The influence of psychosocial factors on the disablement process in women with multiple sclerosis and women with fibromyalgia syndrome
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The purpose of this secondary analysis was to test a multivariate model of disability separately in women with two different conditions, multiple sclerosis (MS) and fibromyalgia syndrome (FMS), and to compare respective models across groups. Guided by the Disablement Process Model, this study examined the influences of functional limitations, depressive symptoms, economic adequacy, and social support on disability by use of two-group structural equation modeling (SEM). Nonprobability samples of women with MS (N = 118) and women with FMS (N = 197) were recruited for separate health promotion intervention studies. Baseline data collection occurred between 1997 and 1998 for women with MS enrolled in the Wellness Intervention and between 2004 and 2006 for women with FMS enrolled in the Lifestyle Counts Intervention. Participants in both samples were largely married, well-educated, middle-age, and Caucasian. Descriptive statistics, bivariate correlations, and SEM were conducted with the Statistical Package for the Social Sciences 15.0 and Amos 7.0 software programs. Mean scores of the major study variables indicated poorer physical and mental health for the sample of women with FMS compared to that with MS. Controlling for age, duration of illness, and education, greater functional limitations predicted greater SFdisability and Role Physical (RP)-disability in both groups. The influence of Functional Limitations on both SF-disability and RP-disability was greater for women with FMS than MS. The effect of Depressive Symptoms on SF-disability was equivalent across groups. Feeling depressed significantly impacted RP-disability, although these effects were not equal across groups. Depressive Symptoms played a larger role than did Functional Limitations in explaining SF- and RP-disability in women with MS. Social Support affected Depressive Symptoms equally for both groups. For women with MS, compared to women with FMS, Economic Adequacy had greater detrimental effects on Depressive Symptoms and both measures of disability. Social Support and Depressive Symptoms mediated the effect of Functional Limitations on disability. Adjustment to life with a chronic illness depends on, at the very least, individual physical, social, and psychological capacities. Practitioners should be sensitive to depressive symptoms and availability of social support in women with MS or FMS.