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jafari M, lotfizadeh M, hashemi R. Investigating the relationship between stress, anxiety and depression with the quality of life of patients with multiple sclerosis. TB 2023; 22 (1) :1-15
URL: http://tbj.ssu.ac.ir/article-1-3422-en.html
URL: http://tbj.ssu.ac.ir/article-1-3422-en.html
University of Medical Sciences, Shahrekord, Iran , m.jafari@skums.ac.ir
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Investigating the relationship between stress, anxiety and depression with the quality of life of patients with multiple sclerosis
Majid Jafari(MD)1, Masoud Lotfizadeh(Ph.D.)2, Razieh Hashemi (GP)1
1.Corresponding Author:Assistant Professor, Clinical Research Development Unit, Ayatollah Kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran.
Tel: 09133698429 Email: m.jafari@skums.ac.ir
2.Associate Professor, Social Factors of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
3.General practitioner, Social Factors of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
Abstract
Introduction: Multiple sclerosis (MS) is an autoimmune disease which can affect all aspects of a person's life. Therefore, the present study aims to investigate the relationship between stress, anxiety and depression with the quality of life of patients with MS.
Methods: This cross-sectional descriptive study was conducted in 2018-2019 on 245 patients with MS in Shahrekord city. Non-random sampling method was used and data collection tool was Depression, Anxiety and Stress Questionnaire (DASS-21) and Quality of Life Questionnaire in MS Patients (MISIS-29). The data were analyzed through SPSS 20 software.
Results: In the present study, only 26.6% of the patients experienced high quality of life, and 30.5% of patients had severe to moderate anxiety, 13/8% moderate stress, and 34.2% experienced moderate and severe depression. There was a significant relationship between the stress and anxiety of the patients and their jobs (p<0.05) and also there was a significant difference between the quality of life and the patients’ education (p<0.05). A significant relationship was observed between the level of stress, depression, and anxiety of the patients with the quality of life and with the physical and mental subscales (p<0.001).
Conclusion: The results indicated the prevalence of mental disorders in patients with MS, which has affected the quality of life of patients. Therefore, providing suitable interventions to deal with or adapt to these symptoms and ultimately improve the quality of life in MS patients seems necessary. This article is the result of the general practice thesis of Razia Hashemi from Shahrekord University of Medical Sciences.
Keywords: Multiple Sclerosis, Anxiety, Stress, Depression, Quality of Life
References
1- Ferreira AM, Leal B, Ferreira I, Brás S, Moreira I, Samões R, et al. Depression and anxiety in multiple sclerosis patients: The role of genetic variability of interleukin 1β. Multiple Sclerosis and Related Disorders. 2021; 52:102982.
2-Walton C, King R, Rechtman L, Kaye W, Leray E, Marrie RA, et al. Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS. Multiple Sclerosis Journal. 2020; 26(14):1816-21.
3-Cattaneo D, Gervasoni E, Anastasi D, Di Giovanni R, Brichetto G, Carpinella I, et al. Prevalence and patterns of subclinical motor and cognitive impairments in non-disabled individuals with early multiple sclerosis: A multicenter cross-sectional study. Annals of Physical and Rehabilitation Medicine. 2022; 65(1):101491.
4-Silveira C, Guedes R, Maia D, Curral R, Coelho R. Neuropsychiatric symptoms of multiple sclerosis: state of the art. Psychiatry Investigation. 2019; 16(12):877.
5-Sanmukhani J, Satodia V, Trivedi J, Patel T, Tiwari D, Panchal B, et al. Efficacy and safety of curcumin in major depressive disorder: a randomized controlled trial. Phytotherapy research. 2014; 28(4):579-85.
6-Ghahremani A, Mosa Farkhani S, Baniasadi M, Hojjat SK, Namdar Ahmadabad H, Salarbashi D, et al. Personality traits of patients with multiple sclerosis and their correlation with anxiety and depression levels: A cross‐sectional case–control study. Brain and Behavior. 2022; 12(5): 2596.
