Document Type : Original Article

Authors

1 Department of Consulting, School of Education and Psychology, Shahid Beheshti University, Tehran, Iran

2 Department of Educational and Developmental Psychology, School of Education and Psychology, Shahid Beheshti University, Tehran, Iran

3 Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Stress has been known as a risk factor for the onset and modification of autoimmune disorders such as myasthenia gravis (MG). However, the patients can control their stress and improve their quality of life (QOL) using some factors such as psychological and social support. Psychological capital and social support play a key role in decreasing stress and improving QOL in the patients with MG. Therefore, the present study aimed to assess the mediator role of the psychological capital and social support in perceived stress and QOL of the patients with MG.
Methods: In the present cross-sectional study, 203 patients with MG, including 138 women and 65 men, were selected from Iran Myasthenia Gravis Association and Shariati Hospital, Tehran City, Iran, using available sampling. The selected patients completed the Myasthenia Gravis Quality of Life questionnaire
(MG-QOL), Luthans Psychological Capital Questionnaire (PCQ), Multidimensional Scale of Perceived Social Support (MSPSS), and Cohen Perceived Stress Scale (PSS-14). 
To assess the mediator role of the psychological capital and the perceived social support in the relationship with the perceived stress and QOL of the patients with MG, structural equation modeling (SEM) was used.
Results: There was a significant negative relationship between the perceived stress and the variables of psychological capital (including hope, resilience, optimism, and self-efficacy), perceived social support dimensions (including support from important people, support from family, and support from friends), and QOL dimensions (including social activity and mental health) (P < 0.01). The results also showed that the perceived social support dimensions (including support from important people, support from family, and support from friends) and the variables of psychological capital (including hope, resilience, optimism, and self-efficacy) had a significant positive relationship with the QOL in patients with MG (P < 0.01). The indirect effect of perceived stress on the QOL through social support and psychological capital was 0.16 and 0.15, respectively, which was statistically significant (P < 0.05).
Conclusion: The present study results show that a part of the shared variance between the conceptual circles of the perceived stress and QOL in patients with MG results from variability in the psychological capital and social support.
 

