Skip to main content

Advertisement

Log in

Quality of life and depression in multiple sclerosis patients: longitudinal results of the BetaPlus study

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Enhancing quality of life (QoL) is an important objective of disease-modifying therapies in multiple sclerosis (MS). Strategies to substantiate the effect on QoL and depression have been suggested, including injection devices and nursing support. This study assesses QoL and depression in MS patients treated with interferon beta-1b (IFNB-1b) and evaluates the impact of different elements of a patient support programme and of coping strategies on QoL and depression. A prospective, observational, 2-year cohort study was conducted. MS patients were eligible if they had previously switched to IFNB-1b. Data were collected every 6 months. For the measurement of QoL the Functional Assessment of MS (FAMS) was used. Depression symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D); coping strategies were assessed using the 66-item version of Ways of Coping Questionnaire. A total of 1,077 patients were recruited into the study. Seven hundred (65 %) patients completed the study. Within the subgroup completing questionnaires on QoL (N = 472) and depression (N = 363), QoL increased (110.4 vs. 115.8, p < 0.001), and the proportion of depressed patients decreased from 53.7 to 43.3 % (p < 0.001). Modelling QoL and depressions, the use of the autoinjector Betaject® over time showed a positive association with QoL (p = 0.049). The support from a nurse was positively associated with lower depressive symptoms (p = 0.039). The coping strategies ‘planful problem-solving’ and ‘positive reappraisal’ were associated with higher QoL and lower depressive symptoms. Patients on IFNB-1b treatment who were included in the patient support programme and completed the study showed an improvement in QoL. Moreover, compared to baseline the proportion of depressive patients decreased. Coping strategies as well as supportive elements such as autoinjectors and nurses had a significant impact on QoL and depression. However, the study had the general limitations of a non-controlled design.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Borras C, Rio J, Porcel J, Barrios M, Tintore M, Montalban X (1999) Emotional state of patients with relapsing-remitting MS treated with interferon beta-1b. Neurology 52:1636–1639

    Article  PubMed  CAS  Google Scholar 

  2. Cella DF, Dineen K, Arnason B, Reder A, Webster KA, Karabatsos G, Chang C, Lloyd S, Steward J, Stefoski D (1996) Validation of the functional assessment of multiple sclerosis quality of life instrument. Neurology 47:129–139

    Article  PubMed  CAS  Google Scholar 

  3. European Study Group on interferon beta-1b in secondary progressive MS (1998) Placebo-controlled multicentre randomised trial of interferon beta-1b in treatment of secondary progressive multiple sclerosis. European Study Group on interferon beta-1b in secondary progressive MS. Lancet 352:1491–1497

    Article  Google Scholar 

  4. Folkman S, Lazarus R (1988) Manual for the ways of coping questionnaire. Consulting Psychology Press, Paolo Alto

    Google Scholar 

  5. Forbes A, While A, Mathes L, Griffiths P (2006) Evaluation of a MS specialist nurse programme. Int J Nurs Stud 43:985–1000

    Article  PubMed  Google Scholar 

  6. Freeman JA, Thompson AJ, Fitzpatrick R, Hutchinson M, Miltenburger C, Beckmann K, Dahlke F, Kappos L, Polman C, Pozzilli C (2001) Interferon-beta1b in the treatment of secondary progressive MS: impact on quality of life. Neurology 57:1870–1875

    Article  PubMed  CAS  Google Scholar 

  7. Ghubash R, Daradkeh TK, Al Naseri KS, Al Bloushi NB, Al Daheri AM (2000) The performance of the Center for Epidemiologic Study Depression Scale (CES-D) in an Arab female community. Int J Soc Psychiatry 46:241–249

    Article  PubMed  CAS  Google Scholar 

  8. Hourai Y, Brochet B, Grau G, Epicure Study Group (2004) Reduction of injection site reactions of MS patients newly starten on Beterferon® therapy with the Betaject® and Betaject®Light autoinjectors. Mult Scler 10(Suppl 2):252

    Google Scholar 

  9. IFNB Multiple Sclerosis Study Group (1993) Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. The IFNB Multiple Sclerosis Study Group. Neurology 43:655–661

    Article  Google Scholar 

  10. Jacobs LD, Cookfair DL, Rudick RA, Herndon RM, Richert JR, Salazar AM, Fischer JS, Goodkin DE, Granger CV, Simon JH (1995) A phase III trial of intramuscular recombinant interferon beta as treatment for exacerbating-remitting multiple sclerosis: design and conduct of study and baseline characteristics of patients. Multiple Sclerosis Collaborative Research Group (MSCRG). Mult Scler 1:118–135

