As a prevalent progressive autoimmune disease, multiple sclerosis (MS) affects the central nervous system, including the brain and spinal cord (1). This chronic, incurable and debilitating disease is mostly reported in high-income countries and mainly involves women, especially at the ages of 20–40 years (2, 3). Both known and unknown factors contribute to this disease as the main cause of neurological defects (1). The pathophysiology of MS is characterized by myelin loss and axonal damage (4). Depending on the site and extend of the damage, the patients experience symptoms such as physical weakness (3), muscle weakness and spasm, imbalance, vertigo, visual impairment, speech disorders (5, 6), bladder and intestines disorders, sexual dysfunction, cognitive and emotional deficits (7), pain and fatigue (5, 8). Despite the role of genetic and environmental risk factors in MS, its specific causes are yet to be identified and its prevention is still a matter of debate (9).
With a globally-uneven distribution, MS is mostly observed in North America and Europe with frequencies of 140 and 108 in every 100,000, respectively. The lowest frequencies are also related to East Asia and the Sahara (2.2 and 2.1 per 100,000, respectively). According to the MS International Federation, the mean prevalence of the disease increased from 30/100,000 in 2008 to 33/100,000 in 2013 (10), affecting over 2.5 million people worldwide (5). Research by the WHO also suggests a global prevalence of 30 per 100,000 (11). The prevalence of MS in temperate areas of North America, southern Australia and southern New Zealand is 0.1–0.2%, which is approximately 10–20 times lower than that in tropical regions such as Asia, tropical Africa and the Middle East (12). The overall annual incidence of MS is 3.6 and 2 in every 100,000 females and males, respectively (13).
The population of Iranian patients with MS has markedly grown from 50,000 in 2014 to 70,000 in 2016. With a 20 times higher incidence of MS (15–30 per 10,000), Iran ranks first in the Middle East (14). Experts warn of 5000 new cases annually diagnosed with MS in Iran (15). With a prevalence of 35.9 per 100,000, Isfahan ranks among seven provinces with the highest prevalence of MS in this country (16). According to numerical statistics, the prevalence of MS is 2–3 times higher in women than in men (2, 17). About 70–88% of the patients can stay alive 25 years after the onset of their clinical symptoms, and the mean life expectancy from the onset of symptoms to death is 24–45 years. MS is the main or major cause of death in 50–70% of cases. Severe defects caused by progressive disability coupled with increased risk of infection raise the risk of death (10).
MS can profoundly affect different areas of life such as employment, housekeeping, social activities, family relationships and married life (18). The psychological consequences of MS include restlessness, weakness, fatigue, anxiety, depression, low self-esteem, sleep disorders and concentration problems. All these symptoms influence normal functioning, decrease quality of life (2), cause a feeling of incompetence and lower self-confidence in the patients. Emergence of this disease, especially at young ages, impairs the patients’ confidence in their health and body. The patients may also perceive the unpredictable and unpleasant nature of the course of MS as an obstacle to their future plans (15). In addition to impaired quality of life, high levels of psychosocial problems such as psychological distress and communication problems have been reported in patients with MS (18).
Physical, emotional and cognitive functions widely vary among the patients during their disease course (19). The patients should adopt coping strategies against a wide range of disabilities and adjust their lifestyle accordingly (20). In other words, coping strategies are required for tackling new challenges that emerge with the disease progression (21).
One may resort to behavioral and cognitive strategies defined as coping to adapt themselves to difficult situations and problems in life such as crises and diseases (22). In the 1960s, Lazarus introduced and defined the concept of coping as “cognitive and behavioral efforts made to dominate, tolerate or decrease demands and their conflicts” (23).
Coping with MS has been defined as either a process or coping strategies in their abstract form (22). Coping has been also used to emphasize successful reactions to a situation or crisis (24). According to Bishop et al. (2012), coping with MS is a multidimensional concept that reflects the patient’s response to psychosocial and functional changes (24).
Coping with chronic diseases such as MS has rarely been addressed in literature despite its importance. Selecting appropriate tools to identify behavioral processes and thereby modify the lifestyle of patients plays a key role in health psychology (25). Non-specificity and major methodological limitations constitute the drawbacks of the so far used instruments. Coping in MS patients has been poorly and ambiguously defined (26) and rarely been investigated in Iran. Identifying methods for coping with the consequences of MS and numerous socio-individual problems facing the patients can help with their treatment. The present research was therefore conducted to translate and validate a Persian version of the CHIP scale in MS patients.