Evaluation of an adjustment group for people with multiple sclerosis: a pilot randomized controlled trial

Abstract

Objective: The aim was to evaluate a group treatment for people with multiple sclerosis and low mood.

Design: Randomized controlled trial.

Setting: Community.

Participants: Patients with multiple sclerosis and low mood, scoring >7 on the Hospital Anxiety and Depression Scales or >2 on the General Health Questionnaire 12.

Interventions: Participants either attended an adjustment group for six, 2-hour group treatment sessions or were on a waiting list to attend the group.

Outcomes: Hospital Anxiety and Depression Scale, General Health Questionnaire 12, Multiple Sclerosis Self Efficacy Scale, Multiple Sclerosis Impact Scale and Short Form 36 administered 3 and 6 months after random allocation.

Results: Of the 219 patients identified, 100 (46%) reported depressive symptoms and 126 (58%) anxiety symptoms. Forty participants were recruited, aged 25—68 (mean 47.7 SD 9.7) and eight were men. Patients allocated to the group intervention reported fewer depressive symptoms than those in the control group (U 109.5, P<0.05) but there were no significant differences in anxiety symptoms, self-efficacy or quality of life.

Conclusion: Depressive symptoms were reduced following group intervention, which suggests this may be an effective psychological treatment and warrants further evaluation.

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References

Goldman Consensus Group. The Goldman Consensus statement on depression in multiple sclerosis. Mult Scler 2005; 11: 328-37.

Lobentanz IS , Asenbaum S. , Vass K. et al. Factors influencing quality of life in multiple sclerosis patients: disability, depressive mood, fatigue and sleep quality. Acta Neurol Scand 2004; 110: 6.

Solari A. , Ferrari G. , Radice D. A longitudinal survey of self-assessed health trends in a community cohort of people with multiple sclerosis and their significant others. J Neurol Sci 2005; 243: 13-20.

McGuigan C. , Hutchinson M. Unrecognised symptoms of depression in a community-based population with multiple sclerosis. J Neurol 2005; 253: 219-23.

Mohr DC , Hart SL , Fonareva I. , Tasch ES Treatment of depression for patients with multiple sclerosis in neurology clinics. Mult Scler 2006; 12: 204-208.

Zephir H. , De Seze J. , Stojkovic T. et al. Multiple sclerosis and depression: influence of interferon <beta> therapy. Mult Scler 2003; 9: 284-88.

Arnett PA , Randolph JJ Longitudinal course of depression symptoms in multiple sclerosis. J Neurol Neurosurg Psychiatry 2006; 77: 606-10.

Alarcia R. , Ara JR , Martin J. , Bertol V. Predicting factors for depression in multiple sclerosis. Neurologia 2004; 19: 364-68.

Diaz-Olavarrieta C. , Cummings JL , Velazquez J. , Garcia de la Cadena C. Neuropsychiatric manifestations of multiple sclerosis. J Neuropsychiatry Clin Neurosci 1999; 11: 51-57.

10.

Korostil M. , Feinstein A. Anxiety disorders and their clinical correlates in multiple sclerosis patients. Mult Scler 2007; 13: 67-72.

11.

Feinstein A. , O’Connor P. , Gray T. , Feinstein K. The effects of anxiety on psychiatric morbidity in patients with multiple Sclerosis. Mult Scler 1999; 5: 323-26.

12.

Janssens ACJ , van Doorn PA , de Boer JB et al. Impact of recently diagnosed multiple sclerosis on quality of life, anxiety, depression and distress of patients and partners. Acta Neurol Scand 2003; 108: 389-95.

13.

Crayton HJ , Rossman HS Managing the symptoms of multiple sclerosis: A multimodal approach . Clin Ther 2006; 28: 445-60.

14.

Feinstein A. Mood disorders in multiple sclerosis and the effects on cognition. J Neurol Sci 2006 ; 245: 63-66.

15.

Mohr DC , Goodkin DE Treatment of depression in multiple sclerosis: review and meta-analysis . Clin Psychol Sci Pract 1999; 6: 1-9.

16.

Wang JL , Rreimer MA , Metz LM , Patten SB Major depression and quality of life in individuals with multiple sclerosis . Int J Psychiatry Med 2000; 30: 309-17.

17.

D’ Alisa S. , Miscio G. , Baudo S. , Simone A. , Tesio L. , Mauro A. Depression is the main determinant of quality of life in multiple sclerosis: a classification-regression (CART) study. Disabil Rehabil 2006; 28: 307-14.

18.

Simmons RD , Ponsonby AL , van der Mei IAF , Sheridan P. What affects your MS? Responses to an anonymous, Internet-based epidemiological survey. Mult Scler 2004; 10: 202-11.

19.

Ackerman KD , Rabin B. , Heyman R. , Anderson BP , Houch PR , Frank E. Stressful life events precede multiple sclerosis disease exacerbations. Psychosom Med 2000 ; 62: 147.

20.

Potagas C. , Mitsonis C. , Watier L. et al. Influence of anxiety and reported stressful life events on relapses in multiple sclerosis: a prospective study. Mult Scler 2008; 14: 1262-68.

