In this cross-sectional study of 97 patients, we evaluated self-awareness among patients with MS (pwMS) and its association with depression. We demonstrated that self-awareness was linked to depression in patients with MS. Information regarding self-awareness and its association with risk factors in MS patients is insufficient. Our study is inimitable, as it focuses mainly on the different themes of self-awareness in pwMS. To our knowledge, this is the first study to assess major types of self-awareness and their association with depression in patients with MS.
In our study, we evaluated self-awareness using the SCSR questionnaire, which is divided into three main subcategories. Private self-consciousness included 9 themes like “I think about myself a lot.” Public self-consciousness evaluated 7 themes such as “I’m concerned about what other people think of me.” Social anxiety includes dimensions like “Large groups make me nervous.” A study was conducted in an MS hospital in England to investigate how pwMS perceive themselves. Twelve participants participated in the study through interviews. The study observed three themes, (i) ‘my body didn’t belong to me’: changes in the body's relationship, (ii) ‘I miss the way I feel about myself’: self-body changes, and (iii) ‘let’s just try and live with it’: integrating self and MS. It has been concluded that MS affects the self, as evidenced by changes in the self. It was found that changes in the self in pwMS negatively affected the frame of the mind [13]. Kessler Medical Rehabilitation Research and Education Corporation piloted a report analyzing self-awareness and cognitive activity in patients with MS. Neuropsychological tests and the Frontal Systems Behavior Scale (FrSBe) were employed in the study, and responses were recorded from 26 pwMS. Self-awareness of neural and behavioral symptoms is linked to a decline in cognition [14]. Forty-three patients were assessed for recognition deficits and frequency of anosognosia in MS. Visual Analog Test assessing anosognosia (VATA-m) and Mayo-Portland Adaptability Inventory (MPAI) scales were used in this study. This study suggests an impaired self-awareness mechanism in patients with MS [15]. A case-control study was conducted with 94 patients with pwMS and 65 healthy controls (HC) to elucidate metacognitive awareness in MS. Participants performed activities such as a money management survey and completed the purchase using the internet. Intellectual awareness is significantly affected by tasks such as social interaction, money management, and task performance. There were no significant differences in online awareness between the pwMS and HC [16]. In our study, we found that pwMS were low in private self-awareness. Furthermore, we deduced that MS patients were associated with high public self-awareness and showed average social anxiety scores. Numerous studies have found that individuals high in private self-awareness have increased awareness of inner feelings, improved consistency in behavior over time, stronger associations between behavior and self-reporting, and increased efficiency of extraneous mood variables. Those with higher levels of private self-awareness provided more detailed and accurate descriptions of themselves than those with lower levels. Individuals with high public self-awareness have been seen to have high levels of self-reporting conventionalism, an increased need for connection, decreased self-respect, and minimal risk-taking. High public self-conscious subjects are more obedient than low public-conscious subjects in experimental settings. A study conducted by Fenigstein (1979) reported that women with high public self-awareness were more likely to be rejected by peers than were women with low public self-awareness. Prominent levels of public self-consciousness may be essential prerequisites for social anxiety. [17]
Our study supports the finding that self-awareness is associated with the severity of depressive symptoms in pwMS. According to one study, people with MS who have lower social cognitive function tend to have more anxiety, depression, and psychosocial fatigue [18]. Private self-consciousness connects significantly more strongly with the personal than with the social aspects of identity, whereas public self-consciousness is significantly more strongly correlated with social than with the personal components of identity [5]. Physical severity, cognitive decline, and reported illness management have been linked to anxiety and depression in patients with MS, which has been validated by previous research [19]. A cross-sectional population-based study conducted in Sweden implied that the prevalence of depression in pwMS is high, irrespective of demographic factors, including age and disease severity. This fact supports the worsening character of depression and its relationship with worse self-reporting and decreased sense of coherence (SOC) [20]. A personality trait disposition that indicates the magnitude of undesirable events, such as depression, anxiety, self-awareness, and anger, has been referred to as neurotocism [21]. Increased neurotocism is associated with MS in patients with depression. The same study showed that MS patients suffering from depression are extraverted to a lesser extent and less aware than MS patients without depression [22]. One hundred and eighty-nine MS patients with a verified diagnosis were recruited from three French hospitals for a cross-sectional questionnaire survey. Participants answered questions covering the following topics: Hospital Anxiety and Depression Scale (HADS) results for anxiety and depression, as measured by the EPS-25; iii. The positive and Negative Emotionality Scale (EPN-31) measures both positive and negative emotions. The Bermond-Vorst Alexithymia Questionnaire measured alexithymia, whereas the CHIP-Neuro questionnaire measured coping with health problems and injuries. The connections between these areas were investigated using a path analysis. This study demonstrated that both direct and indirect pathways cause anxiety to increase a person's risk of depression [23].
LIMITATIONS:
Our study has a few limitations. One important limitation of our study is that we did not have any data on the cognitive performance of the patients. A noteworthy constraint of this study was its modest sample size. The sample size was established through mathematical calculation aimed at attaining sufficient statistical power. Nonetheless, the eventual count of participants fell short of the initial expectations. Furthermore, this study was not designed for the uneducated population.
FUTURE RECOMMENDATIONS:
Based on the findings of our study, practitioners should consider the diversity of self-awareness and depression in patients with Multiple Sclerosis when creating a treatment plan. Furthermore, the association between self-awareness and depression in our study may pave the way for better assessment and rehabilitation interventions in the MS population. We would like to suggest that neuropsychiatric therapies like cognitive behavioral therapy (CBT) should be focused on and captivated in patients with MS to improve the prognosis, lifestyle, quality of life, and depression management. To sum up, the deployment of different scales and interventions to explore self-awareness and its association with variable determinants in MS is highly endorsed.