Frederick W. Foley

Helplessness, self-efficacy, cognitive distortions, and depression in multiple sclerosis and spinal cord injury

The aim of this study was to determine if learned helplessness, self-efficacy, and cognitive distortions would predict depression in a sample of 80 individuals with multiple sclerosis (MS) and 80 individuals with a spinal cord injury (SCI). As MS and SCI usually present with disparate disease courses and etiologies, a secondary objective was to determine if individuals with MS would exhibit greater levels of helplessness, cognitive distortions, and depression and lower levels of self-efficacy than those with SCI. Results indicated that helplessness and self-efficacy significantly predicted depression for both the MS and SCI groups after controlling for confounding variables. Cognitive distortions had no independent effect, indicating that cognitive distortions may have caused feelings of helplessness and low self-efficacy and, in this way, had indirect effects on depression. The MS group exhibited significantly greater levels of depression and helplessness and significantly lower levels of self-efficacy than the SCI group. It was hypothesized that it may have been the combination of an unpredictable course of disease activity and the possibility of being affected by MS in many different ways that produced greater feelings of depression, helplessness, and low self-efficacy in the MS group.

Rehabilitation of intimacy and sexual dysfunction in couples with multiple sclerosis

Sexual dysfunction is a highly prevalent symptom of multiple sclerosis (MS), with little published research on effective treatments. This pilot study tested the efficacy of a counseling intervention in nine couples utilizing a quasi-experimental research design. The intervention consisted of 12 counseling sessions, communication with the MS medical treatment team, education, and tailoring symptomatic treatments so they interfere less with sexual function. Repeated measures analysis of variance indicated significant improvements in affective and problem-solving communication, marital satisfaction, and sexual satisfaction during the treatment vs. the waiting list phase of the study (F=1.7, P5.001). MS patients and their spouses reported similar levels of improvement.

Cognitive and motor functioning in patients with multiple sclerosis: Neuropsychological predictors of walking speed and falls

While motor and cognitive impairments are common in Multiple Sclerosis (MS) patients, research concerning their relationship in this population has been limited. We aimed to evaluate cross-sectional associations between cognitive functions, walking speed, and falls in patients with MS. Through a retrospective chart review of 81 patients with MS, we examined whether measures of cognitive function predicted walking speed on the Timed 25-Foot Walk and self-reported fall frequency. Hierarchical linear regressions showed that after controlling for age, gender, and disease severity, slower processing speed and IQ predicted slower gait speed, while poorer verbal memory predicted increased frequency of falls. Moreover, a binary logistic regression showed that poorer verbal memory also predicted increased risk of multiple falls. Thus, specific cognitive functions are meaningfully related to mobility limitations in patients with MS. These findings suggest that risk assessment for gait decline and falls should include cognitive assessment in patients with MS.

Urban voices: The quality-of-life experience among women of color with breast cancer

OBJECTIVES Research on the health-related quality of life (HRQL) among women of color (i.e., Hispanics and African Americans) with breast cancer suggests that they may be at elevated risk for a variety of physical and psychosocial sequelae. The context in which these women perceive, experience, and respond to these HRQL challenges can provide important information for planning a culturally appropriate palliative care treatment plan. METHODS In an effort to understand the quality of life experience after breast cancer among women of color, this study describes the nature and impact of physical, emotional, and menopausal symptoms among African American (n = 8) and Hispanic (n = 12) breast cancer survivors based on qualitative data gathered through semistructured interviews. Themes were identified and categorized into six HRQL domains: physical (e.g., pain, nausea), psychological (e.g., sadness, irritability), cognitive (e.g., memory problems), sexual (e.g., decreased desire), social/functional (e.g., financial strain, social distress), and spiritual/existential (e.g., increased faith, spiritual coping), with high interrater reliability (kappa = .81). RESULTS For both groups, physical issues had a major impact on HRQL, with psychological issues being additionally salient for Hispanic women. Most (88%) African American women voiced positive changes in their faith after diagnosis whereas 50% of Hispanic women viewed faith as an important way of coping with breast cancer. SIGNIFICANCE OF RESULTS This research broadens our understanding of the experience of breast cancer among ethnic minority women, and in turn, offers some key directions for guiding the development of culturally tailored HRQL interventions.

Psychological Predictors of Depression in Multiple Sclerosis

The aim of this study was to determine if learned helplessness, cognitive distortions, and self-efficacy would predict depression in a sample of eighty patients with multiple scle rosis (MS). Results indicated that depression was significantly related to higher scores on measures of learned helplessness and cognitive distortions, and lower scores on a measure of perceived self-efficacy. Significant correlations were also found between help lessness, cognitive distortions, and self-efficacy. However, depression was not signifi cantly related to disability or disease activity in this sample. When helplessness, cog nitive distortions, and self-efficacy were examined simultaneously in a multiple regression analysis, only helplessness predicted depression after controlling for demo graphic and disease-related variables. Cognitive distortions and self-efficacy did not have an independent effect. Implications of these findings, including issues for future research and treatment, were discussed. Key Words: Multiple sclerosis—Depression—Leamed helplessness—Cognitive distortions—Self-efficacy.

