Cleveland Clinic Mellen Center for Multiple Sclerosis, 9500 Euclid Ave/ U10, Cleveland, OH 44195, USA.
Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA; Center for Outcomes Research & Evaluation, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Mult Scler Relat Disord. 2023 Apr;72:104591. doi: 10.1016/j.msard.2023.104591. Epub 2023 Feb 26.
Stigma experienced by persons living with multiple sclerosis (PwMS) is underrepresented in the literature. Discovering how the experience of stigma impacts quality of life and mood symptoms in PwMS may guide future care considerations with the goal of improving overall quality of life.
A retrospective review of data from the Quality of Life in Neurological Disorders (Neuro-QoL) set of measures and PROMIS Global Health (PROMIS-GH) scale was conducted. Multivariable linear regression was used to assess relationships between baseline (first visit) Neuro-QoL Stigma, Anxiety, Depression, and PROMIS-GH. Mediation analyses examined whether mood symptoms mediated the relationship between stigma and quality of life (PROMIS-GH).
6,760 patients (mean age 60.2 ± 8.9 years, 27.7% male, 74.2% white) were included. Neuro-QoL Stigma was significantly related to PROMIS-GH Physical Health (beta=-0.390, 95% CI [-0.411, -0.368]; p < 0.001) and PROMIS-GH Mental Health (beta=-0.595, 95% CI [-0.624, -0.566]; p < 0.001). Neuro-QoL Stigma was also significantly related to Neuro-QoL Anxiety (beta=0.721, 95% CI [0.696, 0.746]; p < 0.001) and Neuro-QoL Depression (beta=0.673, 95% CI [0.654, 0.693]; p < 0.001). Mediation analyses revealed that both Neuro-QoL Anxiety and Depression partially mediated the relationship between Neuro-QoL Stigma and PROMIS-GH Physical and Mental Health.
Results demonstrate stigma is associated with decreased quality of life in both physical and mental health domains in PwMS. Stigma was also associated with more significant symptoms of anxiety and depression. Finally, anxiety and depression play a mediating role in the relationship between stigma and both physical and mental health in PwMS. Therefore, tailoring interventions to effectively reduce symptoms of anxiety and depression in PwMS may be warranted, as it will likely improve overall quality of life and reduce negative impacts of stigma.
多发性硬化症患者（PwMS）所经历的污名在文献中代表性不足。了解污名经历如何影响 PwMS 的生活质量和情绪症状，可能有助于指导未来的护理考虑，以提高整体生活质量。
对神经疾病生活质量（Neuro-QoL）成套测量和 PROMIS 全球健康（PROMIS-GH）量表中的数据进行回顾性分析。多变量线性回归用于评估基线（首次就诊）Neuro-QoL 污名、焦虑、抑郁与 PROMIS-GH 之间的关系。中介分析检验了情绪症状是否在污名与生活质量（PROMIS-GH）之间起中介作用。
纳入 6760 例患者（平均年龄 60.2±8.9 岁，27.7%为男性，74.2%为白人）。Neuro-QoL 污名与 PROMIS-GH 身体健康（β=-0.390，95%CI[-0.411，-0.368]；p<0.001）和 PROMIS-GH 心理健康（β=-0.595，95%CI[-0.624，-0.566]；p<0.001）显著相关。Neuro-QoL 污名也与 Neuro-QoL 焦虑（β=0.721，95%CI[0.696，0.746]；p<0.001）和 Neuro-QoL 抑郁（β=0.673，95%CI[0.654，0.693]；p<0.001）显著相关。中介分析显示，Neuro-QoL 焦虑和抑郁均部分介导了 Neuro-QoL 污名与 PROMIS-GH 身体健康和心理健康之间的关系。
结果表明，污名与 PwMS 生理和心理两个健康领域的生活质量下降有关。污名也与更显著的焦虑和抑郁症状有关。最后，焦虑和抑郁在 PwMS 污名与生理和心理健康之间的关系中起中介作用。因此，有必要针对 PwMS 量身定制干预措施，以有效减轻焦虑和抑郁症状，这可能会提高整体生活质量，减轻污名的负面影响。
