluated using a standardized tool. For population-based studies we assessed heterogeneity quantitatively using the I 2 statistic, and conducted meta-analyses. Results: We included 118 studies in this review. Among population-based studies, the prevalence of anxiety was 21.9% (95% CI: 8.76%–35.0%), while it was 14.8% for alcohol abuse, 5.83% for bipolar disorder, 23.7% (95% CI: 17.4%–30.0%) for depression, 2.5% for substance abuse, and 4.3% (95% CI: 0%–10.3%) for psychosis. Conclusion: This review confirms that psychiatric comorbidity, particularly depression and anxiety, is common in MS. However, the incidence of psychiatric comorbidity remains understudied. Future comparisons across studies would be enhanced by developing a consistent approach to measuring psychiatric comorbidity, and reporting of age-, sex-, and ethnicity-specific estimates.

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Predicting quality of life in multiple sclerosis: accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change.

Robert Zivadinov, Elizabeth Wahlig, Frederick Munschauer … (2005)

Health-related quality of life (HQOL) is poor in multiple sclerosis (MS) but the clinical precipitants of the problem are not well understood. Previous correlative studies demonstrated relationships between various clinical parameters and diminished HQOL in MS. Unfortunately, these studies failed to account for multiple predictors in the same analysis. We endeavored to determine what clinical parameters account for most variance in predicting HQOL, and employability, while accounting for disease course, physical disability, fatigue, cognition, mood disorder, personality, and behavior disorder. In 120 MS patients, we measured HQOL (MS Quality of Life-54) and vocational status (employed vs. disabled) and then conducted detailed clinical testing. Data were analyzed by linear and logistic regression methods. MS patients reported lower HQOL (p<0.001) and were more likely to be disabled (45% of patients vs. 0 controls). Physical HQOL was predicted by fatigue, depression, and physical disability. Mental HQOL was associated with only depression and fatigue. In contrast, vocational status was predicted by three cognitive tests, conscientiousness, and disease duration (p<0.05). Thus, for the first time, we predicted HQOL in MS while accounting for measures from these many clinical domains. We conclude that self-report HQOL indices are most strongly predicted by measures of depression, whereas vocational status is predicted primarily by objective measures of cognitive function. The findings highlight core clinical problems that merit early identification and further research regarding the development of effective treatment.

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TEMPS-A: validation of a short version of a self-rated instrument designed to measure variations in temperament.

H S Akiskal, Girardin Jean-Louis, Mark H. Rapaport … (2005)

To validate a short English-language version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A), a self-report questionnaire designed to measure temperamental variations in psychiatric patients and healthy volunteers. Its constituent subscales and items were formulated on the basis of the diagnostic criteria for affective temperaments (cyclothymic, dysthymic, irritable, hyperthymic, and anxious), originally developed by the first author and his former collaborators. Further item wording and selection were achieved at a later stage through an iterative process that incorporated feedback from clinicians, researchers, and research volunteers. A total of 510 volunteers (284 patients with mood disorders, 131 relatives of bipolar probands, and 95 normal controls) were recruited by advertisement in the newspapers, announcements on radio and television, flyers and newsletters, and word of mouth. All participants were interviewed using the Structured Clinical Interview for DSM-III-R, and completed the 110-item TEMPS-A and the Temperament and Character Inventory (TCI-125). The factorial structure, the alpha coefficients, and the item-total correlations coefficients of the TEMPS-A and the correlation coefficients between the dimensions of the TCI and the TEMPS-A subscales were then determined. A principal components analysis with a Varimax rotation found that 39 out of the 110 original items of the TEMPS-A loaded on five factors that were interpreted as representing the cyclothymic, depressive, irritable, hyperthymic, and anxious factors. Coefficients alpha for internal consistency were 0.91 (cyclothymic), 0.81 (depressive), 0.77 (irritable), 0.76 (hyperthymic), and 0.67 (anxious) subscales. We found statistically significant positive correlations between all-but the hyperthymic-subscales and harm avoidance. Positive correlations with the hyperthymic and cyclothymic, and novelty seeking and negative correlations with the remaining subscales were also recorded. Other major findings included positive correlations between the hyperthymic and reward dependence, persistence and self-directedness; positive correlation between the self-transcendence and the cyclothymic, hyperthymic and the anxious; and negative correlations between the depressive, cyclothymic, irritable, anxious and cooperativeness. As the full-scale anxious temperament was added after the four scales of the TEMPS-A were developed, it has only been evaluated in 345 subjects. These data indicate that the TEMPS-A in its shortened version is a psychometrically valid scale with good internal consistency. The proposed five subscale structure is upheld. Concurrent validity against the TCI is shown. Most importantly, for each of the temperaments, we were able to show positive attributes which are meaningful in an evolutionary context, along with traits which make a person vulnerable to mood shifts. This hypothesized dual nature of temperament, which is upheld by our data, is a desirable characteristic for a putative behavioral endophenotype in an oligogenic model of inheritance for bipolar disorder.

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Author and article information

Contributors

S. Salhofer-Polanyi: sabine.salhofer-polanyi@meduniwien.ac.at

F. Friedrich: fabian.friedrich@meduniwien.ac.at

S. Löffler: sophie.loeffler@gmx.net

P. S. Rommer: paulus.rommer@meduniwien.ac.at

A. Gleiss: andreas.gleiss@meduniwien.ac.at

R. Engelmaier: roland.engelmaier@gmail.net

F. Leutmezer: +43 1 40400 3117 , fritz.leutmezer@meduniwien.ac.at

B. Vyssoki: benjamin.vyssoki@meduniwien.ac.at

Journal

Journal ID (nlm-ta): BMC Psychiatry

Journal ID (iso-abbrev): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-244X

Publication date (Electronic): 23 May 2018

Publication date PMC-release: 23 May 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 143

Affiliations

[1 ]ISNI 0000 0000 9259 8492, GRID grid.22937.3d, Department of Neurology, , Medical University of Vienna, ; Währingergürtel 18-20, 1090 Vienna, Austria

[2 ]ISNI 0000 0001 2286 1424, GRID grid.10420.37, Department of Psychiatry and Psychotherapy Division of Social Psychiatry, , University of Vienna, ; Vienna, Austria

[3 ]ISNI 0000 0001 2286 1424, GRID grid.10420.37, Center for Medical Statistics, Informatics, and Intelligent Systems of the Medical, , University of Vienna, ; Vienna, Austria

Article

Publisher ID: 1719

DOI: 10.1186/s12888-018-1719-6

PMC ID: 5966924

PubMed ID: 29792188

SO-VID: 2eda399d-1a3d-4a96-98ff-468c0de5254a

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 19 November 2017

Date accepted : 3 May 2018

Funding

Funded by: Austrian Ministry of Health

Award ID: Unrestricted grant

Funded by: MS Society Vienna

Award ID: Unrestricted

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ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: temperament,multiple sclerosis,health-related quality of life,temps,musiqol

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ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: temperament, multiple sclerosis, health-related quality of life, temps, musiqol

Health-related quality of life in multiple sclerosis: temperament outweighs EDSS

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Abstract

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Electronic supplementary material

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Karger: Neurology and Neuroscience

Most cited references 23

The incidence and prevalence of psychiatric disorders in multiple sclerosis: A systematic review

Predicting quality of life in multiple sclerosis: accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change.

TEMPS-A: validation of a short version of a self-rated instrument designed to measure variations in temperament.

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