A mixed-methods cross-sectional study on the associations between internalized stigma, physical activity, and quality of life in people with multiple sclerosis

Multiple sclerosis is associated with psychological distress and stigma, which are related to psychological well-being and engagement in health-promoting behaviors. The aim of this study was to examine the association between stigma, psychological well-being, and physical activity, while also exploring relationships with perceived health status and sociodemographic/clinical variables in people with multiple sclerosis. One hundred and twenty-seven participants with multiple sclerosis completed an online survey assessing depression, anxiety and stress (DASS-21), stigma (SSCI-8), happiness (OHQ-8), perceived health status (SF-12) and physical activity (IPAQ-Single Item). Regression models were used to determine the predictors for the psychological outcomes and the level of physical activity. In addition, an open-ended question, analyzed using qualitative content analysis, was used to explore participants' perceived needs to improve their quality of life. Internalized stigma significantly predicted higher levels of depression (OR = 1.57, 95% CI [1.27-1.94], p < 0.001), anxiety (OR = 1.24, 95% CI [1.03-1.49], p = 0.021), stress (OR = 1.47, 95% CI [1.15-1.87], p = 0.002), and a lower level of happiness (OR = 0.36, 95% CI [0.24-0.56], p < 0.001). Internalized stigma was also associated with lower weekly physical activity (OR = 0.50 [CI_95% = 0.31-0.83], p = 0.007). In addition, the qualitative analysis revealed a strong demand for expert-guided physical activity, psychological support, and person-centered care. Internalized stigma was associated with both the psychological well-being and health behaviors of people with multiple sclerosis. An integrated care approach may support not only psychological well-being but also physical activity, contributing to a higher quality of life.