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40 Social Support Moderates the Relationship Between Pain and Sleep Quality in Multiple Sclerosis
- Kaitlin E. Riegler, Megan L. Bradson, Garrett A. Thomas, Peter A. Arnett
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 554
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Objective:
Lower levels of social support in persons with Multiple Sclerosis (PwMS) are associated with myriad poor outcomes including worse mental health, lower quality of life, and reduced motor function (Kever et al., 2021). Social support has also been associated with physical pain (Alphonsus et al., 2021) and sleep disturbance (Harris et al., 2020) in PwMS. Pain is one of the most common symptoms of MS (Valentine et al., 2022) and is also known to be related to sleep disturbance (Neau et al., 2012). With these considerations in mind, the goal of the current study was to examine social support as a possible moderator in the relationship between pain and sleep quality in PwMS.
Participants and Methods:This cross-sectional study included 91 PwMS (females = 76). A neuropsychological battery and psychosocial questionnaires were administered. For sleep quality a composite was created from the sleep and rest scale of the Sickness Impact Profile (SIP), sleep-related items on the Multiple Sclerosis-Symptom Severity Scale (MS-SSS) (i.e., sleeping too much or sleep disturbance, fatigue or tiredness, and not sleeping enough), and an item from the Sleep Habits Questionnaire (SHQ) ("How many nights on average are you troubled by disturbed sleep?"). This composite (a = .76) has been used in prior research. Lower scores were indicative of worse sleep quality. Pain intensity and pain interference were measured using the Brief Pain Inventory (BPI). Pain intensity was calculated from four pain indices (i.e., pain at its worst in the last 24 hours, at its least in the last 24 hours, on average, and current pain at the time of the assessment) and pain interference was calculated from seven indices (i.e., general activity, mood, walking ability, normal work, relationships with others, sleep, and enjoyment of life). The Social Support Questionnaire (SSQ) measured average satisfaction with supports. A series of hierarchical linear regressions were conducted with the sleep quality index as the outcome variable and satisfaction with social supports, both indices of pain (intensity and interference), and their interactions as predictors. Then, simple effects tests were used to clarify the pattern of any significant interactions.
Results:Regression analysis revealed that the interaction between pain interference and satisfaction with social support was significant (p = .034). Simple effects tests revealed that when satisfaction with social support was high, pain interference was associated with better sleep quality (p < .001). The interaction between pain intensity and satisfaction with social supports was also significant (p = .014). Simple effects test revealed that at high levels of satisfaction with social supports, pain intensity was associated with better sleep quality (p < .001).
Conclusions:Satisfaction with social support moderated the relationship between pain interference and pain intensity on sleep quality in PwMS. Specifically, high satisfaction with social support buffers against the negative effects of pain interference and pain intensity on sleep quality in PwMS. This provides evidence that interventions aimed at increasing social supports in PwMS may lead improvements in sleep quality and reduce the impact of pain on sleep quality.
41 High Stress and Negative Attributional Style is Associated with Depression Symptoms in Multiple Sclerosis
- Megan L. Bradson, Kaitlin E. Riegler, Garrett A. Thomas, Gray A. Vargas, Peter A. Arnett
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 554-555
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Objective:
Depression is highly prevalent in persons with multiple sclerosis (pwMS). A reformulated version of the learned helplessness theory posits that individuals who attribute the cause of negative events to personal factors (internal), perceive that the cause persists for a long period of time (stable), and believe it is present in all situations (global) are at an increased risk for depression. As such, it is critical to examine possible modifiable factors that buffer against the deleterious effects of negative attributional style. Therefore, the current study investigated whether stress moderates the relationship between negative attributional style and depression symptoms in an MS sample.
Participants and Methods:Thirty-six pwMS (30 Female, 6 Male) completed a comprehensive neuropsychological test battery and psychosocial questionnaires that assessed cognitive attributional style, daily stressors, and depression symptoms. The Attributional Style Questionnaire (ASQ) was used to create internal, stable, and global attribution dimension scores, as well as an overall attributional style score combining the three dimensions. Stress was quantified as the total score of perceived hassles from the Hassles and Uplifts Scale (HUS). Depression symptoms were measured using the Beck Depression Inventory-Fast Screen (BDI-FS). Hierarchical linear regressions were conducted with depression symptoms as the outcome variable. Each dimension of attributional style (internal, stable, global, or overall ASQ), stress, and their interactions were included as predictors. Simple effects tests were used to clarify the pattern of any significant interaction.
