Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
International Journal of Behavioral Medicine
Published in: International Journal of Behavioral Medicine 1/2023

Open Access 24-03-2022 | Multiple Sclerosis | Full length manuscript

The Mediating Role of Stigma, Internalized Shame, and Autonomous Motivation in the Relationship Between Depression, Anxiety, and Psychological Help-Seeking Attitudes in Multiple Sclerosis

Authors: Tamrin Barta, Litza Kiropoulos

Published in: International Journal of Behavioral Medicine | Issue 1/2023

Login to get access

Abstract

Background

Depression and anxiety are commonly experienced in individuals with multiple sclerosis (MS) yet little is known about factors associated with psychological help-seeking attitudes in those with MS.

Method

The current study investigated whether increased stigma related to chronic illness, internalized shame, and autonomous motivation mediated the relationship between depressive and anxiety symptoms and psychological help-seeking attitudes in individuals with MS. Two hundred fifty-four participants with MS completed an online questionnaire assessing depressive and anxiety symptoms, stigma related to chronic illness, internalized shame, autonomous motivation, and psychological help-seeking attitudes.

Results

Stigma related to chronic illness, internalized shame, and autonomous motivation mediated the relationships between increased depressive symptoms and anxiety symptoms and psychological help-seeking attitudes. The study also found that higher levels of chronic illness–related stigma and internalized shame were associated with more negative psychological help-seeking attitudes and higher autonomous motivation was associated with more positive psychological help-seeking attitudes. There were no direct effects of depressive or anxiety symptoms on psychological help-seeking attitudes.

