title: Impact of anger on the health-related quality of life of multiple sclerosis patients.
abstract: BACKGROUND
  There is evidence of the presence of a disturbed pattern of anger in multiple sclerosis (MS). Emotion changes, including anger, are thought to influence health-related quality of life (HRQoL). However, although deleterious consequences of anger on physical health have been well reported, there are no studies that have analysed the effects of anger on the HRQoL in patients with MS. Our purpose was to assess the extent to which anger impacts on the HRQoL of a cohort of MS patients.
  
  
  METHODS
  One hundred and fifty-seven consecutive MS patients were enrolled in the study. Participants were administered affective trait measures (Beck Depression Inventory, Beck Anxiety Inventory) and anger measures (the Spanish adapted version of the State-Trait Anger Expression Inventory-2). HRQoL was quantified using the Functional Assessment of MS.
  
  
  RESULTS
  Linear regression analyses revealed that even after controlling for socio-demographic and clinical variables, higher levels of anger expression-in (tendency to handle anger by keeping it inside) independently predicted worse overall HRQoL of MS patients (β = -0.15, p = 0.04). We further found that this relationship was moderated by gender, showing that anger expression-in is a more influential predictor of the HRQoL in women with MS.
  
  
  CONCLUSIONS
  The present study provides evidence that anger negatively affects the HRQoL of MS patients. Our results may have implications for those involved in treating emotional complications of MS and especially regarding psychotherapeutic interventions to improve HRQoL of MS patients.
authors.affiliation: Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Labiano-Fontcuberta
authors.affiliation: Department of psycho-oncology, Leicestershire Partnership Trust and University of Leicester, Leicester, UK.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
authors.affiliation: Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Moreno-García
authors.affiliation: Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.
authors.forename: Verónica
authors.initials: V
authors.lastname: Puertas-Martín
authors.affiliation: Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain jbenitol67@gmail.com.
authors.forename: Julián
authors.initials: J
authors.lastname: Benito-León
mesh_terms: D000328:Adult; D000786:Anger; D001007:Anxiety / Q000523:psychology; D015331:Cohort Studies; D003863:Depression / Q000523:psychology; D004644:Emotions; D005221:Fatigue / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012959:Socioeconomic Factors
keywords: Anger; health-related quality of life; multiple sclerosis; neuropsychiatric; non-motor features