7-Karimi S, Andayeshgar B, Khatony A. Prevalence of anxiety, depression, and stress in patients with multiple sclerosis in Kermanshah-Iran: a cross-sectional study. BMC psychiatry. 2020; 20(1):1-8.
8-Hanna M, Strober LB. Anxiety and depression in multiple sclerosis (MS): antecedents, consequences, and differential impact on well-being and quality of life. Multiple Sclerosis and Related Disorders. 2020; 44:102261.
9-Hakiminya B, Poorafkari N, Ghafari D. Factors affecting quality of life with emphasis on social intelligence and social health (the case of Kermanshah city). Journal of Applied Sociology. 2017; 28(2):163-78.
10-Aboutalebi H, Yazdchi N, Akbarinejhad HS. Effectiveness of compassion-focused therapy on death anxiety and quality of life among women with multiple sclerosis. Medical Science Journal of Islamic Azad Univesity-Tehran Medical Branch. 2022; 32(1):92-101.
11-Wilmer MT, Anderson K, Reynolds M. Correlates of Quality of Life in Anxiety Disorders: Review of Recent Research. Current Psychiatry Reports. 2021; 23(11):1-9.
12-Hussenoeder FS, Jentzsch D, Matschinger H, Hinz A, Kilian R, Riedel-Heller SG, et al. Depression and quality of life in old age: a closer look. European Journal of Ageing. 2021; 18(1):75-83.
13-Norton PJ. Depression Anxiety and Stress Scales (DASS-21): Psychometric analysis across four racial groups. Anx Stress Cop. 2007; 20(3):253-65.
14- 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(5):962-73.
15- Etemadifar M, Janghorbani M, shaygannejad V, Ashtari F. “Prevalence of MS in Isfahan, Iran. Neuroepidemiology. 2006; 27(1): 39-44.
16- Wasay M, Khatri LA. Khealani B, Sheerani M. MS in Asian countries. Int MS J. 2006; 13(2):58-65.
17- Hosseininezhad M, Saadat S, Bakhshipour H, Nasiri P. Prevalence and Incidence of Multiple Sclerosis (MS) in Guilan Province. J Shahid Sadoughi Uni Med Sci 2020; 29(1): 3438 -47.
18- Masoodi R, Mohammadi E, Nabavi SM. The effect of Orem based self-care program on physical quality of life in multiple sclerosis patients. Shahrekord University of Medical Sciences Journal. 2008;2(10): 21-9 [Persian].
19- Hazrati M, Zahmat Keshan N, DejBakhsh T, Nik Seresht AR, Zeyghami B, The effect of rehabilitation process on the quality of life in Multiple Sclerosis patients. Armaghane-Danesh, Journal OF Yasuj University OF Medical Sciences. 2005; 39(10): 53-64
20-Janardhan V, Bakshi R. Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. Journal of the Neurological Sciences. 2002; 205(1): 51-8.
21- Solari A, Ferrari G, A longitudinal survey of self-assessed health trends in a community cohort of people with multiple sclerosis and their significant others. Journal of the Neurological Sciences. 2006; 243(1): 13 – 20.
22- Benito-Leo´NJ, Morales JM, Rivera-Navarro J, Health-related quality of life and its relationship to cognitive and emotional functioning in multiple sclerosis patients European. Journal of Neurology. 2002; 9(5): 497–502.
23- Nortved TMW, Riise T, Myhr KM, Nyland HL. Performance of SF-36, SF-12 and RAND –36 Summary scales in a Multiple sclerosis population .Med care. 2000; 36(10): 1022-1028.
24- Shahabian M, Majidi A, Ashjaei E, Allahyari F, Hosseini Nejad SJ. Relationship between Spiritual Health and Quality of Life in Patients with Multiple Sclerosis. Religion and Health, Spring & Summer. 2020; 8(1): 11-18
25-Ashjazadeh N, Hadianfard H, Feridoni S, Farjam E. Assessment of health-related quality of life in patients with multiple sclerosis living in the Fars province of Iran. Neuroimmunol Neuroinflamm. 2016; 3(3):57-62.
