Sainz de la Maza Susana, Maurino Jorge, Castillo-Triviño Tamara, Borges Mónica, Sebastián Torres Berta, Sotoca Javier, Alonso Torres Ana María, Caminero Ana B, Borrega Laura, Sánchez-Menoyo José L, Barrero-Hernández Francisco J, Calles Carmen, Brieva Luis, Blasco María Rosario, Dotor García-Soto Julio, Rodríguez-Regal Ana, Navarro-Cantó Laura, Agüera-Morales Eduardo, Garcés Moisés, Carmona Olga, Gabaldón-Torres Laura, Forero Lucía, Hervás Mariona, Gómez-Ballesteros Rocío
Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Medical Department, Roche Farma, Madrid, Spain.
Patient Prefer Adherence. 2023 Jun 14;17:1431-1439. doi: 10.2147/PPA.S411069. eCollection 2023.
Hopelessness is a risk factor for depression and suicide. There is little information on this phenomenon among patients with relapsing-remitting multiple sclerosis (RRMS), one of the most common causes of disability and loss of autonomy in young adults. The aim of this study was to assess state hopelessness and its associated factors in early-stage RRMS.
A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. The State-Trait Hopelessness Scale (STHS) was used to measure patients´ hopelessness. A battery of patient-reported and clinician-rated measurements was used to assess clinical status. A multivariate logistic regression analysis was conducted to determine the association between patients' characteristics and state hopelessness.
A total of 189 patients were included. Mean age (standard deviation-SD) was 36.1 (9.4) years and 71.4% were female. Median disease duration (interquartile range-IQR) was 1.4 (0.7, 2.1) years. Symptom severity and disability were low with a median EDSS (IQR) score of 1.0 (0, 2.0). A proportion of 65.6% (n=124) of patients reported moderate-to-severe hopelessness. Hopelessness was associated with older age (p=0.035), depressive symptoms (p=<0.001), a threatening illness perception (p=0.001), and psychological and cognitive barriers to workplace performance (p=0.029) in the multivariate analysis after adjustment for confounders.
Hopelessness was a common phenomenon in early-stage RRMS, even in a population with low physical disability. Identifying factors associated with hopelessness may be critical for implementing preventive strategies helping patients to adapt to the new situation and cope with the disease in the long term.
绝望是抑郁症和自杀的一个风险因素。在复发缓解型多发性硬化症（RRMS）患者中，关于这一现象的信息很少，RRMS是年轻成年人残疾和自主能力丧失的最常见原因之一。本研究的目的是评估早期RRMS患者的状态性绝望及其相关因素。
进行了一项多中心、非干预性研究。纳入诊断为RRMS、病程≤3年且扩展残疾状态量表（EDSS）评分为0 - 5.5的成年患者。使用状态-特质绝望量表（STHS）测量患者的绝望程度。使用一系列患者报告和临床医生评定的测量方法来评估临床状态。进行多因素逻辑回归分析以确定患者特征与状态性绝望之间的关联。
共纳入189例患者。平均年龄（标准差-SD）为36.1（9.4）岁，71.4%为女性。疾病持续时间中位数（四分位间距-IQR）为1.4（0.7，2.1）年。症状严重程度和残疾程度较低，EDSS（IQR）评分中位数为1.0（0，2.0）。65.6%（n = 124）的患者报告有中度至重度绝望。在对混杂因素进行调整后的多因素分析中，绝望与年龄较大（p = 0.035）、抑郁症状（p = <0.001）、对疾病的威胁感知（p = 0.001）以及工作场所表现的心理和认知障碍（p = 0.029）相关。
绝望在早期RRMS中是一种常见现象，即使在身体残疾程度较低的人群中也是如此。识别与绝望相关的因素对于实施预防策略可能至关重要，这些策略有助于患者适应新情况并长期应对疾病。
