Clinical and psychological factors associated with fear of relapse in people with multiple sclerosis: A cross-sectional study

Background: Fear of relapse (FoR) is one of the main psychological concerns in people with relapsing-remitting multiple sclerosis (PwRRMS). It has disastrous consequences on treatment adherence, quality of life (QoL), and clinical course. Although the issue is closely linked to psychosocial aspects, it is not widely explored despite its overall impact on managing the condition. The determinants of FoR are vital for the optimization of therapeutic intervention toward ensuring patient welfare. Methods: This cross-sectional study, carried out in Isfahan, Iran, from December 2023 to September 2024, investigated demographic, clinical, and psychological characteristics in PwRRMS. The level of FoR was measured by the Fear of Relapse Scale, and for anxiety, depression, and obsessive-compulsive symptoms, the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), and the Yale-Brown Obsessive-Compulsive Scale (YBOCS) were used, respectively. Correlation between these factors were analyzed using linear regression. Results: A total of 189 PwRRMS were included. Multivariable linear regression analysis identified significant correlation between the higher annualized relapse rate (ARR) (B = 10.18, standardized 0.14, p-value < 0.05), anxiety (B = 0.32, standardized beta = 0.19, p-value < 0.05), depression (B = 0.63, standardized beta = 0.42, p-value <0.001) and Expanded Disability Status Scale (EDSS) (B = 2.19, standardized beta = 0.11, p-value < 0.05) with the FoR among PwRRMS. On the other hand, other demographic, clinical, and psychological variables, including disease duration, disability, and obsessive behavior, were found to lack a significant correlation with FoR (p-value < 0.05). Conclusion: This study points out that ARR, anxiety, and depression are among the leading independent risk factors of FoR in PwRRMS. Given the great potential for attenuation with focused treatments and psychological consultation, becoming major contributors to the decrease of FoR and, importantly, to improved overall patient well-being, their proper management and clinical follow-up should be considered an important issue in dealing with such patients.