    PubMed  CAS  Google Scholar 

  11. Johnson KP, Brooks BR, Cohen JA, Ford CC, Goldstein J, Lisak RP, Myers LW, Panitch HS, Rose JW, Schiffer RB (1995) Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind placebo-controlled trial. The Copolymer 1 Multiple Sclerosis Study Group. Neurology 45:1268–1276

    Article  PubMed  CAS  Google Scholar 

  12. Jongen PJ, Sindic C, Carton H, Zwanikken C, Lemmens W, Borm G (2010) Improvement of health-related quality of life in relapsing remitting multiple sclerosis patients after 2 years of treatment with intramuscular interferon-beta-1a. J Neurol 257:584–589

    Article  PubMed  CAS  Google Scholar 

  13. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452

    Article  PubMed  CAS  Google Scholar 

  14. Lily O, McFadden E, Hensor E, Johnson M, Ford H (2006) Disease-specific quality of life in multiple sclerosis: the effect of disease modifying treatment. Mult Scler 12:808–813

    Article  PubMed  CAS  Google Scholar 

  15. Lynch SG, Kroencke DC, Denney DR (2001) The relationship between disability and depression in multiple sclerosis: the role of uncertainty, coping, and hope. Mult Scler 7:411–416

    PubMed  CAS  Google Scholar 

  16. Mikol D, Lopez-Bresnahan M, Taraskiewicz S, Chang P, Rangnow J (2005) A randomized, multicentre, open-label, parallel-group trial of the tolerability of interferon beta-1a (Rebif) administered by autoinjection or manual injection in relapsing-remitting multiple sclerosis. Mult Scler 11:585–591

    Article  PubMed  CAS  Google Scholar 

  17. Miller A, Dishon S (2006) Health-related quality of life in multiple sclerosis: the impact of disability, gender and employment status. Qual Life Res 15:259–271

    Article  PubMed  Google Scholar 

  18. Miller D, Rudick RA, Hutchinson M (2010) Patient-centered outcomes: translating clinical efficacy into benefits on health-related quality of life. Neurology 74(Suppl 3):S24–S35

    PubMed  Google Scholar 

  19. Mohr DC, Goodkin DE, Gatto N, Van der Wende J (1997) Depression, coping and level of neurological impairment in multiple sclerosis. Mult Scler 3:254–258

    Article  PubMed  CAS  Google Scholar 

  20. Molyneux PD, Barker GJ, Barkhof F, Beckmann K, Dahlke F, Filippi M, Ghazi M, Hahn D, MacManus D, Polman C, Pozzilli C, Kappos L, Thompson AJ, Wagner K, Yousry T, Miller DH (2001) Clinical-MRI correlations in a European trial of interferon beta-1b in secondary progressive MS. Neurology 57:2191–2197

    Article  PubMed  CAS  Google Scholar 

  21. Montel SR, Bungener C (2007) Coping and quality of life in one hundred and thirty five subjects with multiple sclerosis. Mult Scler 13:393–401

    Article  PubMed  CAS  Google Scholar 

  22. Murrell SA, Himmelfarb S, Wright K (1983) Prevalence of depression and its correlates in older adults. Am J Epidemiol 117:173–185

    PubMed  CAS  Google Scholar 

  23. Neilley LK, Goodin DS, Goodkin DE, Hauser SL (1996) Side effect profile of interferon beta-1b in MS: results of an open label trial. Neurology 46:552–554

    Article  PubMed  CAS  Google Scholar 

  24. Nortvedt MW, Riise T (2003) The use of quality of life measures in multiple sclerosis research. Mult Scler 9:63–72

    Article  PubMed  CAS  Google Scholar 

  25. Nortvedt MW, Riise T, Myhr KM, Nyland HI (1999) Quality of life in multiple sclerosis: measuring the disease effects more broadly. Neurology 53:1098–1103

    Article  PubMed  CAS  Google Scholar 

  26. Paolicelli D, Direnzo V, Trojano M (2009) Review of interferon beta-1b in the treatment of early and relapsing multiple sclerosis. Biologics 3:369–376

    PubMed  CAS  Google Scholar 

  27. Parkin D, Jacoby A, McNamee P, Miller P, Thomas S, Bates D (2000) Treatment of multiple sclerosis with interferon beta: an appraisal of cost-effectiveness and quality of life. J Neurol Neurosurg Psychiatry 68:144–149

    Article  PubMed  CAS  Google Scholar 

  28. Paty DW, Li DK (1993) Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. II. MRI analysis results of a multicenter, randomized, double-blind, placebo-controlled trial. UBC MS/MRI Study Group and the IFNB Multiple Sclerosis Study Group. Neurology 43:662–667