26-Healy BC, Casady EC, Chitnis T, Weiner HL, Glanz BI. Estimating the Association between Physical Activity and Health-Related Quality of Life in Individuals with Multiple Sclerosis. Multiple Sclerosis and Related Disorders. 2022;1(65): 104006.
27-Gil-González I, Martín-Rodríguez A, Conrad R, Pérez-San-Gregorio MÁ. Quality of life in adults with multiple sclerosis: a systematic review. BMJ open. 2020; 10(11): e041249.
28-Meyer-Arndt L, Schmitz-Hübsch T, Bellmann-Strobl J, Brandt AU, Haynes J-D, Gold SM, et al. Neural processes of psychological stress and relaxation predict the future evolution of quality of life in multiple sclerosis. Frontiers in neurology. 2021;(12).
29- Abakay H, Doğan H, Yetkin MF, Ayşe GÜ, Çaliş HT, Caltekin MD. The effects of incontinence on functionality, disability, and quality of life in male and female patients with multiple sclerosis. Multiple Sclerosis and Related Disorders. 2022;1(66):104010.
30. Pfaffenberger N, Pfeiffer K-P, Deibl M, Hofer S, Ulmer H, Association of factory influencing health related quality of life in MS, Acta Neurol Scand 2006; 114(2): 102-108.
31. Harishabadi Mehdi, Karimi Monghi Hossein, Foroghipour Mohsen, Mazloum Seyedreza. Quality of life of patients with multiple sclerosis referred to Ghaem (Aj) Mashhad Hospital in 2018. Journal of North Khorasan University of Medical Sciences [Internet]. 1389; 2(4 (consecutive 6)): 7-12.
32-Peres DS, Rodrigues P, Viero FT, Frare JM, Kudsi SQ, Meira GM, et al. Prevalence of depression and anxiety in the different clinical forms of multiple sclerosis and associations with disability: A systematic review and meta-analysis. Brain, Behavior, & Immunity-Health. 2022;1(24): 12100484.
33-Alharbi NA, Alawi SH, Alharbi YM, Alharbi MY, Alsamarh TN, Aldubaiyan AA, et al. Prevalence of depression and anxiety among adult patients with multiple sclerosis at Riyadh City, Saudi Arabia. Neurosciences Journal. 2022; 27(2):71-8.
34-Valentine TR, Alschuler KN, Ehde DM, Kratz AL. Prevalence, co-occurrence, and trajectories of pain, fatigue, depression, and anxiety in the year following multiple sclerosis diagnosis. Multiple Sclerosis Journal. 2022; 28(4):620-31.
35-Kołtuniuk A, Rosińczuk J. The Levels of Depression, Anxiety, Acceptance of Illness, and Medication Adherence in Patients with Multiple Sclerosis-Descriptive and Correlational Study. International Journal of Medical Sciences. 2021; 18(1):216.
36-Tauil CB, Grippe TC, Dias RM, Dias-Carneiro RP, Carneiro NM, Aguilar AC, Silva FM, Bezerra F, Almeida LK, Massarente VL, Giovannelli ED. Suicidal ideation, anxiety, and depression in patients with multiple sclerosis. Arquivos de neuro-psiquiatria. 2018; 76:296-301.
35-Füvesi J, Bencsik K, Losonczi E, Fricska-Nagy Z, Mátyás K, Mészáros E, et al. Factors influencing the health-related quality of life in Hungarian multiple sclerosis patients. Journal of the neurological.2010;293(1-2):59-64.
36- Zarei M, Hasanzade M Ali, Sheykh S.Assessment of the prevalence of stress, anxiety and depression in multiple sclerosis patients conducted in Zahedan. 2014:19(3) 13-21.
37-Dehgani A, Mohammad Khan S, Memariyan R. Prevalence of stress, anxiety and depression in patients with Multiple sclerosis. Alborz University of Medical Sciences J 2013; 2(2): 82-88.