Conclusion

The significant mediating roles of stigma-related chronic illness, internalized shame, and autonomous motivation indicate that these factors may be useful to include in future depression and anxiety intervention studies targeting MS populations.
Literature
1.
Pagnini F, Bosma CM, Phillips D, Langer E. Symptom changes in multiple sclerosis following psychological interventions: a systematic review. BMC Neurol. 2014 Nov 30;14:222.
2.
Boeschoten RE, Braamse AMJ, Beekman ATF, et al. Prevalence of depression and anxiety in multiple sclerosis: a systematic review and meta-analysis. J Neurol Sci. 2017;372:331–41.CrossRef
3.
Marrie RA, Reingold S, Cohen J, et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review. Mult Scler. 2015;21(3):305–17.CrossRef
4.
Beiske AG, Svensson E, Sandanger I, et al. Depression and anxiety amongst multiple sclerosis patients. Eur J Neurol. 2008;15(3):239–45.CrossRef
5.
Rickwood D, Thomas K. Conceptual measurement framework for help-seeking for mental health problems. Psychol Res Behav Manag. 2012;5:173–83.CrossRef
6.
Mojtabai R, Evans-Lacko S, Schomerus G, Thornicroft G. Attitudes toward mental health help seeking as predictors of future help-seeking behavior and use of mental health treatments. Psychiatr Serv. 2016;67(6):650–7.CrossRef
7.
Blundell Jones J, Walsh S, Isaac C. Putting one foot in front of the other: a qualitative study of emotional experiences and help-seeking in women with multiple sclerosis. J Clin Psychol Med Settings. 2014;21(4):356–73.CrossRef
8.
Mojtabai R, Olfson M, Sampson NA, et al. Barriers to mental health treatment: results from the National Comorbidity Survey Replication. Psychol Med. 2011;41(8):1751–61.CrossRef
9.
Corrigan PW, Watson AC, Barr L. The self–stigma of mental illness: implications for self–esteem and self–efficacy. J Soc Clin Psychol. 2006;25(8):875–84.CrossRef
10.
Rao D, Choi SW, Victorson D, Bode R, Peterman A, Heinemann A, Cella D. Measuring stigma across neurological conditions: the development of the stigma scale for chronic illness (SSCI). Qual Life Res. 2009;18(5):585–95.CrossRef
11.
Anagnostouli M, Katsavos S, Artemiadis A, et al. Determinants of stigma in a cohort of hellenic patients suffering from multiple sclerosis: a cross-sectional study. BMC Neurol. 2016;16:101.CrossRef
12.
Cadden MH, Arnett PA, Tyry TM, Cook JE. Judgment hurts: the psychological consequences of experiencing stigma in multiple sclerosis. Soc Sci Med. 2018;208:158–64.CrossRef
13.
Grytten N, Måseide P. ‘When I am together with them I feel more ill.’ The stigma of multiple sclerosis experienced in social relationships. Chronic Illn. 2006;2(3):195–208.
14.
Clement S, Schauman O, Graham T, et al. What is the impact of mental health-related stigma on help-seeking?. A systematic review of quantitative and qualitative studies. Psychol Med. 2015;45(1):11–27.CrossRef
15.
Vogel DL, Wade NG, Hackler AH. Perceived public stigma and the willingness to seek counseling: the mediating roles of self-stigma and attitudes toward counseling. J Couns Psychol. 2007;54(1):40–50.CrossRef
16.
Gilbert P. The relationship of shame, social anxiety and depression: the role of the evaluation of social rank. Clin Psychol Psychother. 2000;7(3):174–89.CrossRef
17.
Chen J, Taylor B, Winzenberg T, et al. Comorbidities are prevalent and detrimental for employment outcomes in people of working age with multiple sclerosis. Mult Scler. 2020;26(12):1550–9.CrossRef
18.
Kim S, Thibodeau R, Jorgensen RS. Shame, guilt, and depressive symptoms: a meta-analytic review. Psychol Bull. 2011;137(1):68–96.CrossRef
19.
Li L, Lee SJ, Jiraphongsa C, et al. Improving the health and mental health of people living with HIV/AIDS: 12-month assessment of a behavioral intervention in Thailand. Am J Public Health. 2010;100(12):2418i2425.
20.
Cândea DM, Szentagotai-Tătar A. Shame-proneness, guilt-proneness and anxiety symptoms: a meta-analysis. J Anxiety Disord. 2018;58:78–106.CrossRef
21.
Rüsch N, Müller M, Ajdacic-Gross V, Rodgers S, Corrigan PW, Rössler W. Shame, perceived knowledge and satisfaction associated with mental health as predictors of attitude patterns towards help-seeking. Epidemiol Psychiatr Sci. 2014;23(2):177–87.CrossRef
22.
Schulze LN, Klinger-König J, Stolzenburg S, et al. Shame, self-identification with having a mental illness, and willingness to seek help in northeast Germany. Psychiatry Res. 2020;285:112819.CrossRef
23.
Deci EL, Ryan RM. Facilitating optimal motivation and psychological well-being across life’s domains. Can Psychol. 2008;49(1):14–23.CrossRef
24.
Deci EL, Ryan RM. Self-determination theory: a macrotheory of human motivation, development, and health. Can Psychol. 2008;49(3):182–5.CrossRef
25.
Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68–78.CrossRef
26.
Bombardier CH, Cunniffe M, Wadhwani R, et al. The efficacy of telephone counseling for health promotion in people with multiple sclerosis: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89(10):1849–56.CrossRef
27.
Dashti A, Yousefi H, Maghsoudi J, Etemadifar M. The effects of motivational interviewing on health promoting behaviors of patients with multiple sclerosis. Iranian J Nursing Midwifery Res. 2016;21:640–5.CrossRef
28.
Holt C, Milgrom J, Gemmill AW. Improving help-seeking for postnatal depression and anxiety: a cluster randomised controlled trial of motivational interviewing. Arch Womens Ment Health. 2017;20(6):791–801.CrossRef
