Mediating Role of Resilience on Quality of Life in Individuals With Multiple Sclerosis: A Structural Equation Modeling Approach

Abstract

Objective: To examine the relationship between disease-related risk factors, protective factors, coping, and resilience on quality of life in adults with multiple sclerosis (MS).

Design: Quantitative descriptive research employing structural equation modeling.

Setting: Online survey fielded to community members associated with the Greater New England Chapter of the National Multiple Sclerosis Society.

Participants: Convenience sample of 271 individuals with MS.

Intervention: Not applicable.

Main outcome measures: The Leeds Multiple Sclerosis Quality of Life (LMSQoL) scale was the primary outcome. Other measures entered into the model included the Brief Resilience Scale (BRS) and the Coping Orientation to Problems Experienced (COPE) scale modeled as 2 latent variables: emotion-based coping and problem-based coping. Disability level, fatigue, walking impairment, fear of falling, falls, and pain were modeled as a latent variable for risk factors while physical activity, self-efficacy, social support, optimism, and health locus of control were modeled as a latent variable of protective factors.

Results: BRS had a total effect of -0.44 on LMSQoL, significant at P<.001. Protective factors also directly and significantly increased QoL (total effect size -0.46; P<.001). Emotion-based coping and problem-based coping had insignificant effects on QoL. Risk factors had a complex influence on QoL, mediated by resilience, protective factors, emotion-based coping, and problem-based coping. Risk factors had total effect size of 0.32 on quality of life (significant at P<.001). Whereas higher risk factors decreased QoL, both directly and indirectly, resilience increased the likelihood of higher QoL with a slightly higher effect size. The model fit the data reasonably well and explained 96.7% of the variance in QoL in people with MS.

Conclusions: The model suggests that developing interventions that increase protective factors and broaden and build resilience may contribute to improved quality of life in individuals with MS.

Keywords: Multiple sclerosis; Protective factors; Quality of life; Risk factors.