38-Okiishi CG, Paradiso S, Robinson RG. Gender differences in depression associated with neurologic illness: clinical correlates and pharmacologic response. The Journal of Gender-Specific Medicine 2001; 4: 65– 72.
39-Beiske AG, Svensson E, Sandanger I, Czujko B, Pedersen ED, Aarseth J, Myhr K. M. Depression and anxiety amongst multiple sclerosis patients. Eur J Neurol 2008; 15(2): 239- 45.
40-Janssens AC, Van Doorn PA, De Boer JB, Van der Meche FG, Passchier J, Hintzen RQ. Impact of recently diagnosed multiple sclerosis on quality of life, anxiety, depression and distress of patients and partners. Acta Neurologica Scandinavica. 2003; 108(6):389-95.
41-Ochoa-Morales A, Hernández-Mojica T, Paz-Rodríguez F, Jara-Prado A, Trujillo-De Los Santos Z, Sánchez-Guzmán M, et al. Quality of life in patients with multiple sclerosis and its association with depressive symptoms and physical disability. Multiple sclerosis and related disorders. 2019; 36:101386.
42- Brown RF, Valpiani EM, Tennant CC, Dunn SM, Sharrock M, Hodgkinson S, Pollard JD. Longitudinal assessment of anxiety, depression, and fatigue in people with multiple sclerosis. Psychology and Psychotherapy: Theory, Research and Practice. 2009 Mar; 82(1):41-56.
43-Esfahani D, Alimohammadi, Zadeh P. The effectiveness of psychological training on the depression of caregivers of patients with multiple sclerosis. Behavioral science research. 2020; 18(1):91-100.
44- Rabati sh. The effectiveness of cognitive behavioral therapy on self-efficacy in pain, fatigue, life expectancy and depression in patients with multiple sclerosis: a clinical trial. Iranian Journal of Psychiatry and Clinical Psychology. 2021; 26(4):418-31.
45-Buja A, Graffigna G, Mafrici SF, Baldovin T, Pinato C, Bolzonella U, et al. Adherence to therapy, physical and mental quality of life in patients with multiple sclerosis. Journal of Personalized Medicine. 2021; 11(7):672.
Majid Jafari(MD)1, Masoud Lotfizadeh(Ph.D.)2, Razieh Hashemi (GP)1
1.Corresponding Author:Assistant Professor, Clinical Research Development Unit, Ayatollah Kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran.
Tel: 09133698429 Email: m.jafari@skums.ac.ir
2.Associate Professor, Social Factors of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
3.General practitioner, Social Factors of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
Abstract
Introduction: Multiple sclerosis (MS) is an autoimmune disease which can affect all aspects of a person's life. Therefore, the present study aims to investigate the relationship between stress, anxiety and depression with the quality of life of patients with MS.
Methods: This cross-sectional descriptive study was conducted in 2018-2019 on 245 patients with MS in Shahrekord city. Non-random sampling method was used and data collection tool was Depression, Anxiety and Stress Questionnaire (DASS-21) and Quality of Life Questionnaire in MS Patients (MISIS-29). The data were analyzed through SPSS 20 software.
Results: In the present study, only 26.6% of the patients experienced high quality of life, and 30.5% of patients had severe to moderate anxiety, 13/8% moderate stress, and 34.2% experienced moderate and severe depression. There was a significant relationship between the stress and anxiety of the patients and their jobs (p<0.05) and also there was a significant difference between the quality of life and the patients’ education (p<0.05). A significant relationship was observed between the level of stress, depression, and anxiety of the patients with the quality of life and with the physical and mental subscales (p<0.001).
Conclusion: The results indicated the prevalence of mental disorders in patients with MS, which has affected the quality of life of patients. Therefore, providing suitable interventions to deal with or adapt to these symptoms and ultimately improve the quality of life in MS patients seems necessary. This article is the result of the general practice thesis of Razia Hashemi from Shahrekord University of Medical Sciences.
