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Advances in Environmental Biology, 8(15) Special 2014, Pages: 336-341 AENSI Journals Advances in Environmental Biology ISSN-1995-0756 EISSN-1998-1066 Journal home page: http://www.aensiweb.com/AEB/ The Effect of Anxiety and Social Support on Adherence in Patient with Multiple Sclerosis 1Sara Akbarzadeh, 2Mona Nemati and 3Banafsheh Ghasemizadeh 1 M.A in Educational Psychology , University of Allame Tabatabaie 2Department of Psychology ,Science and Research Branch, Islamic Azad University, Bushehr,Iran 3M.A in General Psychology , Karaj Branch , Islamic Azad University (IAU) , Karaj , Iran ARTICLE INFO Article history: Received 25 September 2014 Received in revised form 8 October 2014 Accepted 15 December 2014 Available online 25 December 2014 Keywords: multiple sclerosis, support, adherence. anxiety, ABSTRACT The purpose of this study was to examine the relationship between anxiety and social support on adherence Patients with multiple sclerosis in Tehran in 2013. Method of the study was cross-correlation method. The sample consisted of 120 patients with MS Society in Tehran Community support for MS patients Iran who were selected style. For all patients completed questionnaires Phillips anxiety and social support. Data were analyzed using multivariate analysis of variance. The findings showed that the adherence to social support and family Anxiety at a= 0/05 significant difference. social © 2014 AENSI Publisher All rights reserved. To Cite This Article: Sara Akbarzadeh, Mona Nemati and Banafsheh Ghasemizadeh., The Effect of Anxiety and Social Support on Adherence in Patient with Multiple Sclerosis. Adv. Environ. Biol., 8(15), 336-341, 2014 INTRODUCTION Multiple sclerosis is a chronic and debilitating disease that causes great disability in young adults and the middle aged [14]. It is commonly seen in young adults with various pathologic conditions of the central nervous system. From the pathological point of view, multiple sclerosis, with several areas of white matter inflammation, glial scar and central nervous system characterized Demyelization. Clinical course of benign and asymptomatic is rapidly progressive and debilitating variable [27]. In recent years, the prevalence of multiple sclerosis increases in the world. The main cause of this disease is unknown, but some sources say that because of the role of genetics and the immune system is common in the presence of infectious agents, although there is not yet any conclusive evidence to prove the hypothesis [8]. On the other hand, the condition of independence and ability to participate in family threats the community activities and they suffers the lack of the competence and reliability of self-propelled and Make one's body and her health[25]. The adherence in chronic disease is one of the main objectives of the World Health Organization through which we can reduce the morbidity and mortality. The overall patient adherence to prescribed performance was Time spent by the physician and the medical team about the amount and frequency of drug use. Non-adherence can include a wide range of behavior that can be intentional or unintentional. A number of factors that could affect the lack of adherence to treatment include depression, education, mental disorders, cognitive impairment, dementia, anxiety, cost of treatment, side effects and long-term treatment (Consultant Pharmacists Society of America, 2011). Given the importance of adherence to treatment and research that has been done on the causes of nonadherence is clear that Psychosocial factors in adherence to effective treatment. Therefore, in this study we explore the psychological aspects. The variables examined in this study include: social support and anxiety. Research hypothesis: 1. There was a significant difference between social support and adherence and non-adherence to treatment in multiple sclerosis patients. 2. There is a relationship between anxiety, adherence and lack of adherence to treatment in multiple sclerosis patients. Corresponding Author: Mona Nemati, Department of Psychology ,Science and Research Branch, Islamic Azad University, Bushehr, Iran 337 Sara Akbarzadeh et al, 2014 Advances in Environmental Biology, 8(15) Special 2014, Pages: 336-341 Definition of Multiple Sclerosis (MS): MS is a disease of the central nervous system that has created many challenges in the psychological adjustment of patients all over the world. The purpose of this study was to identify the predictors of adherence to treatment in patients with MS society in Tehran in 2013. The above study is a descriptive correlation method. The sample consisted of 120 patients with MS and the MS society in Tehran, Iran, in support of the MS patients who were selected as the style. For all patients, a demographic questionnaire, followed by treatment of MS patients, general self-efficacy, character Neo - short form of depression, quality of life, anxiety, Panas positive and negative effect, social support and feedback of Phillips was completed. Data using multivariate analysis of variance and discriminant analysis and logistic regression analysis were used. The findings showed that the adherence to depression, the