Keywords

  1. Dhillon S. Eculizumab: A review in generalized myasthenia gravis. Drugs 2018; 78(3): 367-76.
  2. Sieb JP. Myasthenia gravis: an update for the clinician. Clin Exp Immunol 2014; 175(3): 408-18.
  3. Wong SH, Huda S, Vincent A, Plant GT. Ocular myasthenia gravis: Controversies and updates. Curr Neurol Neurosci Rep 2014; 14(1): 421.
  4. Adavi A, Fathi Marghmalaki R, Madmoli Y. The effect of cognitive-behavioral stress management training on perceived stress in women with hypertension. 3 JNE 2017; 6(1): 56-62.
  5. Cohen S, Kamarck T, Mermelstein R. Perceived stress scale. Measuring stress: A guide for health and social scientists. New York, NY: Oxford University Press; 1994.
  6. Ebrahimi L, Moradi F. Corelation of perceived social support and psychological hardness with perceived stress and aggression in retired veterans. Iran J War Public Health 2018; 10(3): 157-64. [In Persian].
  7. Klein DM, Turvey CL, Pies CJ. Relationship of coping styles with quality of life and depressive symptoms in older heart failure patients. J Aging Health 2007; 19(1): 22-38.
  8. Movahedi M, Mohammadkani SH, Hasani J, Moghadasin M. The relationship between the perceived stress and the quality of life among the women with breast cancer. yafte 2018; 20(3): 100-9. [In Persian].
  9. Kulkantrakorn K, Jarungkiatkul W. Quality of life of myasthenia gravis patients. J Med Assoc Thai 2010; 93(10): 1167-71.
  10. Leonardi M, Raggi A, Antozzi C, Confalonieri P, Maggi L, Cornelio F, et al. The relationship between health, disability and quality of life in myasthenia gravis: results from an Italian study. J Neurol 2010; 257(1): 98-102.
  11. Liu FB, Chen XL, Guo L, Liu XB. Evaluation of a scale of patient-reported outcomes for the assessment of myasthenia gravis patients in China. Chin J Integr Med 2012; 18(10): 737-45.
  12. Padua L, Evoli A, Aprile I, Caliandro P, Mazza S, Padua R, et al. Health-related quality of life in patients with myasthenia gravis and the relationship between patient-oriented assessment and conventional measurements. Neurol Sci 2001; 22(5): 363-9.
  13. Raggi A, Leonardi M, Mantegazza R, Casale S, Fioravanti G. Social support and self-efficacy in patients with Myasthenia Gravis: A common pathway towards positive health outcomes. Neurol Sci 2010; 31(2): 231-5.
  14. Winter Y, Schepelmann K, Spottke AE, Claus D, Grothe C, Schroder R, et al. Health-related quality of life in ALS, myasthenia gravis and facioscapulohumeral muscular dystrophy. J Neurol 2010; 257(9): 1473-81.
  15. Howard S, Creaven AM, Hughes BM, O'Leary ED, James JE. Perceived social support predicts lower cardiovascular reactivity to stress in older adults. Biol Psychol 2017; 125: 70-5.
  16. Kotan VO, Kotan Z, Aydin B, Yalvac HD. Psychopathology, psychosocial factors and quality of life in patients with myasthenia gravis. J Neurol Sci 2016; 33: (3)50; 482-93.
  17. Kaminski HJ, Kusner LL. Myasthenia gravis and related disorders. New York, NY: Springer; 2018.
  18. Aghayousefi A, Shaghaghi F, Dehestani M, Barghi Irani Z. The relationship between quality of life (QOL) and psychological capital with illness perception in MS patients. Health Psychology, 2012; 1(1): 29-41. [In Persian].
  19. Luthans F, Youssef CM, Avolio BJ. Psychological capital: Developing the human competitive edge. New York, NY: Oxford University Press; 2007.
  20. Rahnema S, Baghersad Z, Shirazi M, Chitsaz A, Etemedifar M. Association between family caregivers' quality of life and psychological capital of the patients with multiple sclerosis. J Isfahan Med Sch 2016; 34(377): 335-40. [In Persian].
  21. Jeong A, Min JH, Kang YK, Kim J, Choi M, Seok JM, et al. Factors associated with quality of life of people with Myasthenia Gravis. PLoS One 2018; 13(11): e0206754.
  22. Studart P, Galvao-de AA, Bezerra-Filho S, Caribe A, Reis AN, Daltro C, et al. Is history of suicidal behavior related to social support and quality of life in outpatients with bipolar I disorder? Psychiatry Res 2016; 246: 796-802.
  23. Unalan D, Gocer S, Basturk M, Baydur H, Ozturk A. Coincidence of low social support and high depressive score on quality of life in elderly. Eur Geriatr Med 2015; 6(4): 319-24.
  24. Muppidi S, Wolfe GI, Conaway M, Burns TM. MG-ADL: Still a relevant outcome measure. Muscle Nerve 2011; 44(5): 727-31.
  25. Burns TM, Conaway MR, Cutter GR, Sanders DB. Less is more, or almost as much: A 15-item quality-of-life instrument for myasthenia gravis. Muscle Nerve 2008; 38(2): 957-63.
  26. Ostovan VR, Fatehi F, Davoudi F, Nafissi S. Validation of the 15-item myasthenia gravis quality of life questionnaire (MG-QOL15) Persian version. Muscle Nerve 2016; 54(1): 65-70.
  27. Luthans F, Avolio BJ, Avey JB. Psychological Capital (PsyCap) Questionnaire (PCQ). California, CA: Mind Garden; 2007.
  28. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess 1988; 52(1): 30-41.
  29. Bruwer B, Emsley R, Kidd M, Lochner C, Seedat S. Psychometric properties of the Multidimensional Scale of Perceived Social Support in youth. Compr Psychiatry 2008; 49(2): 195-201.
  30. Chou KL. Assessing Chinese adolescentsÇÖ social support: the multidimensional scale of perceived social support. Personality and Individual Differences 2000; 28(2): 299-307.
  31. Baron RA, Franklin RJ, Hmieleski KM. Why entrepreneurs often experience low, not high, levels of stress: The joint effects of selection and psychological capital. J Manag 2016; 42(3): 742-68.
  32. Mensah J, Amponsah T. Mitigating occupational stress: The role of psychological capital. J Workplace Behav Health 2016; 31(4): 189-203.
  33. Linley P, Nielsen K, Wood A, Gillett R, Biswas-Diener R. Using signature strengths in pursuit of goals: Effects on goal progress, need satisfaction, and well-being, and implications for coaching psychologists. International Coaching Psychology Review 2010; 5(1): 8-17.
  34. Bandura A. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall; 1986. p. 23-8.
  35. Snyder CR, Rand KL, Sigmon DR. Hope theory. Handbook of positive psychology. New York, NY: Oxford University Press; 2002; 257: 276.
  36. Snyder CR. Hypothesis: There is hope. Handbook of hope: Theory, measures, and applications. San Diego, CA: Academic Press; 2000. p. 3-21.
  37. Seligman MEP, Rashid T, Parks AC. Positive psychotherapy. Am Psychol 2006; 61(8): 774-88.
  38. Luthans F, Avolio BJ, Avey JB, Norman SM. Positive psychological capital: Measurement and relationship with performance and satisfaction. Personnel Psychology 2007; 60(3): 541-72.
  39. Margolis JD, Stoltz PG. How to bounce back from adversity. Harv Bus Rev 2010; 88(1-2): 86-92.
  40. Fawzy FI, Fawzy NW, Hyun CS, Elashoff R, Guthrie D, Fahey JL, et al. Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Arch Gen Psychiatry 1993; 50(9): 681-9.
  41. Spiegel D, Butler LD, Giese-Davis J, Koopman C, Miller E, DiMiceli S, et al. Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer: A randomized prospective trial. Cancer 2007; 110(5): 1130-8.
  42. Zakowski SG, Ramati A, Morton C, Johnson P, Flanigan R. Written emotional disclosure buffers the effects of social constraints on distress among cancer patients. Health Psychol 2004; 23(6): 555-63.
  43. Cordova MJ, Cunningham LL, Carlson CR, Andrykowski MA. Posttraumatic growth following breast cancer: A controlled comparison study. Health Psychol 2001; 20(3): 176-85.