COVID-19 pandemic and mental distress in Multiple Sclerosis: implications for clinical management

BACKGROUND: in multiple sclerosis (MS), disease-related factors and dysfunctional coping might favour the development of mental distress induced by COVID-19 containment measures.METHODS: we explored the relationship between mental distress, disability and coping strategies in the Italian MS population under lockdown. Structural equation modeling (SEM) was applied to information collected via web-survey to identify modifiable factors that could account for mental distress.RESULTS: 845 subjects (497 MS and 348 controls) were included in the study. MS patients showed higher scores than controls for depression (p=0.005), but not for anxiety, emotional dyscontrol or sleep disturbances. The SEM explained 74% of the variance observed in depression score. Within the model, three latent factors were characterized from measured variables: motor disability and cognitive dysfunction contributed to disability (beta=0.509 and beta=0.836, p<0.001); positive attitude and exercise contributed to active attitude (beta=0.386 and beta=0.297, p<0.001); avoidance, social support and watching TV contributed to passive attitude (beta=0.301, beta=0.243 and beta=0.212, p<0.001). As per the relationship between latent factors and their influence on depression, disability contributed to passive attitude (beta=0.855, p<0.001) while both passive and active attitude significantly influenced depression (beta=0.729 and beta=-0.456, p<0.001).CONCLUSION: as practical implication of our model, favoring exercise would enhance active attitude and its positive impact on mental well-being while, at the same time, reducing the negative impact of disability on depression, representing a valuable tool to face COVID-19 related mental distress.