Hopelessness in Patients with Early-Stage Relapsing-Remitting Multiple Sclerosis

Susana Sainz de la Maza,1 Jorge Maurino,2 Tamara Castillo-Triviño,3 Mónica Borges,4 Berta Sebastián Torres,5 Javier Sotoca,6 Ana María Alonso Torres,7 Ana B Caminero,8 Laura Borrega,9 José L Sánchez-Menoyo,10 Francisco J Barrero-Hernández,11 Carmen Calles,12 Luis Brieva,13 María Rosario Blasco,14 Julio Dotor García-Soto,4 Ana Rodríguez-Regal,15 Laura Navarro-Cantó,16 Eduardo Agüera-Morales,17 Moisés Garcés,18 Olga Carmona,19 Laura Gabaldón-Torres,20 Lucía Forero,21 Mariona Hervás,22 Rocío Gómez-Ballesteros2 1Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain; 2Medical Department, Roche Farma, Madrid, Spain; 3Department of Neurology, Hospital Universitario Donostia, San Sebastián, Spain; 4Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain; 5Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain; 6Department of Neurology, Hospital Universitari Vall d´Hebrón, Barcelona, Spain; 7Department of Neurology, Hospital Regional Universitario de Málaga, Málaga, Spain; 8Department of Neurology, Complejo Asistencial de Ávila, Ávila, Spain; 9Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain; 10Department of Neurology, Hospital de Galdakao-Usansolo, Galdakao, Spain; 11Department of Neurology, Hospital Universitario Clínico San Cecilio, Granada, Spain; 12Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain; 13Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain; 14Department of Neurology, Hospital Universitario Puerta de Hierro, Madrid, Spain; 15Department of Neurology, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain; 16Department of Neurology, Hospital General Universitario de Elche, Elche, Spain; 17Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain; 18Department of Neurology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; 19Department of Neurology, Fundació Salut Empordà, Figueres, Spain; 20Department of Neurology, Hospital Francesc de Borja, Gandía, Spain; 21Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain; 22Department of Neurology, Consorci Corporació Sanitària Parc Taulí, Sabadell, SpainCorrespondence: Jorge Maurino, Medical Department, Roche Farma, Ribera del Loira, 50, Madrid, 28042, Spain, Tel +34 913 24 81 00, Email jorge.maurino@roche.comBackground: Hopelessness is a risk factor for depression and suicide. There is little information on this phenomenon among patients with relapsing-remitting multiple sclerosis (RRMS), one of the most common causes of disability and loss of autonomy in young adults. The aim of this study was to assess state hopelessness and its associated factors in early-stage RRMS.Methods: A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0– 5.5 were included. The State-Trait Hopelessness Scale (STHS) was used to measure patients´ hopelessness. A battery of patient-reported and clinician-rated measurements was used to assess clinical status. A multivariate logistic regression analysis was conducted to determine the association between patients’ characteristics and state hopelessness.Results: A total of 189 patients were included. Mean age (standard deviation-SD) was 36.1 (9.4) years and 71.4% were female. Median disease duration (interquartile range-IQR) was 1.4 (0.7, 2.1) years. Symptom severity and disability were low with a median EDSS (IQR) score of 1.0 (0, 2.0). A proportion of 65.6% (n=124) of patients reported moderate-to-severe hopelessness. Hopelessness was associated with older age (p=0.035), depressive symptoms (p=< 0.001), a threatening illness perception (p=0.001), and psychological and cognitive barriers to workplace performance (p=0.029) in the multivariate analysis after adjustment for confounders.Conclusion: Hopelessness was a common phenomenon in early-stage RRMS, even in a population with low physical disability. Identifying factors associated with hopelessness may be critical for implementing preventive strategies helping patients to adapt to the new situation and cope with the disease in the long term.Keywords: relapsing-remitting multiple sclerosis, hopelessness, depressive symptoms, workplace difficulties, suicide