Patients' etiological beliefs about causation of multiple sclerosis
 KOSMA K.1, KARARIZOU E.2, LIATSOS K.3, PAPADOPOULOS G.1, SIANNI A.1
1Dromokaitio Psychiatric Hospital of Athens, Greece
2Department of Neurology, Aeginition Hospital, University of Athens
3Mitera Maternity Hospital of Athens, Greece

Health beliefs are known to predict health-related behaviors therefore understanding patients' health beliefs is an important prerequisite to effective health communication. The results of numerous relevant studies have shown that patients often hold beliefs that are greatly at variance with medical knowledge and it has been reported that they often blame psychological factors or special events for triggering their disease.

Similar studies in multiple sclerosis (MS) research have showed that a considerable amount of patients, believe that stress can worsen their symptoms and a growing literature tried to address this question. It has also been reported that stressful life events such as family conflicts and stress in the work place are associated with exacerbation and subsequent development of brain lesions,however up to now it has not been provided a consensus opinion of the relationship between stress and relapses in relapsing -remitting multiple sclerosis and there is almost no literature on stress in primary progressive multiple sclerosis.

If patients beliefs about the etiology of their disease are in divergence with medical opinion this could compromise help seeking behavior, therapeutic relationship and at last compliance with treatment.

The foregoing points motivated us to conduct a study with the aim to identify the causes to which patients with MS attribute their illness and furthermore to associate socio-demographic and clinical variables with the causal attributions made.

A total of 88 patients (22 male, and 66 female) with clinically definite multiple sclerosis according to McDonald et al criteria for multiple sclerosis participated in the study. Patients were prompted to answer a short questionnaire, concerning the cause of their illness and their awareness of psychological or other factors that might have triggered their disease. Additional data on each patient included duration of the disease and educational level.

The results showed that 25,0% of MS patients gave a non medical congruent explanation when they were asked about the cause of their illness and 79,5% answered that psychological factors may have triggered their disease. Educational level did not seem to influence the way multiple sclerosis patients think about their disease and this was a surprise to us. Additionally, psychological factors were mentioned almost from the same proportion of patients suffering from relapsing remitting or progressive forms of the disease. In contrast the duration of the illness had a bearing on the causal attributions made since patients that had been ill for long, blamed less often psychological reasons. Thus, it would seem possible to hypothesize that causal attributions made are not static ones but may change with the progress of the illness.

A gender difference in the answers given was also evident in the present study. The cause not known was more frequently mentioned when the illness occurred in a male patient. Also chance and destiny were more frequently reported from males. The reason for this gender difference was not apparent to us since males traditionally are thought to be better exposed to information.

What became evident in the present study is that despite the increasing exposure to information available through electronic mass media in our days, a large proportion of MS patients give a non congruent medical explanation when they were asked about the cause of their illness and even a bigger proportion believe that psychological reasons triggered MS.

Current literature identifies that education, support and teaching patients to cope are important for the management of the consequences of MS and should therefore complement medical intervention.In this context, more information about multiple sclerosis patients beliefs of the disease could prove helpful to guide clinicians attempts to educate patients, assist them to address their concerns, clarify misconceptions and make informed choices.

Whether MS patients help seeking behavior and compliance with treatment is affected from beliefs they hold about their illness should be further assessed in future studies. Encephalos 2009, 46(3):132-137.

Key words: Multiple sclerosis, patients beliefs, etiology.