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Table 4: Bonferroni pairwise comparison between the means of dependent variables
Role Bodily General Vitality Social Role General
limitations pain health functioning limitations mental
of physical perceptions of emotional health
health problems
problems
Physical functioning D = 12.52 D = 30.00 D = 15.60 D = 8.56 D = -1.92 D = .61 D = 13.82
S = 3.560 S = 3.05 S = 4.41 S = 2.98 S = 3.71 S= 3.05 S = 2.74
P = .018 P = .000 P = .017 P = NS* P = NS P = NS P = .000
Role limitations of D = 17.47 D = 3.08 D = -3.96 D = -14.45 D = -11.91 D = 1.30
physical health problems S = 4.03 S = 4.53 S = 4.09 S = 4.06 S = 3.81 S = 3.79
P = .001 P = NS P = NS P = .016 P = NS P = NS
Bodily pain D = -14.39 D =-21.43 D = -31.92 D = -29.38 D = -16.17
S = 3.91 S = 2.00 S = 3.03 S = 2.32 S = 1.66
P = .011 P = .000 P = .000 P = .000 P = .000
General health D = -7.04 D = -17.53 D = -14.99 D = -1.78
perceptions S = 4.015 S = 4.02 S = 3.87 S = 3.71
P = NS P = .001 P = .005 P = NS
Vitality D=-10.490 D = -7.953 D = 5.260
S = 3.659 S = 2.691 S = 2.037
P = NS P = NS P = NS
Social functioning D = 2.53 D = 15.75
S = 3.42 S = 3.08
P = NS P = .000
Role limitations of D= 13.212
emotional problems S = 2.092
P = .000
*Not significant
several significant differences between the means. Our study also shows that the scores of the mental
components of the HRQoL were significantly lower
For example, physical and social functions were not than those of the physical components among the
statistically different; however, physical function study participants. Of note, it is commonly believed
was statistically different from the general health that MS is a progressive and physically disabling
perceptions and general mental health. The paired t-test sickness, and patients with MS are more likely to
indicated that there was a significant difference between display mental and psychological problems. Patients
the average of the physical component and that of the with MS may feel low self-efficacy because they
mental component (t = 5.72, df = 99, P < .001). feel that there are many limitations affecting their
activities, and they are restricted from participating
DISCUSSION in social events. Low self-efficacy in a chain of events

that can impact work, social life, family relationships,
In this study, our findings suggest that the total HRQoL mood and QoL. [18] Common neuropsychiatric
scores in patients with MS were significantly lower disorders experienced by patients with MS are
than those of the normal general population in Iran. anxiety, depression, cognitive decline, irritability and
[11]
Similar findings have been previously reported in anger. Some studies have reported that the rate of
[19]
other countries, [12,13] which also demonstrated lower depression, anxiety and suicide in the patients with
HRQoL scores in patients with MS when compared MS is higher than that of the general population with
with those of healthy persons. Furthermore, HRQoL other medical conditions. The neuropsychiatric
[20]
scores among patients with MS were even lower than symptoms of MS occur early during the course of
those among patients with other chronic diseases the disease. For example, researchers observe the
such as rheumatoid arthritis and inflammatory bowel presence of cognitive function impairment in 60%
disease. [14] Reports from other countries have shown the of patients with a disease duration of less than 2
same results, for example, patients with MS have more years. Additionally, research suggests that as early
[21]
frequently reported chronic pain than members of a as one year following diagnosis with MS, about half of
healthy control group. [15] Alternatively, these reports patients exhibit depression, anxiety and distress. [22] In
have documented a higher percent of unemployment a recent critical review conducted by Ciro et al. the
[23]
and retirement among patients with MS. [16] The authors authors found several case reports of bipolar disorder
of a review article in Croatia described patients with clearly preceding MS onset. Some studies examining
MS as having a lower quality of life than that of either the HRQoL in the patients with MS have shown that
a non-patient population or an otherwise unhealthy the clinicians are more concerned with the physical
population. The above mentioned findings can be problems of the disease whereas the patients mainly
[17]
explained by the chronic and long-standing course of believed that their vitality, role limitations, emotional
MS as well as the unpredictable and disabling nature problems, and mental health are essential indicators
of the disease. of disease burden. [24]

60 Neuroimmunol Neuroinflammation | Volume 3 | March 14, 2016