29.
José SM. Psychological aspects of multiple sclerosis. Clin Neurol Neurosurg. 2008;110(9):868–77.CrossRef
30.
Hunter A, Marck CH, Butler E, et al. Improving the detection and treatment of depression in Australians with multiple sclerosis: a qualitative analysis. Mult Scler Relat Disord. 2021;56:103290.CrossRef
31.
Bowen J, Gibbons L, Gianas A, Kraft GH. Self-administered Expanded Disability Status Scale with functional system scores correlates well with a physician-administered test. Mult Scler. 2001;7(3):201–6.CrossRef
32.
Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335–43.CrossRef
33.
Tan-Kristanto S, Kiropoulos LA. Resilience, self-efficacy, coping styles and depressive and anxiety symptoms in those newly diagnosed with multiple sclerosis. Psychol Health Med. 2015;20(6):635–45.CrossRef
34.
Mackenzie CS, Knox VJ, Gekoski WL, Macaulay HL. An adaptation and extension of the attitudes toward seeking professional psychological help scale. J Appl Soc Psychol. 2004;34(11):2410–33.CrossRef
35.
Hyland P, Boduszek D, Dhingra K, et al. A test of the inventory of attitudes towards seeking mental health services. Br J Guid Counc. 2014;43(4):397–412.CrossRef
36.
Cook DR. Measuring shame: the internalized shame scale. Alcohol Treat Q. 1988;4(2):197–215.CrossRef
37.
del Rosario PM, White RM. The internalized shame scale: temporal stability, internal consistency, and principal components analysis. Pers Individ Differ. 2006;41(1):95–103.CrossRef
38.
Rybak CJ, Brown B. Assessment of internalized shame. Alcohol Treat Q. 1996;14(1):71–83.CrossRef
39.
Weinstein N, Przybylski AK, Ryan RM. The index of autonomous functioning: development of a scale of huma autonomy. J Res Pers. 2012;46(4):397–413.CrossRef
40.
Tabachnick BG, Fidell LS. Using multivariate statistics. Harlow; UK: Pearson Education, Inc; 2013.
41.
Hayes A. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York, NY: The Guilford Press; 2018.
42.
Bollen KA, Stine R. Direct and indirect effects: classical and bootstrap estimates of variability. Sociol Methodol. 1990;20:115.CrossRef
43.
Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40(3):879–91.CrossRef
44.
Cheung MWL. Comparison of methods for constructing confidence intervals of standardized indirect effects. Behav Res Methods. 2009;41(2):425–38.CrossRef
45.
Hayes AF, Montoya AK, Rockwood NJ. The analysis of mechanisms and their contingencies: PROCESS versus structural equation modeling. Australas Mark J. 2017;25(1):76–81.CrossRef
46.
Chwastiak L, Ehde DM, Gibbons LE, et al. Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am J Psychiatry. 2002;159(11):1862–8.CrossRef
47.
Janssens AC, van Doorn PA, de Boer JB, et al. Impact of recently diagnosed multiple sclerosis on quality of life, anxiety, depression and distress of patients and partners. Acta Neurol Scand. 2003;108(6):389–95.CrossRef
48.
Pompili M, Forte A, Palermo M, et al. Suicide risk in multiple sclerosis: a systematic review of current literature. J Psychosom Res. 2012;73(6):411–7.CrossRef
49.
Mackenzie CS, Gekoski WL, Knox VJ. Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes. Aging Ment Health. 2006;10(6):574–82.CrossRef
50.
Vogel DL, Wester SR, Larson LM. Avoidance of counseling: psychological factors that inhibit seeking help. J Couns Dev. 2007;85(4):410–22.CrossRef
51.
Jose PE. The merits of using longitudinal mediation. Educ Psychol. 2016;51(3–4):331–41.CrossRef
52.
Thomas PW, Thomas S, Hillier C, Galvin K, Baker R. Psychological interventions for multiple sclerosis. Cochrane Database Syst Rev. 2006;(1):CD004431.
53.
Kiropoulos LA, Kilpatrick T, Holmes A, Threader J. A pilot randomized controlled trial of a tailored cognitive behavioural therapy based intervention for depressive symptoms in those newly diagnosed with multiple sclerosis. BMC Psychiatry. 2016;16(1):435.CrossRef
54.
Sollom AC, Kneebone II. Treatment of depression in people who have multiple sclerosis. Mult Scler J. 2007;13(5):632–5.CrossRef
Metadata
Title
The Mediating Role of Stigma, Internalized Shame, and Autonomous Motivation in the Relationship Between Depression, Anxiety, and Psychological Help-Seeking Attitudes in Multiple Sclerosis
Authors
Tamrin Barta
Litza Kiropoulos
Publication date
24-03-2022
Publisher
Springer US
Published in
International Journal of Behavioral Medicine / Issue 1/2023
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI
https://doi.org/10.1007/s12529-022-10078-6

Other articles of this Issue 1/2023

International Journal of Behavioral Medicine 1/2023 Go to the issue

Brief Report

Implementation of a Novel Medication Regimen Following Cardiac Rehabilitation: an Application of the Health Action Process Approach

Full length manuscript

Moderation of Weight Misperception on the Associations Between Obesity Indices and Estimated Cardiovascular Disease Risk

Full length manuscript

Mapping Patients’ Perceived Facilitators and Barriers to In-Center Hemodialysis Attendance to the Health Belief Model: Insights from a Qualitative Study

Full length manuscript

Psychological Distress Increases 30-Fold Among People with HIV in the First Year on ART in Nigeria—a Call for Integrated Mental Health Services

Full length manuscript

Improving Sleep Among Teachers: an Implementation-Intention Intervention

Full length manuscript

Illness Identity in Inflammatory Bowel Disease