Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
Mult Scler. 2010 Apr;16(4):463-71. doi: 10.1177/1352458509358714. Epub 2010 Jan 19.
The objective of this article is to examine the role of coping strategies in multiple sclerosis outcomes among civilians under a military attack during the 2006 war between Hezbollah and Israel. Participants were 156 patients with relapsing-remitting multiple sclerosis. We analysed the relationships between coping and emotional distress and between coping and multiple sclerosis exacerbation. We also assessed a model of the relationship between perceived stress, event-related stress, and coping with increased risk of multiple sclerosis exacerbations using multivariate logistic regression. Ways of coping and subjective stress were evaluated by means of structured interviews using questionnaires previously validated. The more distressed our respondents were during the war, the more likely they were to employ a variety of ways of coping. Correlation coefficients between coping scores and perceived war stress ranged from 0.2 to 0.44 (p < 0.001-0.01). Correlation coefficients between the various coping scores and broader indices of distress ranged from 0.28 to 0.5 (p < 0.001). Of the remitting patients during and following the war, 47.1% reported the use of 'direct coping and planning', compared to 16.7% of patients who relapsed during the same period (p = 0.014). 'Direct coping and planning' was negatively related to exacerbation of multiple sclerosis symptoms (OR = 0.1, 95% CI = 0.02-0.5). The Nagelkerke R(2) was 0.26. Our findings point to an association between 'direct coping and planning' and reduced multiple sclerosis relapse rate during wartime. Further research should explore whether the employment of specific ways of coping can reduce the risk for relapse among patients with multiple sclerosis during periods of distress.
本文旨在探讨在 2006 年真主党与以色列之间的战争期间，平民在军事袭击下多发性硬化症的应对策略的作用。参与者为 156 例复发缓解型多发性硬化症患者。我们分析了应对策略与情绪困扰之间的关系，以及应对策略与多发性硬化症恶化之间的关系。我们还使用多元逻辑回归评估了感知压力、与事件相关的压力和应对方式与多发性硬化症恶化风险增加之间关系的模型。使用先前验证过的问卷，通过结构化访谈评估应对方式和主观压力。我们的受访者在战争期间越感到痛苦，他们就越有可能采用多种应对方式。应对评分与感知战争压力之间的相关系数范围为 0.2 至 0.44（p < 0.001-0.01）。应对评分与更广泛的痛苦指数之间的相关系数范围为 0.28 至 0.5（p < 0.001）。在战争期间和之后缓解的患者中，有 47.1％的患者报告使用“直接应对和计划”，而在同一时期复发的患者中有 16.7％（p = 0.014）。“直接应对和计划”与多发性硬化症症状恶化呈负相关（OR = 0.1，95％CI = 0.02-0.5）。Nagelkerke R（2）为 0.26。我们的研究结果表明，“直接应对和计划”与战时多发性硬化症复发率降低之间存在关联。进一步的研究应探讨在痛苦时期，采用特定的应对方式是否可以降低多发性硬化症患者的复发风险。