    Article  PubMed  CAS  Google Scholar 

  29. Porcel J, Rio J, Sanchez-Betancourt A, Arevalo MJ, Tintore M, Tellez N, Borras C, Nos C, Montalban X (2006) Long-term emotional state of multiple sclerosis patients treated with interferon beta. Mult Scler 12:802–807

    Article  PubMed  CAS  Google Scholar 

  30. Pozzilli C, Schweikert B, Ecari U, Oentrich W (2011) Supportive strategies to improve adherence to IFN beta-1b in Multiple Sclerosis—Results of the BetaPlus observational cohort study. J Neurol Sci. doi:10.1016/j.jns.2011.04.026:

    Google Scholar 

  31. PRISMS Study Group (1998) Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. PRISMS (prevention of relapses and disability by interferon beta-1a subcutaneously in multiple sclerosis) Study Group. Lancet 352:1498–1504

    Article  Google Scholar 

  32. Putzki N, Fischer J, Gottwald K, Reifschneider G, Ries S, Siever A, Hoffmann F, Kafferlein W, Kausch U, Liedtke M, Kirchmeier J, Gmund S, Richter A, Schicklmaier P, Niemczyk G, Wernsdorfer C, Hartung HP (2009) Quality of life in 1,000 patients with early relapsing-remitting multiple sclerosis. Eur J Neurol 16:713–720

    Article  PubMed  CAS  Google Scholar 

  33. Rabe-Hesketh S, Skrondal A, Skrondal A (2008) Multilevel and longitudinal modeling using stata. Stata Press Publication, College Station

    Google Scholar 

  34. Radloff L (1977) The CES-D Scale: a self-report depression for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google Scholar 

  35. Rudick RA, Miller D, Hass S, Hutchinson M, Calabresi PA, Confavreux C, Galetta SL, Giovannoni G, Havrdova E, Kappos L, Lublin FD, Miller DH, O’Connor PW, Phillips JT, Polman CH, Radue EW, Stuart WH, Wajgt A, Weinstock-Guttman B, Wynn DR, Lynn F, Panzara MA (2007) Health-related quality of life in multiple sclerosis: effects of natalizumab. Ann Neurol 62:335–346

    Article  PubMed  CAS  Google Scholar 

  36. Rudick RA, Polman CH (2009) Current approaches to the identification and management of breakthrough disease in patients with multiple sclerosis. Lancet Neurol 8:545–559

    Article  PubMed  Google Scholar 

  37. Shinar D, Gross CR, Price TR, Banko M, Bolduc PL, Robinson RG (1986) Screening for depression in stroke patients: the reliability and validity of the Center for Epidemiologic Studies Depression Scale. Stroke 17:241–245

    Article  PubMed  CAS  Google Scholar 

  38. Simone IL, Ceccarelli A, Tortorella C, Bellacosa A, Pellegrini F, Plasmati I, De Caro MF, Lopez M, Girolamo F, Livrea P (2006) Influence of interferon beta treatment on quality of life in multiple sclerosis patients. Health Qual Life Outcomes 4:96

    Article  PubMed  Google Scholar 

  39. Thompson AJ, Toosy AT, Ciccarelli O (2010) Pharmacological management of symptoms in multiple sclerosis: current approaches and future directions. Lancet Neurol 9:1182–1199

    Article  PubMed  CAS  Google Scholar 

  40. Turpin KV, Carroll LJ, Cassidy JD, Hader WJ (2007) Deterioration in the health-related quality of life of persons with multiple sclerosis: the possible warning signs. Mult Scler 13:1038–1045

    Article  PubMed  CAS  Google Scholar 

  41. Vermersch P, de Seze J, Delisse B, Lemaire S, Stojkovic T (2002) Quality of life in multiple sclerosis: influence of interferon-beta1 a (Avonex) treatment. Mult Scler 8:377–381

    Article  PubMed  CAS  Google Scholar 

  42. Vickrey BG, Hays RD, Harooni R, Myers LW, Ellison GW (1995) A health-related quality of life measure for multiple sclerosis. Qual Life Res 4:187–206

    Article  PubMed  CAS  Google Scholar 

  43. Zivadinov R, Zorzon M, Tommasi MA, Nasuelli D, Bernardi M, Monti-Bragadin L, Cazzato G (2003) A longitudinal study of quality of life and side effects in patients with multiple sclerosis treated with interferon beta-1a. J Neurol Sci 216:113–118

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This research was funded by Bayer Pharma AG.

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carlo Pozzilli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pozzilli, C., Schweikert, B., Ecari, U. et al. Quality of life and depression in multiple sclerosis patients: longitudinal results of the BetaPlus study. J Neurol 259, 2319–2328 (2012). https://doi.org/10.1007/s00415-012-6492-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-012-6492-8

Keywords

Navigation