The role of illness uncertainty and intrusiveness in multiple sclerosis

Abstract

Multiple sclerosis (MS) is a chronic, progressive disease that is often experienced as an uncertain and intrusive illness. A path model was utilized to examine the direct effects of illness uncertainty and intrusiveness on psychosocial adjustment; and the indirect effects mediated by optimism and coping styles. Eighty MS outpatients were interviewed at one time point following a neurological exam. The Mishel Illness Uncertainty Scale-Community Form, Intrusiveness Rating Scale, Life Orientation Test, COPE, Psychosocial Adjustment to Illness Scale-Self-Report, State-Trait Anger Scale-State Form, and Center for Epidemiological Studies Depression Scale were utilized.;The hypotheses were: (1) greater illness intrusiveness and uncertainty would be predictive of worse psychosocial adjustment (functioning, depression, & anger); (2) optimism would be a significant mediating variable in the relationship between illness intrusiveness and uncertainty and psychosocial adjustment; (3) the use of nonadaptive coping styles (focusing on & venting of emotions, denial, behavioral disengagement, mental disengagement, and alcohol & drug usage) would mediate the effects of illness intrusiveness and uncertainty on psychosocial adjustment; and (4) the use of adaptive coping styles (planning, active coping, instrumental social support, emotional social support acceptance, and positive reinterpretation & growth) would mediate the effects of illness intrusiveness and uncertainty on psychosocial adjustment.;The results showed that illness intrusiveness consistently had significant direct effects on psychosocial adjustment (functioning, depression, & anger), as well as indirect effects through optimism and nonadaptive coping. Illness uncertainty primarily demonstrated its effects on adjustment indirectly through optimism and nonadaptive coping. These two principal findings suggest that illness intrusiveness has a more consistent direct effect on adjustment because it may be related to disease characteristics. Another important finding was that optimism and nonadaptive coping were mediators for mood states (depression & anger), but not for functioning. In addition, adaptive coping did not demonstrate any mediating effects. In summary, further research is needed to examine other mediating variables that would provide a more comprehensive understanding of the stress-illness paradigm.