Does depression in multiple sclerosis mediate effects of cognitive functioning on quality of life?

PURPOSE: Patients with multiple sclerosis (MS) are at significant risk for decreased quality of life (QoL), in part due to factors such as cognitive impairment and depression. However, objective versus subjective assessments of cognitive functioning may differentially predict QoL, and it remains unknown whether they each impact QoL through levels of depression. The aims of the present study included (1) testing the effects of cognitive impairment on MS-related QoL via depression symptoms and (2) examining whether perceived and objective cognitive functioning differentially predict QoL through depression. METHODS: Patients formally diagnosed with MS (N = 128) participated in cognitive assessment (Brief International Cognitive Assessment for Multiple Sclerosis) and completed self-report measures of perceived cognitive functioning (perceived deficits questionnaire), depression (Hospital Anxiety and Depression Scale), and MS-related QoL (functional assessment of multiple sclerosis). RESULTS: Mediational hypotheses were tested by regression and structural equation modeling. As hypothesized, both perceived and objective cognitive functioning independently predicted lower QoL controlling for the effects of depression (p < 0.001). Consistent with hypotheses, depression mediated effects of both perceived (95% CI [0.31, 0.68]) and objective cognitive functioning (95% CI [0.09, 6.96]) on QoL when tested in separate models. However, when both predictors were modeled simultaneously, depression only mediated the effects of perceived (not objective) cognitive functioning (95% CI for standardized effect [0.10, 0.61]). CONCLUSIONS: This study, thus, suggests the need to conceptualize different pathways by which objective and subjective cognitive impairment may shape QoL in the lives of individuals with MS.

Big five traits and interpersonal goals during stressors as predictors of hair cortisol.

Background: Hair cortisol concentrations (HCC) provide a biomarker for stress adaptation, which has downstream health consequences. Personality traits (e.g., neuroticism) and social processes (e.g., chronic interpersonal goals) may confer risk or buffer against dysregulated cortisol secretion. However, few studies have examined personality or interpersonal factors predicting hair cortisol, which estimates longer-term secretion and therefore provides a potential biomarker for studying trait-like psychological processes. The present study investigated effects of personality traits and daily interpersonal goals during stressors on HCC. Method: Participants (N = 90) reported Big Five traits at baseline, recorded interpersonal (self-image and compassionate) goals pursued during their worst psychosocial stressors for 4-5 weeks (1,949 entries), then provided a hair sample to estimate cortisol secretion over the past two months. Results: As hypothesized, neuroticism predicted higher HCC, beyond other Big Five traits (b = 7.45, SE = 3.36, p = .029). Moreover, this effect was greater for those chronically striving to promote/protect one's self-image during psychosocial stressors (b = 14.53, SE = 4.72, p = .003), and for those low in conscientiousness (b = 14.84, SE = 4.83, p = .003). Moderate extraversion was associated with higher HCC. Striving to support others (compassionate goals) exerted no direct or interactive effect on HCC, contrary to hypotheses. Conclusions: Results support the relevance of neuroticism and maladaptive interpersonal strivings to longer-term neuroendocrine responses, suggesting hair cortisol as a potential method for studying links of trait-like psychological and HPA processes.

Compassionate and self-image goals as interpersonal maintenance factors in clinical depression and anxiety.

OBJECTIVE: Interpersonal models of depression and anxiety have not examined the role of interpersonal goals in shaping relationships and symptoms. Striving to promote/protect desired self-images (self-image goals) may undermine relationships and increase symptoms, whereas striving to support others (compassionate goals) may be protective, but clinical relevance is unknown. METHOD: We tested effects of compassionate versus self-image goals on interpersonal functioning and symptoms in clinically depressed and/or anxious participants (N = 47) during 10 days of experience sampling, over a 6-week follow-up, and in a dyadic relationship. RESULTS: Participants reported higher conflict and symptoms on days that they most pursued self-image goals, but noted higher perceived support and lower symptoms when pursuing compassionate goals. Goals prospectively predicted symptom changes 6 weeks later. Lastly, informant-rated interpersonal goals predicted relationship satisfaction of both patients and significant others. CONCLUSION: Results suggest the relevance of self-image and compassionate goals for the interpersonal maintenance of depression and anxiety.