Threatening illness perception and associated factors in early-stage relapsing-remitting multiple sclerosis

Rocío Gómez-Ballesteros^1*Susana Sainz De La Maza²Mónica Borges³Jesús Martín-Martínez⁴Javier Sotoca⁵Ana Alonso⁶Ana B. Caminero⁷Laura Borrega⁸José L. Sánchez-Menoyo⁹Francisco J. Barrero-Hernández¹⁰Carmen Calles¹¹Luis Brieva¹²María R. Blasco-Quílez¹³Julio Dotor García-Soto³Ana Rodríguez-Regal¹⁴Laura Navarro-Cantó¹⁵Eduardo Agüera¹⁶Moisés Garcés-Redondo¹⁷Olga Carmona¹⁸Laura Gabaldón-Torres¹⁹Lucía Forero²⁰Mariona Hervás²¹Tamara Castillo-Triviño²²Jorge Maurino¹

• ¹Roche (Spain), Madrid, Spain
• ²Ramón y Cajal University Hospital, Madrid, Madrid, Spain
• ³Virgen Macarena University Hospital, Seville, Spain
• ⁴Hospital Universitario Miguel Servet, Zaragoza, Aragon, Spain
• ⁵Mútua Terrassa University Hospital, Barcelona, Catalonia, Spain
• ⁶Regional University Hospital of Malaga, Málaga, Andalusia, Spain
• ⁷Hospital de Avila, Avila, Spain
• ⁸Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
• ⁹Galdakao University Hospital, Galdakao, Spain
• ¹⁰San Cecilio University Hospital, Granada, Spain
• ¹¹Hospital Universitario Son Espases, Palma de Mallorca, Spain
• ¹²University Hospital Arnau de Vilanova, Lleida, Catalonia, Spain
• ¹³Puerta de Hierro University Hospital Majadahonda, Madrid, Madrid, Spain
• ¹⁴Pontevedra University Hospital, Pontevedra, Spain
• ¹⁵Hospital General Universitario de Elche, Elche, Spain
• ¹⁶Reina Sofia University Hospital, Cordoba, Spain
• ¹⁷Lozano Blesa University Clinical Hospital, Zaragoza, Aragon, Spain
• ¹⁸Fundació Salut Empordà, Figueres, Spain
• ¹⁹Regional Hospital Francesc De Borja, Gandía, Spain
• ²⁰Hospital Universitario Puerta del Mar, Cadiz, Spain
• ²¹Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
• ²²Donostia University Hospital, San Sebastian, Spain

Background: Multiple sclerosis is one of the most common causes of neurological disability in young adults, with major consequences for their future lives. Patients with early-stage relapsingremitting multiple sclerosis (RRMS) experience uncertainty and intense emotions as the diagnosis is disclosed. Illness perception at this point can influence levels of adjustment, coping strategies, treatment adherence, and well-being of the patient. However, there is limited information on patient illness perception surrounding the diagnosis.The aim of this study was to assess illness perception and associated factors in early-stageMethods: A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration of ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. The Brief-Illness Perception Questionnaire (B-IPQ) was used to assess the patients' cognitive and emotional representations of their illness. Different patient-reported measures were used to gather information on pain, fatigue, mood/anxiety, quality of life, symptom severity, feelings of hopelessness, perception of stigma, cognition, hand dexterity, gait, and workplace difficulties. A multivariate logistic regression analysis was performed to assess the association between the patients' illness perception and demographic and clinical characteristics, as well as patient-reported outcomes.Results: A total of 189 patients were included (mean age: 36.1±9.4 years, 71.4% females, mean disease duration: 1.4±0.8 years). The median EDSS score was 1.0 (interquartile range: 0.0-2.0). A total of 36.5% of the patients (n=69/189) had a moderate-to-high threatening illness perception, and 45.5% thought that their disease was caused by psychological factors. Higher EDSS scores, symptom severity, poorer psychological quality of life, perception of stigma, and greater hopelessness were predictors of moderate-to-high threatening illness perception.Conclusions: Threatening illness perceptions are common among patients with early-stage RRMS.Identifying these beliefs and their associated factors, and establishing individualized interventions, may help patients deal with their condition.