Multiple sclerosis and mental health related quality of life: The role of defense mechanisms, defense styles and family environment

Background: Multiple sclerosis is a demyelinating chronic neurologic disease that can lead to disability and thus to deterioration of quality of life. Psychological parameters such as ego defense mechanisms, defense styles and family environment are important factors in the adaptation process, and as such they can play important roles in QoL. This study aims to assess the psychological factors as well as the clinical and demographic characteristics related to mental health quality of life (MHQoL). Methods: This was an observational, cross-sectional study conducted in a sample of 90 people with MS in the years 2018-2020. All participants completed the following questionnaires: MSQoL-54, DSQ-88, LSI, FES-R, SOC, BDI-II, STAI. Disability was assessed using EDSS. Results: In multiple linear regression, significant roles were played by depression (R-2: 41.1%, p: 0.001) and, to a lesser extent, the event of a relapse (R-2: 3.5%, p: 0.005), expressiveness (R-2: 3.6%, p < 0.05) and image distortion style (R-2: 4.5%, p: 0.032). After performing a hierarchical-stepwise analysis (excluding depression), the important factors were maladaptive defense style (R-2: 23.7%, p: 0.002), the event of relapse (R-2: 8.1%, p < 0.001), expressiveness (R-2: 5.5%, p: 0.004) and self-sacrificing defense style (R-2: 2.4%, p: 0.071). Conclusion: Psychological factors play important roles in MHQoL of people with multiple sclerosis. Thus, neurologists should integrate in their practice an assessment by mental health specialists.Moreover, targeted psychotherapeutic interventions could be planned i to improve QoL.