Keywords: Multiple Sclerosis, Anxiety, Stress, Depression, Quality of Life
References
1- Ferreira AM, Leal B, Ferreira I, Brás S, Moreira I, Samões R, et al. Depression and anxiety in multiple sclerosis patients: The role of genetic variability of interleukin 1β. Multiple Sclerosis and Related Disorders. 2021; 52:102982.
2-Walton C, King R, Rechtman L, Kaye W, Leray E, Marrie RA, et al. Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS. Multiple Sclerosis Journal. 2020; 26(14):1816-21.
3-Cattaneo D, Gervasoni E, Anastasi D, Di Giovanni R, Brichetto G, Carpinella I, et al. Prevalence and patterns of subclinical motor and cognitive impairments in non-disabled individuals with early multiple sclerosis: A multicenter cross-sectional study. Annals of Physical and Rehabilitation Medicine. 2022; 65(1):101491.
4-Silveira C, Guedes R, Maia D, Curral R, Coelho R. Neuropsychiatric symptoms of multiple sclerosis: state of the art. Psychiatry Investigation. 2019; 16(12):877.
5-Sanmukhani J, Satodia V, Trivedi J, Patel T, Tiwari D, Panchal B, et al. Efficacy and safety of curcumin in major depressive disorder: a randomized controlled trial. Phytotherapy research. 2014; 28(4):579-85.
6-Ghahremani A, Mosa Farkhani S, Baniasadi M, Hojjat SK, Namdar Ahmadabad H, Salarbashi D, et al. Personality traits of patients with multiple sclerosis and their correlation with anxiety and depression levels: A cross‐sectional case–control study. Brain and Behavior. 2022; 12(5): 2596.
7-Karimi S, Andayeshgar B, Khatony A. Prevalence of anxiety, depression, and stress in patients with multiple sclerosis in Kermanshah-Iran: a cross-sectional study. BMC psychiatry. 2020; 20(1):1-8.
8-Hanna M, Strober LB. Anxiety and depression in multiple sclerosis (MS): antecedents, consequences, and differential impact on well-being and quality of life. Multiple Sclerosis and Related Disorders. 2020; 44:102261.
9-Hakiminya B, Poorafkari N, Ghafari D. Factors affecting quality of life with emphasis on social intelligence and social health (the case of Kermanshah city). Journal of Applied Sociology. 2017; 28(2):163-78.
10-Aboutalebi H, Yazdchi N, Akbarinejhad HS. Effectiveness of compassion-focused therapy on death anxiety and quality of life among women with multiple sclerosis. Medical Science Journal of Islamic Azad Univesity-Tehran Medical Branch. 2022; 32(1):92-101.
11-Wilmer MT, Anderson K, Reynolds M. Correlates of Quality of Life in Anxiety Disorders: Review of Recent Research. Current Psychiatry Reports. 2021; 23(11):1-9.
12-Hussenoeder FS, Jentzsch D, Matschinger H, Hinz A, Kilian R, Riedel-Heller SG, et al. Depression and quality of life in old age: a closer look. European Journal of Ageing. 2021; 18(1):75-83.
13-Norton PJ. Depression Anxiety and Stress Scales (DASS-21): Psychometric analysis across four racial groups. Anx Stress Cop. 2007; 20(3):253-65.
14- 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(5):962-73.
15- Etemadifar M, Janghorbani M, shaygannejad V, Ashtari F. “Prevalence of MS in Isfahan, Iran. Neuroepidemiology. 2006; 27(1): 39-44.
16- Wasay M, Khatri LA. Khealani B, Sheerani M. MS in Asian countries. Int MS J. 2006; 13(2):58-65.
17- Hosseininezhad M, Saadat S, Bakhshipour H, Nasiri P. Prevalence and Incidence of Multiple Sclerosis (MS) in Guilan Province. J Shahid Sadoughi Uni Med Sci 2020; 29(1): 3438 -47.
18- Masoodi R, Mohammadi E, Nabavi SM. The effect of Orem based self-care program on physical quality of life in multiple sclerosis patients. Shahrekord University of Medical Sciences Journal. 2008;2(10): 21-9 [Persian].
