Cohort study, with 157 participants who decided to take part in the study out of 400 randomly selected from a database of 1144 patients, aged 32–90 years, and 30% men and 70% women. Patients with EDSS ≥6.5 were excluded. They were asked to complete self-report questionnaires concerning self-efficacy (MSSS) and LOC (MHLC), depression (HADS), anxiety, general stress and psychological distress (PSS), and disability (GNDS). Moreover, they were asked to provide clinical information specifically relevant to their current disease status. Control group was given by non-anxious MS patients.
Anxiety was the primary health outcome. 89 (56.7 %) subjects were clinically anxious, showing the following: (1) higher level of disability ( value < 0.001); (2) lower level of self-efficacy ( value < 0.001); (3) higher level of depression ( value < 0.001); (4) higher level of stress ( value < 0.001). LOC was not a predictive variable of clinical anxiety.
Cohort study with 140 participants (97 females and 43 males, aged 18–83 years). They were asked to compile a self-reported questionnaire concerning control cognitions and causal attribution (RCDS-II, CAL), LOC (MHRLOC), perceived fatigue (FSS), and coping (WOCQ). Moreover, they were asked about exercise frequency.
LOC had a mixed influence on fatigue threshold and perception. When the causes of fatigue were perceived as external, and stable, uncontrollable, participants reported higher fatigue scores. However, this was not statistically significant and moreover the scales RCDS-II and CAL gave contradictory results. Fatigue threshold instead correlated with psychosocial cognitions and attributions as well as with lifestyle, exercise frequency, and coping.
Cohort study with 115 participants (36 men and 79 women, aged 27–80 years). They were asked about their sociodemographic, medical, and psychological characteristics by completing dedicated questionnaires about disabilities (EDSS), depression (Zung rating score), anxiety (STAI), coping (CHIP), social support (SSQ6), LOC, alexithymia (TAS-20), and self-esteem (SEI).
25.9% of the participants reported high depression scores, while 36.3% of the subjects were anxious. Functional status (EDSS), trait anxiety, alexithymia, and satisfaction with social support system were predictive factors of depression. LOC was not a direct predictive factor.
Cohort study with 457 participants. They were asked to answer to the locus of control inventory (Croatian version of Rotter's scale) and CCEI questionnaire of personality. The sample was subdivided into 3 groups, according to time since the diagnosis. No clear information about age and gender is given in the article.
405 (88.6%) MS patients exhibited external LOC. As the disease progressed, LOC shifted from internality to externality. Depression and anxiety sub-scales increased too, in a statistically significant way. Statistical analysis confirmed the hypothesized relationship between external LOC and anxiety, depression and maladaptive behavior.
2-year longitudinal trial with 132 MS patients, randomly selected from an initial list of 172 subjects, with a mean age of 43 years ± 9, 73% women, and 27% men, comparing a coping skills teaching group () with a peer telephone support group (). MS patients with EDSS ranging from 1 to 8.5 were included. Psychotic patients or those with cognitive impairment were excluded. Subjects were asked to fill in different questionnaires about perceived fatigue (SIP, MAFS), self-reported health status, LOC (MHLC), coping strategies (WCC), self-efficacy (MSSE), and quality of life and wellbeing (AIMS). They were also assessed with neuropsychological tests (the Rao cognitive battery, the Wisconsin Card Sorting Task, and the Trail Making Test).
The peer support intervention increased the externality of LOC and the use of blameful coping strategies but did not influence psychosocial role performance or wellbeing. Instead, the coping skills teaching group increased the internality of LOC and the use of reframing coping strategies, as well as social activity, satisfaction with family, and global satisfaction scores.
Matched case-control study with 25 subjects aged 29–58 years, 36% men and 64% women. LOC beliefs were investigated in terms of their relationship with anxiety and depression, using the RLOC, the BDI, the STAI, the pain self-perception scale (WHYMPI), and the Barthel ADL. The matched comparison group was given by spinal cord injury patients (SCI). Barthel ADL was used to create subgroups.
SCI patients were more internally oriented than MS subjects. However, internality of LOC was not linked to lower levels of depression or anxiety.
Randomized study, with 100 participants (aged 21–78 years) randomly selected from the membership list of a state MS support group. No information is available about the gender distribution. The participants were asked to compile self-report questionnaire about disabilities (the Kurtzke DSS) and LOC (HLOC). A further questionnaire was developed by the author, concerning the level of knowledge and self-care practices. The sample was subdivided in two categories: referred as “internal” (exhibiting internality of LOC) and “external” (exhibiting externality of LOC) patients.
Subjects with an internal LOC were more aware and informed about their disease, performed more self-care, and had a more benign course of MS. Time since the diagnosis was not statistically significant.
Cross-sectional study with 60 22–72-year-old patients, 18 men and 42 women. They were asked about their body image (the Holtzman inkblots) and representation, depression (PERI), and locus of control (using the Rotter's Internal-External LOC Scale). Moreover, sociodemographic parameters (sex and age) and clinically relevant information (duration of disease and degree of disability) were investigated.
Internal LOC was negatively correlated with depression and positively with body image and perception, but was uncorrelated with disease duration or disability.
Longitudinal study with 103 participants (mean age 52 years, 68% women). They were asked about sociodemographic, disease-related, medical parameters (physical mobility, degree of impairment), and social-psychological variables (self-concept instrument). The authors elaborated ad hoc indexes (like EMSR, LOCONTR, MOBDIF, SCALDIF, SCALT, and SYMPINDX). Control group is given by a sample of healthy subjects, with similar age, gender distribution.
Females were more likely to show positive adjustment. Subjects with an internal LOC had more positive adjustment scores.
A = 0 B = 2 C = 1 D = 1 E = 2 F = 2 G = 2
ADL: activities of daily living; AIMS: Arthritis Impact Measurement Scale; BDI: Beck Depression Inventory; CAL: Causal Attribution List; CCEI: Crown-Crisp Experiential Index; CHIP: coping about health injuries and problems; DSS: Disabilities Status Scale; EDSS: Expanded Disability Status Scale; EMSR, effect of MS on social relationships; FSS: Fatigue Severity Scale; GHQ-12: General Health Questionnaire; GNDS: Guys Neurological Disability Scale; HADS: Hospital Anxiety and Depression Scale; HLOC: health locus of control; LOCONTR: locus of control; MAFS: Multidimensional Assessment of Fatigue Scale; MHLC: multidimensional health locus of control; MHRLOC: multidimensional health-related locus of control; MOBDIF: change in mobility; MSSE: multiple sclerosis self-efficacy; MSSS: Multiple Sclerosis Self-efficacy Scale; PERI: psychiatry epidemiology research interview; PSS: Perceived Stress Scale; RCDS-II: Revised Causal Dimension Scale; RHS: Ryff Happiness Scale; RLOC: recovery of locus of control; SCALDIF: self-concept over time; SCALT: self-concept; SYMPINDX: Symptom Index; SEI: Self-Esteem Inventory; SIP: Sickness Impact Profile; SSQ6: Social Support Questionnaire; STAI: Spielberger Trait Anxiety Inventory; TAS-20: Toronto Alexithymia Scale; WCCC: Way of Coping Checklist; WHYMPI: West Haven-Yale Multidimensional Pain Inventory; WOCQ: Ways of Coping Questionnaire.
