Adaptive coping interventions should be a priority for people with multiple sclerosis and cognitive impairment

Background: Lower quality of life (QoL) experienced by people with multiple sclerosis (PwMS) may be influenced by their coping style. Coping has been shown to provide an indirect link between cognition and stress, depression and anxiety in MS. This research extends this to the assessment of coping as a moderator or mediator between executive function and QoL in PwMS.
Methods: Participants were 107 people with relapsing remitting (83) or secondary progressive (24) MS (mean age: 48.8±11.1 years), administered executive function tasks (Symbol Digit Modalities Test, Word List Generation, Reading Span, Trail Making Test [TMT], Elevator Counting with Distraction, Visual Elevator, Modified 6 Elements, Zoo Map, Action Programming), transformed into Z-scores and totalled to provide an executive function index. Self-reported dispositional coping (COPE) and QoL (MS Quality of Life-54) inventories were also administered.
Results: Coping strategies mediated (behavioural disengagement, acceptance, growth and religion) and moderated (denial, active and total coping) the relationship between executive function and QoL in PwMS. Lower executive function indirectly increased mental health and overall QoL through acceptance, growth and religion coping (SD range between .06 and .24 increase for each unit decrease). Whereas mental health QoL decreased with each executive function unit decrease, through the indirect effect of behavioural disengagement coping (SD=.14 ). In participants who endorsed high denial coping, lower executive function was related to lower mental health and overall QoL (ΔR2=.07 and .04 respectively), while this was not the case in participants who endorsed no-to-low use of denial coping. A relationship between lower executive function and lower physical health QoL was shown for participants who endorsed no-to-low active and total coping (ΔR2=.07 and .04 respectively), which was not seen in moderate to-high users of these coping strategies.
Conclusion: These results imply that in PwMS who have reduced executive function, less cognitively demanding adaptive coping strategies: acceptance, growth and religion, are related to increased QoL, while maladaptive strategies: behavioural disengagement and denial, are associated with poorer QoL. Interventions aimed at reducing avoidant coping strategies and increasing less cognitively demanding adaptive coping strategies in PwMS who experience deficits in executive function are required as a priority.