19- Hazrati M, Zahmat Keshan N, DejBakhsh T, Nik Seresht AR, Zeyghami B, The effect of rehabilitation process on the quality of life in Multiple Sclerosis patients. Armaghane-Danesh, Journal OF Yasuj University OF Medical Sciences. 2005; 39(10): 53-64
20-Janardhan V, Bakshi R. Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. Journal of the Neurological Sciences. 2002; 205(1): 51-8.
21- Solari A, Ferrari G, A longitudinal survey of self-assessed health trends in a community cohort of people with multiple sclerosis and their significant others. Journal of the Neurological Sciences. 2006; 243(1): 13 – 20.
22- Benito-Leo´NJ, Morales JM, Rivera-Navarro J, Health-related quality of life and its relationship to cognitive and emotional functioning in multiple sclerosis patients European. Journal of Neurology. 2002; 9(5): 497–502.
23- Nortved TMW, Riise T, Myhr KM, Nyland HL. Performance of SF-36, SF-12 and RAND –36 Summary scales in a Multiple sclerosis population .Med care. 2000; 36(10): 1022-1028.
24- Shahabian M, Majidi A, Ashjaei E, Allahyari F, Hosseini Nejad SJ. Relationship between Spiritual Health and Quality of Life in Patients with Multiple Sclerosis. Religion and Health, Spring & Summer. 2020; 8(1): 11-18
25-Ashjazadeh N, Hadianfard H, Feridoni S, Farjam E. Assessment of health-related quality of life in patients with multiple sclerosis living in the Fars province of Iran. Neuroimmunol Neuroinflamm. 2016; 3(3):57-62.
26-Healy BC, Casady EC, Chitnis T, Weiner HL, Glanz BI. Estimating the Association between Physical Activity and Health-Related Quality of Life in Individuals with Multiple Sclerosis. Multiple Sclerosis and Related Disorders. 2022;1(65): 104006.
27-Gil-González I, Martín-Rodríguez A, Conrad R, Pérez-San-Gregorio MÁ. Quality of life in adults with multiple sclerosis: a systematic review. BMJ open. 2020; 10(11): e041249.
28-Meyer-Arndt L, Schmitz-Hübsch T, Bellmann-Strobl J, Brandt AU, Haynes J-D, Gold SM, et al. Neural processes of psychological stress and relaxation predict the future evolution of quality of life in multiple sclerosis. Frontiers in neurology. 2021;(12).
29- Abakay H, Doğan H, Yetkin MF, Ayşe GÜ, Çaliş HT, Caltekin MD. The effects of incontinence on functionality, disability, and quality of life in male and female patients with multiple sclerosis. Multiple Sclerosis and Related Disorders. 2022;1(66):104010.
30. Pfaffenberger N, Pfeiffer K-P, Deibl M, Hofer S, Ulmer H, Association of factory influencing health related quality of life in MS, Acta Neurol Scand 2006; 114(2): 102-108.
31. Harishabadi Mehdi, Karimi Monghi Hossein, Foroghipour Mohsen, Mazloum Seyedreza. Quality of life of patients with multiple sclerosis referred to Ghaem (Aj) Mashhad Hospital in 2018. Journal of North Khorasan University of Medical Sciences [Internet]. 1389; 2(4 (consecutive 6)): 7-12.
32-Peres DS, Rodrigues P, Viero FT, Frare JM, Kudsi SQ, Meira GM, et al. Prevalence of depression and anxiety in the different clinical forms of multiple sclerosis and associations with disability: A systematic review and meta-analysis. Brain, Behavior, & Immunity-Health. 2022;1(24): 12100484.
33-Alharbi NA, Alawi SH, Alharbi YM, Alharbi MY, Alsamarh TN, Aldubaiyan AA, et al. Prevalence of depression and anxiety among adult patients with multiple sclerosis at Riyadh City, Saudi Arabia. Neurosciences Journal. 2022; 27(2):71-8.