neuroticism, the extroversion, the conscientiousness, the appetite, the quality of life, the social support, and anxiety in the family a=0/05 significant difference. The results suggest that adherence to MS the patients correlate with the psychological factors for better management of these patients in addition to drug counseling must also be done to reduce anxiety and depression and increased their efficacy to improve their quality of life. Adherence to treatment: Is the most important factor in improving patient adherence to treatment and to achieve this, the relationship between doctor and patient is important. If the satisfactory communication achieved the desired results, these results can include patient satisfaction, increased health, reminders and follow the best of treatment. Good communication with the patient's doctor can help to understand their disease and to identify treatment goals and points. Factors that can affect adherence below is the socio-economic factors, patient care team (for health); factors related to the patient's condition, treatment-related factors, patient-related factors (Consultant Pharmacists Society of America, 2011). In the case of non-compliance with treatment, about 50-30% of treatment fails. If this happens the patient's condition deteriorates, the hospitalization rate increases, the amount of insurance protection decreases and increases treatment costs. Non-adherence can include a wide range of behavior. This behavior can be intentional or unintentional, which ultimately leads to less or more drugs than it is prescribed. Factors that may contribute to the lack of adherence to treatment include: Low literacy / language problem in communication, homelessness, depression, Mental disorders, drug abuse, cognitive or functional impairment, Forgetfulness, nervousness, mental stress, anxiety, lack of insight into the illness, Lack of belief in the goals of treatment, lack of belief in medicine / damaging of the drug, The use of multiple drugs to treat tired of taking drugs, Non-compliance with drug regimens, side effects or fear of side effects, The cost of doctor visits or medication or both, prevention, care and treatment programs, Follow inappropriate or therapeutic changes, missed visits (Consultant Pharmacists Society of America, 2011). Theories of social support: Since the 1970s, the field of social protection, created numerous field studies. However, most studies have been conducted on the relationship between social support and health conditions. This relationship includes the etiology of disease and mortality, immune system function, various physical and mental illness, recovery from illness, therapeutic and preventive effects. Studies have shown that the most important physical and physiological disorders caused by deficiency or lack of social support include: Headache and Tension (migraine), Digestive disorders, loss of appetite, increased activity of the adrenal cortex, increased cholesterol and blood urea, blood pressure, cardiovascular disease and Increased risk of general mortality. In addition to physical health, many studies have been conducted to examine the relationship between social support Tasyrashkar perceived social support on mental health and mental health and wellbeing Have confirmed. Much of the research efforts, focused on the assumption that lower levels of social support, can increase the risk of depressive symptoms. Henderson conducted a meta-analysis, concluded that Despite Applying different scales for measuring social support and depression, in all studies, the results demonstrate the positive effects of social support Reduce the risk of depression was observed [34]. About the effects of social support on quality of life are two kinds of interest: Main effect model: According to this model, the positive effects of social support or lack of social isolation leads to an improved quality of life and is a linear relationship between quality of life and social support. Fleming and Baum theorists suggest that this view is that people who have more social support, quality of life and health are higher[15]. Involvement in various social networks, including networks of friends and family neighborhood provides the communications support resources that attracting more people to the network and the subsequent health 338 Sara Akbarzadeh et al, 2014 Advances in Environmental Biology, 8(15) Special 2014, Pages: 336-341 protection and Better quality of life (Montazeri, 2008). According to studies by the model, those who are in support networks, less depressed and generally better mental health than those do not have a support network. Model of social support as a moderator of stress: According to this model, the relationship between social support, quality of life depends on the level of stress and there is no direct impact on quality of life, social support however, adjusting for the effects of acute and chronic stress, the health help. MS and social support: Social support in patients fights with MS and their auxiliary role in mental health care with this kind. Social support is a coping mechanism emotional stress on the daily functioning of patients and treatment effect. Also, Miller and Murphy [24] known the family reasons (economic, physical assistance, emotional support) to increase effective network protection. Creating and sourcing support life expectancy in these patients Plays [24]. Social support can enhance the quality of life and detract from their depression [9]. MS patients due to physical disabilities who find more people need emotional support. The patient enough support from friends and family in the early stages of the disease are not receiving Because of fatigue, visual impairment, physical disability and symptom their relationship with others is impaired But the family refused to accept the conditions or cannot understand it. If you need support from the people around them, Not only will reduce patient stress But also increases the remission [12]. However, the support must be correct and based on the patient's desire. Families fear of falling ill due to his quick help to increase over time, the inability of MS patients. Social support should be positive Based on respect and allow the patient to be this would make him feel comfortable and Confident he will be damaged and to remain in his independence [24]. Anxiety in different theories: Biological theories: Analysts are valid theory: Analysts believe that the mental conflicts can be suppressed the anxiety producing. If a person is likely to grow in age the negative feelings and desires, "they" share with others and they parents were fearful and to share their thoughts with others, be scared with anxiety. In fact, the contradiction between what he wants and External reality, causing anxiety in the individual. Also sometimes oedipal conflict continues to cause anxiety disorder knows [3]. School of Cognitive Theory: According to cognitive "negative thoughts and attitudes are of the irrational anxiety". According to this school of thoughts, ideas, instead of coming events and external events are concerned, and this is not only about anxiety, it is true in all cases of negative emotions. For fear of an accident should it be thought and analysis and interpreted. This point is important from the practical point of view, this may change the way of thinking can be varied emotions. Anxiety and Illness MS: A study done by Potagas et al [26] to examine the effects of stress, anxiety and violent events MS relapse rate was recorded live in Athens. Based on the findings, high levels of anxiety and Stressful events reported were strongly related. Points (Hamilton Rating Scale) to measure anxiety over 18, Four times the rate of MS relapses and three or more stressful events, 7.5 times the rate of recurrence was associated [26]. A study by the Biscay and Et al to assess depression and Anxiety in Patients with Multiple Sclerosis 120 patients Took place in Norway. Based on the results, 4/31 patients symptoms 3/19 patients reported symptoms of anxiety. In this study, the Signs and symptoms of anxiety and depression almost twice almost three times In MS patients compared with the general population in Norway More happens [11]. According to the results of some studies suggest Symptoms of stress, anxiety and depression in patients with MS with relapses and Reduced quality of life associated with [17] and in addition to mental health patients can thereby preventing depression, Stress and anxiety in patients and provide improve the quality of life and improve their satisfaction [7]. Literature: A study in 2013 in America is done as "the relationship between the fixed tracks variable for changes in medication adherence in patients with multiple sclerosis ". The findings suggest that the evaluation and followup of patients take their medications proven to significantly reduce the rate of adherence [20]. A study in 2013 in Germany have been done, entitled "Evaluation of treatment programs to increase adherence to treatment Interferon beta-1 at the EAE sclerosis patients” on 700 patients over 2 years. The results show that more men than digital treatment Women in the treatment of depression and paper Sex with the 339 Sara Akbarzadeh et al, 2014 Advances in Environmental Biology, 8(15) Special 2014, Pages: 336-341 selected program type is only meaningful relationship Adherence to treatment does not affect the application of [36]. A study in 2012 in France "The knowledge and understanding of the patient and the treatment of multiple sclerosis" was performed on 202 patients. The findings show that patient awareness of the illness and the treatment, the patient's adherence to treatment is effective and the relationship between the doctor and the patient plays an important role. The study was largely due to forgetfulness and lack of adherence to treatment side effects shots, has been particularly muscle pain. A study in 2013 entitled "The forecast is based on the perceived quality of life in patients with multiple sclerosis disease" was performed on 100 patients. The results show that the perception of illness, physical and mental aspects of quality of life for people with MS to predict [5]. A study in 1391 entitled "The relationship between quality of life and knew Roy capital the perception of the disease Am- S. " 231 on my forum - S. done. The findings show that the variable quality of life by 22% and