Avoidant Coping Predicts Quality of Life for Persons with Multiple Sclerosis with High Cognitive Reserve

Background: Multiple Sclerosis (MS) impacts various aspects of health and wellness, and those diagnosed are at greater risk for poorer quality of life (QoL) outcomes when compared to the general public (McCabe & McKern, 2002). In addition to factors such as disease progression and depression, QoL has been associated with cognitive reserve and coping strategy (Arnett et al., 2002; Goretti et al., 2009; Lara et al., 2017; McCabe, 2006; Mikula et al., 2014).

Objectives: The goal of the present study was to determine the impact of the interaction between cognitive reserve and coping strategy on QoL outcomes in persons with MS (PwMS) across multiple domains.

Methods: We examined the effect of the interactions between coping style and cognitive reserve on QoL and disease burden in 97 PwMS (80 females, 17 males). Coping strategy, either active or avoidant, was measured using the COPE inventory (Carver et al., 1989). We defined cognitive reserve as a composite measure that included years of education and scores on the Shipley-2 Vocabulary subtest. QoL and disease burden were assessed using the Functional Assessment of MS (FAMS) scale and the Expanded Disability Status Scale (EDSS), respectively. We examined both the FAMS individual subtests and the overall QoL score.

Results: For those with higher cognitive reserve, greater avoidant coping was associated with lower QoL for the thinking and fatigue subscale (p < .001) and poorer overall QoL (p = .03), and greater active coping was associated with poorer QoL for mobility (p = .001). However, these associations did not hold for those with lower cognitive reserve. Further, there were no associations between coping strategy and cognitive reserve with disease burden.

Conclusions: This study extends previous findings; the results of this research show that avoidant coping, rather than active coping, is associated with poorer thinking and fatigue and overall QoL only for PwMS with greater cognitive reserve. Similarly, greater active coping showed an association with poorer mobility scores, which may indicate that PwMS with greater cognitive reserve and greater subjective motor distress are more likely to employ active coping strategies. Counseling PwMS on the impact of coping strategies on quality of life outcomes, especially for those with greater reserve characteristics such as more years of education, may improve quality of life outcomes in this population.