34-Valentine TR, Alschuler KN, Ehde DM, Kratz AL. Prevalence, co-occurrence, and trajectories of pain, fatigue, depression, and anxiety in the year following multiple sclerosis diagnosis. Multiple Sclerosis Journal. 2022; 28(4):620-31.
35-Kołtuniuk A, Rosińczuk J. The Levels of Depression, Anxiety, Acceptance of Illness, and Medication Adherence in Patients with Multiple Sclerosis-Descriptive and Correlational Study. International Journal of Medical Sciences. 2021; 18(1):216.
36-Tauil CB, Grippe TC, Dias RM, Dias-Carneiro RP, Carneiro NM, Aguilar AC, Silva FM, Bezerra F, Almeida LK, Massarente VL, Giovannelli ED. Suicidal ideation, anxiety, and depression in patients with multiple sclerosis. Arquivos de neuro-psiquiatria. 2018; 76:296-301.
35-Füvesi J, Bencsik K, Losonczi E, Fricska-Nagy Z, Mátyás K, Mészáros E, et al. Factors influencing the health-related quality of life in Hungarian multiple sclerosis patients. Journal of the neurological.2010;293(1-2):59-64.
36- Zarei M, Hasanzade M Ali, Sheykh S.Assessment of the prevalence of stress, anxiety and depression in multiple sclerosis patients conducted in Zahedan. 2014:19(3) 13-21.
37-Dehgani A, Mohammad Khan S, Memariyan R. Prevalence of stress, anxiety and depression in patients with Multiple sclerosis. Alborz University of Medical Sciences J 2013; 2(2): 82-88.
38-Okiishi CG, Paradiso S, Robinson RG. Gender differences in depression associated with neurologic illness: clinical correlates and pharmacologic response. The Journal of Gender-Specific Medicine 2001; 4: 65– 72.
39-Beiske AG, Svensson E, Sandanger I, Czujko B, Pedersen ED, Aarseth J, Myhr K. M. Depression and anxiety amongst multiple sclerosis patients. Eur J Neurol 2008; 15(2): 239- 45.
40-Janssens AC, Van Doorn PA, De Boer JB, Van der Meche FG, Passchier J, Hintzen RQ. Impact of recently diagnosed multiple sclerosis on quality of life, anxiety, depression and distress of patients and partners. Acta Neurologica Scandinavica. 2003; 108(6):389-95.
41-Ochoa-Morales A, Hernández-Mojica T, Paz-Rodríguez F, Jara-Prado A, Trujillo-De Los Santos Z, Sánchez-Guzmán M, et al. Quality of life in patients with multiple sclerosis and its association with depressive symptoms and physical disability. Multiple sclerosis and related disorders. 2019; 36:101386.
42- Brown RF, Valpiani EM, Tennant CC, Dunn SM, Sharrock M, Hodgkinson S, Pollard JD. Longitudinal assessment of anxiety, depression, and fatigue in people with multiple sclerosis. Psychology and Psychotherapy: Theory, Research and Practice. 2009 Mar; 82(1):41-56.
43-Esfahani D, Alimohammadi, Zadeh P. The effectiveness of psychological training on the depression of caregivers of patients with multiple sclerosis. Behavioral science research. 2020; 18(1):91-100.
44- Rabati sh. The effectiveness of cognitive behavioral therapy on self-efficacy in pain, fatigue, life expectancy and depression in patients with multiple sclerosis: a clinical trial. Iranian Journal of Psychiatry and Clinical Psychology. 2021; 26(4):418-31.
45-Buja A, Graffigna G, Mafrici SF, Baldovin T, Pinato C, Bolzonella U, et al. Adherence to therapy, physical and mental quality of life in patients with multiple sclerosis. Journal of Personalized Medicine. 2021; 11(7):672.
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Received: 2022/11/14 | Accepted: 2023/03/5 | Published: 2023/04/30
Received: 2022/11/14 | Accepted: 2023/03/5 | Published: 2023/04/30
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