The impact of sexual dysfunction on health-related quality of life in people with multiple sclerosis

Background: Sexual dysfunction is a prevalent symptom in multiple sclerosis (MS) that may affect patients’ health-related quality of life (HrQoL). Objective: The objective of this paper is to examine the impact of sexual dysfunction on HrQoL in a large national sample using The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19). Methods: Participants were recruited from a large MS registry, the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Participants self-reported demographic information and completed the Patient Determined Disease Steps (PDDS), MSISQ-19, and the Short Form-12 (SF-12). Results: The study population included 6183 persons (mean age: 50.6, SD = 9.6; 74.7% female, 42.3% currently employed). Using multivariate hierarchical regression analyses, all variables excluding gender predicted both the physical component summary (PCS-12) and the mental component summary (MCS-12) of the SF-12. Scores on the MSISQ-19 uniquely accounted for 3% of the variance in PCS-12 scores while disability level, as measured by PDDS, accounted for 31% of the variance. Conversely, MSISQ-19 scores uniquely accounted for 13% of the variance in MCS-12 scores, whereas disability level accounted for less than 1% of the variance. Conclusion: In patients with MS, sexual dysfunction has a much larger detrimental impact on the mental health aspects of HrQoL than severity of physical disability.

The Multiple Sclerosis Intimacy and Sexuality Questionnaire — re-validation and development of a 15-item version with a large US sample

Background: Sexual dysfunction is common in multiple sclerosis (MS) but reliable and valid measurement in this population is needed. Objective: The objective of this research is to re-validate the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 in a large US sample. Methods: A total of 6300 MS patients from the NARCOMS registry completed the MSISQ-19. Unforced principal component analysis utilizing oblique rotation with Kaiser Normalization validated its construct validity. Results: The scree plot supported a three-component solution, with 63% of total variance explained. The components mirrored the original validation study measuring primary, secondary, and tertiary sexual dysfunction. PCA suggested the scale could be shortened to 15 items, which were found to apply equally well to males and females (with one primary item specific for each sex). The components were moderately intercorrelated (Pearson rs ranged from 0.5 to 0.67). The secondary subscale correlated most highly with self-reported disability (r (6081) = 0.44, p < 0.001), whereas the tertiary subscale correlated most highly with psychological distress (r (5992) = –.37, p < 0.001). Cronbach’s alpha for the total scale (0.92) and the subscales (primary, 0.87; secondary, 0.82; tertiary, 0.91) demonstrated good reliability. Conclusion: The revised 15-item MSISQ is a reliable and valid measure of sexual dysfunction in men and women with MS.

Psychoremediation of Communication Skills for Cognitively Impaired Persons with Multiple Sclerosis

Cognitive impairments and emotional distress significantly interfere with the ability of persons with multiple sclerosis (MS) to communicate effectively with family members, friends, employers, and health care providers. This paper describes a step-by-step cognitive-behavioral approach to the treatment of communication skills deficits in cognitively impaired persons with MS. Cognitive problems encountered in MS are discussed in terms of their impact on fundamental elements of communication, including accurate listening, capacity for empathy, making requests of others, making compromises, and giving others feedback about the impact of their behavior. Rehabilitation of these aspects of communication is discussed.

Alcohol and substance use in multiple sclerosis.

BACKGROUND Few studies have examined the prevalence of alcohol and drug use in individuals with multiple sclerosis (MS). The current study sought to examine the prevalence and associated demographic, disease-related, and psychological correlates of substance use in an East Coast United States outpatient MS sample. METHODS 157 individuals with MS completed questionnaires prior to, during or after their visit with an MS neurologist. These questionnaires included: the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), CAGE, CAGE-Adapted to Include Drugs (CAGE-AID), Patient Health Questionnaire-9 item (PHQ-9), Beck Depression Inventory-Second Edition (BDI-II) and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). RESULTS On the AUDIT-C, 40% of individuals with MS met or exceeded the cutoff for excessive alcohol use. They were more highly educated and younger than non-drinkers. Utilizing the CAGE, 6% of the sample met criteria for a lifetime history of excessive alcohol use and men endorsed higher rates of alcohol use than women. Only a small portion of the sample endorsed a history of drug use (CAGE-AID, 4%). Drug use was associated with greater disability and depression symptoms, but lower self-reported anxiety. CONCLUSIONS Current alcohol use was prevalent in this sample, and excessive use was associated with men, younger age, and more education. Reported drug use was minimal and associated with greater disability, more self-reported depression, but fewer anxiety symptoms.

Suicidal thinking in multiple sclerosis.

Purpose. Studies demonstrate that suicidal ideation ((SI)) is greater in persons with multiple sclerosis ((MS)) than in the general population. SI may offer some MS patients a mechanism for feeling in control of their lives, in the face of a daunting, unpredictable disease. In this study, we determined what specific mental constructs or perceptual themes occur for MS patients experiencing SI, while also examining the construct of ‘control’ as a central theme. Methods. Individual interviews ((N  ==  16)) were audiotaped, transcribed and qualitatively analysed by two independent raters to test for key themes in MS patients reporting SI. Results. In relation to SI, eight key themes were identified by both raters as having been expressed in interviews: perceived loss of control, increased family tension, loneliness, hopelessness and frustration, physical and psychological impact of MS, loss of perceived masculinity or femininity, regaining control and failure to achieve desired or expected role functioning. We created a model to explain the emergence of these themes as they contribute to SI among patients with MS. All participants indicated that perceived loss of control elicited thoughts of suicide. Conclusion. Perceived loss of control appears to be a major disease related burden associated with SI in MS patients.