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Longitudinal predictors of psychological distress and self-esteem in people with ALS

From the MRC Center for Neurodegeneration Research, King’s College London, Department of Psychology, Institute of Psychiatry (L.H.G., L.A., R.G.B.); MRC Center for Neurodegeneration Research, King’s College London, Department of Clinical Neurosciences, Institute of Psychiatry (P.N.L.); and King’s College London, Department of Biostatistics and Computing, Institute of Psychiatry (S.L.), London, UK.

Address correspondence and reprint requests to Dr. L. H. Goldstein, Department of Psychology, PO77, Henry Wellcome Building, De Crespigny Park, London SE5 8AF, UK; e-mail: l.goldstein{at}iop.kcl.ac.uk

Objective: To identify predictors of psychological distress (measured by anxiety and depression) and low self-esteem and to determine whether these change over time in people with ALS.

Method: We interviewed 50 patients with ALS living with a spouse/partner; further interviews were held at median intervals of 6 and then 5 months. Although carers were interviewed, we report the patients’ data. Patients completed measures about their social support and marital relationship; the functional impact of ALS; everyday cognitive, emotional, and behavioral changes; symptoms of anxiety and depression; and self-esteem. The ALS Severity Scale was also completed.

Results: From the initial sample of 50, 26 patients were interviewed on all three occasions. At the first interview, negative social support and bulbar impairment were most predictive of psychological distress; pre-illness marital intimacy was the best predictor of patients’ self-esteem. Over time, negative social support and pre-illness marital intimacy retained an ability to predict patients’ affective state and self-esteem.

Conclusions: Social factors are important in determining longer-term psychological well-being in people with ALS who are in the relatively early stages of the disease.

This study was supported by the Motor Neurone Disease Association, UK. The King’s MND Care and Research Center is supported by the Motor Neurone Disease Association, UK.

Disclosure: The authors report no conflicts of interest.

Received February 21, 2006. Accepted in final form June 28, 2006.