21.

Minden SL Mood disorders in multiple sclerosis: diagnosis and treatment. J Neurovirol 2000; 6: S160-67.

22.

Minden SL , Orav J. , Reich P. Depression in multiple sclerosis. Gen Hosp Psychiatry 1987; 9: 426-34.

23.

Feinstein A. An examination of suicidal intent in patients with multiple sclerosis. Neurology 2002; 59: 674-78.

24.

Thomas PW , Thomas S. , Hillier C. , Galvin K. , Baker R. Psychological interventions for multiple sclerosis. Cochrane Database Syst Rev 2006; (1): CD004431.

25.

Larcombe NA , Wilson PH An evaluation of cognitive-behaviour therapy for depression in patients with multiple sclerosis. Br J Psychiatry 1984; 145: 366-71.

26.

Mohr DC , Likosky W. , Bertagnolli A. et al. Telephone-administered cognitive-behavioral therapy for the treatment of depressive symptoms in multiple sclerosis. J Consult Clin Psychol 2000; 68: 356-61.

27.

Mohr DC , Boudewyn AC , Goodkin DE , Bostrom A. , Epstein L. Comparative outcomes for individual cognitive-behaviour therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. J Consult Clin Psychol 2001; 69: 942-49.

28.

Foley FW , Bedell JR , LaRocca NG , Scheinberg LC , Reznikoff M. Efficacy of stress-inoculation training in coping with multiple sclerosis . J Consult Clin Psychol 1987; 55: 919-22.

29.

Rigby, S. Coping with multiple sclerosis. Unpublished PhD thesis, University of Liverpool, Liverpool, UK, 2003.

30.

Wassem R. , Dudley W. Symptom management and adjustment of patients with multiple sclerosis . Clin Nurs Res 2003; 12: 102-17.

31.

Hart S. , Fonareva I. , Merluzzi N. , Mohr DC Treatment for depression and its relationship to improvement in quality of life and psychological well-being in multiple sclerosis patients. Qual Life Res 2005; 14: 695-703.

32.

Peters T. , Somerset M. , Campbell R. , Sharp D. Variables associated with attendance at, and the perceived helpfulness of, meetings for people with multiple sclerosis. Health Soc Care Community 2003; 11: 19-26.

33.

Forman A. , Vesey P. , Lincoln N. Effectiveness of an adjustment group for brain injury patients: a pilot evaluation . Int J Ther Rehabil 2006 ; 13: 223-28.

34.

Maguire BL The effects of imagery on attitude and moods in multiple sclerosis patients . Altern Ther Health Med 1996; 2: 75-79.

35.

Zigmond AS , Snaith RP The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361-70.

36.

Goldberg D. General Health Questionnaire (GHQ-12) . Windsor: NFER-Nelson, 1992.

37.

Nicholl CR , Lincoln NB , Francis VM Assessment of emotional problems in people with multiple sclerosis . Clin Rehabil 2001; 15: 657-68.

38.

Hobart J. , Riazi A. , Lamping D. , Fitzpatrick R. , Thompson A. How responsive is the Multiple Sclerosis Impact Scale (MSIS-29)? A comparison with some other self report scales. J Neurol Neurosurg Psychiatry 2005; 76: 1539-43.

39.

Sharrack B. , Hughs RA The Guy’s Neurological Disability Scale (GNDS): a new disability measure for multiple sclerosis. Mult Scler 1999; 5: 223-33.

40.

Townsend S. Regaining confidence after stroke: a manual for group leaders. Shropshire Enablement Team, 2003.

41.

Hobart J. , Lamping D. , Fitzpatrick R. , Riazi A. , Thompson A. The Multiple Sclerosis Impact Scale (MSIS-29): a new patient-based outcome measure. Brain 2001; 124: 962-73.

42.

Domenech CL , Thornton EW , Young CA , Rigby SA , Tedman S. Development of a self-efficacy scale for people with multiple sclerosis. Mult Scler 1999; 5: S144.

43.

Ware JE , Snow KK , Kosinski M. , Gandek B. SF-36 Health survey manual and interpretation guide. Boston, MA, Nimrod Press, 1993.

44.

Riazi A. , Hobart J. , Lamping D. , Fitzpatrick R. , Thompson A. Multiple Sclerosis Impact Scale (MSIS-29): reliability and validity in hospital based samples. J Neurol Neurosurg Psychiatry 2002; 73: 701-704.

45.

Shnek ZM , Foley FW , LaRocca NG , Smith CR , Halper J. Psychological predictors of depression in multiple sclerosis. J NeuroRehabil 1995; 9: 15-23.

46.

Matthews JNS , Altman DG , Campbell MJ , Royston P. Analysis of serial measurements in medial research. BMJ 1990; 300: 230-35.

47.

Crawford J. , McIvor G. Group psychotherapy: benefits in multiple sclerosis. Arch Phys Med Rehabil 1985; 66: 810-13.

48.

Tesar N. , Baumhackl U. , Kopp M. , Günther V. Effects of psychological group therapy inpatients with multiple sclerosis . Acta Neurol Scand 2003; 107: 393-99.