Results:Regression analyses revealed that the interaction between overall attributional style and stress was significant (p = .025). Simple effects tests revealed that overall attributional style was associated with depression symptoms only in pwMS with high levels of stress (p = .015). For the individual dimensions of the ASQ, several interactions were also significant. The interaction between the internal dimension and stress was significant (p= .009), such that internal attributions were associated with depression symptoms only in pwMS with high levels of stress (p = .002). The interaction between the stable dimension and stress was also significant (p = .01); stable attributional style was associated with depression symptoms only in pwMS with high levels of stress (p = .009). The interaction between the global dimension and stress was not significant.
Conclusions:Stress moderated the relationship between negative attributional style and depression symptoms in pwMS. Specifically, the internal and stable dimensions and overall attributional style were associated with increased depression symptoms only in pwMS who reported high levels of stress, but not in those with low levels of stress. Interventions aimed at reducing and managing stress may help protect against the effects of negative cognitive schemas on depression symptoms in MS. Additionally, previous research demonstrates that attributional style may be a malleable target of evidence-based psychotherapy (Seligman et al., 1988; Proudfoot et al., 2009). Our findings suggest that cognitive therapy specifically targeting the internal and stable dimensions of attributional style may be effective in modifying attributional style, perceptions of stress and, subsequently, improve depression outcomes in MS.
39 Co-Occurring Depression and Anxiety is Associated with Greater Cognitive Variability in Persons with Multiple Sclerosis
- Garrett A. Thomas, Kaitlin E. Riegler, Megan L. Bradson, Dede U. O'Shea, Peter A. Arnett
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 553
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Objective:
Research examining co-occurring anxiety and depression in persons with multiple sclerosis (PwMS) is scarce, though an estimated 20% of PwMS experience clinically significant anxiety and depression (Gascoyne et al., 2019). Recent work by Hanna & Strober (2020) found that PwMS with comorbid anxiety and depression reported worse outcomes in all constructs of symptomatology, disease management, psychological well-being, and quality of life. However, it is unclear how co-occurring anxiety and depression symptoms may influence or exacerbate cognitive difficulties in PwMS. Further, considering there are high levels of comorbidity between depression, anxiety, and fatigue in PwMS, this study aims to examine the unique variances of depression, anxiety, co-occurring depression and anxiety, and fatigue on cognitive functioning.
Participants and Methods:86 PwMS (F=65,M=21) completed a comprehensive neuropsychological battery that included self-report measures of anxiety, depression, and fatigue. An intraindividual variability (IIV) composite score was calculated by combining standardized intraindividual standard deviation and maximum discrepancy scores on measures of attention/processing speed and memory for each participant. Lower scores indicate worse performance (i.e., greater variability). A hierarchical regression was conducted with IIV as the outcome variable and with depression, anxiety, cognitive fatigue, physical fatigue, and the interaction between depression and anxiety as predictors. Expanded Disability Status Scale (EDSS) scores were included as a covariate.
Results:The only model that included a statistically significant predictor of IIV was the final model, which included EDSS, depression, anxiety, cognitive fatigue, physical fatigue, and the interaction between depression and anxiety, F(6,77)=2.97, p=.01, AR2=.08. While the main effects of depression and anxiety were not significant, the interaction between depression and anxiety was significant, F(6,77)=7.20, p=.01, n2=.09. Simple effects tests revealed that the relationship between IIV and anxiety was marginally significant for those at the cutoff for clinical depression (square root BDI-FS=2; BDI-FS=4), F(6,77)=3.52, p=.07, n2=.04. However, the effect of anxiety on IIV increased as depression increased. For example, in those with high levels of depression (1.5 SD above the mean), there was a significant relationship between anxiety and IIV, F(6,77)=4.16, p=.04, n2=.05, though this was not the case for those with low levels of depression (1.5 SD below the mean), F(6,77)=0.01, p=.92, n2=.00.
