The Relationship of Psychological Distress and Cognitive Functioning to Illness Intrusiveness in Patients with Multiple Sclerosis
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Previous research has found that higher levels of disability and psychological distress were related to higher overall illness intrusiveness in multiple sclerosis (MS). The role of cognitive impairment in the relationship between psychological distress and illness intrusiveness has not yet been examined in multiple sclerosis. Individuals with cognitive impairment may experience decreased self-awareness of emotional, cognitive, and functional difficulties; therefore it is important to examine cognitive functioning as a moderator of the relationship between distress and illness intrusiveness. The relationship between distress and illness intrusiveness may be weaker for cognitively impaired compared to cognitively intact individuals because those with cognitive impairment may have decreased awareness. This study used an objective comprehensive examination to measure cognitive impairment and self-reports to measure illness intrusiveness and distress; therefore, self-awareness is particularly relevant. The aim of this study was to determine if cognitive functioning was a moderator of the relationship between psychological distress and self-reported illness intrusiveness (overall illness intrusiveness as well as intrusiveness in the relationships and personal development subscale, intimacy subscale, and instrumental subscale). We hypothesized higher level of distress would be associated with higher illness intrusiveness and the relationship between distress and illness intrusiveness would be stronger for those who are cognitively intact compared to those who are cognitively impaired. Results indicated that higher distress was associated with significantly higher overall illness intrusiveness for both individuals who are cognitively intact and cognitively impaired. Cognitive functioning was a significant moderator and the relationship between distress and overall illness intrusiveness was stronger for those who were cognitively intact compared to cognitively impaired. Higher distress was associated with significantly higher intrusiveness in relationships and personal development domains for both cognitively intact and cognitively impaired individuals and cognitive impairment did not moderate this relationship. Higher distress was associated with significantly higher intrusiveness in intimacy domains for those that were cognitively intact; however, distress was not significantly associated with intrusiveness in intimacy domains for those that were cognitively impaired (although cognitive impairment was not a significant moderator). Higher distress was associated with significantly higher intrusiveness in instrumental functioning domains for cognitively intact and impaired individuals and there was a trend for cognitive impairment to moderate this relationship. Overall the results indicated that for clinical applications reducing distress may be associated with greater reduction in self-reported illness intrusiveness for cognitively intact compared to cognitively impaired individuals; however, reducing distress may still be associated with some reduction in self-reported illness intrusiveness for those with cognitive impairment.