Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy.
Second Division of Neurology, Multiple Sclerosis Center, University of Campania Luigi Vanvitelli, Naples, Italy.
Eur J Neurol. 2021 Oct;28(10):3375-3383. doi: 10.1111/ene.14580. Epub 2020 Nov 3.
In multiple sclerosis (MS), disease-related factors and dysfunctional coping might favor the development of mental distress induced by COVID-19 containment measures. Aim of this study was exploring the relationship between disability, coping strategies, daily life reorganization and neuropsychiatric symptoms in an Italian MS population during the COVID-19 lockdown, in order to identify potentially modifiable factors that could inform clinical management of mental distress in people with MS.
We explored the relationship between mental distress, disability and coping strategies in the Italian MS population under lockdown. Structural equation modeling was applied to information collected via web survey to identify modifiable factors that could account for mental distress.
A total of 845 participants (497 with MS and 348 controls) were included in the study. The MS group had higher scores than the control group for depression (p = 0.005), but not for anxiety, emotional dyscontrol or sleep disturbances. The structural equation modeling explained 74% of the variance observed in depression score. Within the model, three latent factors were characterized from measured variables: motor disability and cognitive dysfunction contributed to disability (β = 0.509 and β = 0.836; p < 0.001); positive attitude and exercise contributed to active attitude (β = 0.386 and β = 0.297; p < 0.001); and avoidance, social support and watching television contributed to passive attitude (β = 0.301, β = 0.243 and β = 0.212; p < 0.001). With regard to the relationship between latent factors and their influence on depression, disability contributed to passive attitude (β = 0.855; p < 0.001), while both passive and active attitude significantly influenced depression (β = 0.729 and β = -0.456; p < 0.001).
As a practical implication of our model, favoring exercise would enhance active attitude and its positive impact on mental well-being while, at the same time, reducing the negative impact of disability on depression, representing a valuable tool in facing COVID-19-related mental distress.
在多发性硬化症（MS）中，疾病相关因素和应对方式障碍可能会导致 COVID-19 防控措施引发的精神困扰。本研究旨在探讨意大利 MS 人群在 COVID-19 封锁期间残疾、应对策略、日常生活重组与神经精神症状之间的关系，以确定可能改变的因素，为 MS 患者的精神困扰提供临床管理依据。
我们探讨了意大利封锁期间 MS 人群的精神困扰、残疾和应对策略之间的关系。通过网络调查收集信息，并应用结构方程模型确定可能改变的因素，以解释精神困扰。
共有 845 名参与者（497 名 MS 患者和 348 名对照）纳入本研究。MS 组的抑郁评分高于对照组（p=0.005），但焦虑、情绪失控或睡眠障碍评分无差异。结构方程模型解释了抑郁评分中观察到的 74%的方差。在模型中，从测量变量中确定了三个潜在因素：运动障碍和认知功能障碍导致残疾（β=0.509 和 β=0.836；p<0.001）；积极的态度和锻炼有助于积极的态度（β=0.386 和 β=0.297；p<0.001）；回避、社会支持和看电视有助于消极的态度（β=0.301、β=0.243 和 β=0.212；p<0.001）。关于潜在因素与抑郁之间的关系，残疾导致消极态度（β=0.855；p<0.001），而积极和消极态度都显著影响抑郁（β=0.729 和 β=-0.456；p<0.001）。
作为我们模型的实际意义，鼓励锻炼可以增强积极的态度及其对心理健康的积极影响，同时减少残疾对抑郁的负面影响，是应对 COVID-19 相关精神困扰的有效工具。