Conclusions:The interaction between depression and anxiety predicted variability in performance such that those with high levels of depression and anxiety demonstrated significantly greater IIV. Since dispersion is considered a marker for neurocognitive integrity, this may suggest that co-occurring psychological disturbances are associated with poorer cognitive integrity, an important consideration for interventions and outcomes. While interventions aimed at treating co-occurring depression and anxiety have been largely overlooked within the MS literature (Butler et al., 2016), transdiagnostic interventions have been beneficial for general adult populations with co-occurring anxiety and depression (McEvoy et al., 2009). Future work should examine the efficacy of interventions aimed at addressing co-occurring depression and anxiety in PwMS, as this may help to improve cognitive functioning, as well as perception of functioning, which will likely further improve quality of life and overall well-being.
Relationship between subjective report and objective assessment of neurocognitive functioning in persons with multiple sclerosis
- Garrett A. Thomas, Kaitlin E. Riegler, Megan L. Bradson, Dede U. O’Shea, Peter A. Arnett
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue 3 / March 2023
- Published online by Cambridge University Press:
- 26 April 2022, pp. 266-273
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Objective:
Persons with multiple sclerosis (PwMS) are at increased risk for cognitive dysfunction. Considering the impact and potential ramifications of cognitive dysfunction, it is important that cognition is routinely assessed in PwMS. Thus, it is also important to identify a screener that is accurate and sensitive to MS-related cognitive difficulties, which can inform decisions for more resource-intensive neuropsychological testing. However, research focused on available self-report screeners has been mixed, such as with the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ). This study aims to clarify the relationship between subjective and objective assessment of cognitive functioning in MS by examining domain-specific performance and intraindividual variability (IIV).
Methods:87 PwMS (F = 65, M = 22) completed a comprehensive neuropsychological battery which included self- and informant-report measures of neurocognitive functioning. Scores were examined in relation to mean performance on five domains of cognitive functioning and two measures of IIV.
Results:The MSNQ-Self was inversely associated with executive function, verbal memory, and visual memory; it was not associated with IIV. The MSNQ-Informant was inversely associated with executive function and verbal memory, and positively associated with one measure of IIV. The MSNQ-Self showed a correlation of moderate effect size with depression (r = .39) while the MSNQ-Informant did not.
Conclusions:Results suggest that the MSNQ-Self and MSNQ-Informant show similar utility. Our findings also suggest that domains of executive function and memory may be most salient, thus more reflected in subjective reports of cognitive functioning. Future work should further examine the impact of mood disturbance with cognitive performance and IIV.
Beyond Measures of Central Tendency: Novel Methods to Examine Sex Differences in Neuropsychological Performance Following Sports-Related Concussion in Collegiate Athletes
- Victoria C. Merritt, Liora S. Greenberg, Erin Guty, Megan L. Bradson, Amanda R. Rabinowitz, Peter A. Arnett
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- Journal:
- Journal of the International Neuropsychological Society / Volume 25 / Issue 10 / November 2019
- Published online by Cambridge University Press:
- 03 September 2019, pp. 1094-1100
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Objective:
The purpose of this study was to examine sex differences in neuropsychological functioning after sports-related concussion using several approaches to assess cognition: mean performance, number of impaired scores, and intraindividual variability (IIV).
Method:In the study, 152 concussed college athletes were administered a battery of neuropsychological tests, on average, 10 days post-concussion (SD = 12.75; Mdn = 4 days; Range = 0–72 days). Mean performance was evaluated across 18 individual neuropsychological variables, and the total number of impaired test scores (>1.5 SD below the mean) was calculated for each athlete. Two measures of IIV were also computed: an intraindividual standard deviation (ISD) score and a maximum discrepancy (MD) score.
Results:Analyses of covariance revealed that, compared with males, females had significantly more impaired scores and showed greater variability on both IIV indices (ISD and MD scores) after adjusting for time since injury and post-concussive symptoms. In contrast, no significant effects of sex were found when examining mean neuropsychological performance.
Conclusion:Although females and males demonstrated similar mean performance following concussion, females exhibited a greater level of cognitive impairment and larger inconsistencies in cognitive performance than males. These results suggest that evaluating cognitive indices beyond mean neuropsychological scores may provide valuable information when determining the extent of post-concussion cognitive dysfunction.