components optimism Efficacy of psychological capital by 29% significant predictors The perception of patients with MS but hope and resiliency factors were significant predictors [1]. Methodology: According to this procedure, library and study Field methods such as questionnaires were used, it can be stated that this study is based on the nature of data collection, correlation is a descriptive study. The study population included all patients were men and women of Iran in Tehran in support of MS patients is fall 2013. To determine the sample size, the formula which is used according to a= 0/05 and using the rate of p= 0/3 d =0/1 calculated and of which 80 have been obtained. However, to increase the reliability of data collected and reduce sampling error, 120 MS patients were selected as the final sample. The final study sample selection, using stratified random sampling was carried out Samples using a questionnaire and social support Philips Anxiety questionnaires were analyzed. To complete the questionnaire and data collection, every day for 3 months in support of the MS Society MS patients Subjects participated in Tehran accidentally the samples were selected. The statistical analysis was performed by using the software 20SPSS. Results of hypotheses: Hypothesis: There is a significant difference between the social support variables and anxiety in patients with adherence and non-adherence. Table 1: Measures MANOVA on the subject of non-compliance and adherence of variables. Effect size P Df error Df hypothesis F Value 0/03 95 24 1/72 0/30 0/30 0/03 95 24 1/72 0/69 0/30 0/03 95 24 1/72 0/43 0/30 0/03 95 24 1/72 0/43 0/30 Tests Pillay effect Wilks Lambda Contributive effect Root of largest face Variable Group According to the index in the table and F values, there is difference between the groups in terms of at least one dependent variable (adherence). To clarify the difference in the analysis of variance, multivariate analysis of variance was attempted. The results of analysis of variance in the MANOVA also revealed that among the factors influencing adherence to changing social support family (4/48 = F and 0/03 = P exist a significant difference. Therefore, the research hypotheses about this variable are approved. Conclusion: In this study, the demographic factors, depression, personality traits, self-efficacy, patient satisfaction, positive and negative emotion, anxiety, quality of life, social support and feedback of adherence to treatment in patients with MS were studied. Table 2: Indicators of compliance and non-compliance with the analysis of variance in the dependent variables of the study. Size effect P F Mean square Degrees of freedom Sum of squares Dependent variable 0/47 0/51 8/97 1 8/97 Covert anxiety 0/004 0/58 0/30 8/40 1 8/40 Manifest Anxiety 0/003 0/99 0/00 0/01 1 0/01 General anxiety 0/000 0/03 4/48 51/61 1 51/61 Family support 0/037 0/63 0/22 2/59 1 2/59 Supporting Friends 0/002 0/34 0/91 5/63 1 5/63 Support from others 0/008 0/26 1/26 63/1 1 63/1 General support 0/011 0/24 1/37 1/97 1 1/97 Patient satisfaction 0/012 Source 340 Sara Akbarzadeh et al, 2014 Advances in Environmental Biology, 8(15) Special 2014, Pages: 336-341 There was a significant difference between social support and adherence and non-adherence to treatment in multiple sclerosis patients. Before changing measured and evaluated between social support and social support questionnaire Phillips. The results showed that three aspects of social support from family, friends and others who The questionnaire was evaluated Between family social support (0/03 significance level) and adherence to the treatment of MS patients, there were significant differences But there is no significant difference between the two other aspects of Because the disease is often associated with stress response and those with chronic diseases Physical disability resulting from disease (Mohr, Pelletier, 2006) The disease is diagnosed, the disease is unpredictable, concerns about health care costs, including job stress is The cause of MS is caused. As a result, social protection and support particularly important role in the family Reduce stress, and thus these patients follow their treatment. There was a relationship between anxiety and adherence and non-adherence to treatment in multiple sclerosis patients. ANOVA was used to analyze anxiety several aspects were studied and the results showed that 21/33% of patients and 20.3% of trait anxiety and state anxiety Of the total respondents, 3.8% without anxiety, anxiety 2/34% average, 26.7% neurotic anxiety, 30.8% had a need psychotherapist. The degree of adherence was no significant difference in anxiety and But it was not significant at an alpha level of anxiety in these patients demonstrated. These results are consistent with the findings of the study was to determine the prevalence of stress frequency, Anxiety and depression in patients with multiple sclerosis that 4/25 patients with normal levels of anxiety, 4/55 on average, and 19.2% reported severe levels are consistent. Results with findings from basic and colleagues (2008) MS patients, 19.3% reported anxiety symptoms were consistent. 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