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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
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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
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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
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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. Among other
studies that have used measures of self-reported symptoms of anxiety, The prevalence of anxiety between 25%
to 41% of MS patients have reported Prevalence of anxiety is much higher than in the general population.
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