Illness identity and its association with self-esteem, hope, social support among patients with multiple sclerosis

Few studies on patients with multiple sclerosis have examined the relationship between self-esteem, social support, hope, and the roles of these variables on illness identity. This study was purposed to examine illness identity and its correlation with self-esteem, hope, and social support among Jordanian patients with multiple sclerosis. A descriptive correlational design was adopted on a convenience sample of 330 participants from outpatient clinics in one of the largest governmental hospitals in Amman, Jordan. A self-reported structured questionnaire included Rosenberg’s Self-Esteem Scale (RSES), the Herth Hope Index, the Multidimensional Scale of Perceived Social Support (MSPSS), and the Illness Identity Questionnaire, in addition to demographic data was used to collect data from April to June 2024. Descriptive statistics (i.e., frequency, percentages, mean0, and standard deviation), and inferential analysis (i.e., Pearson’s correlation and point biserial, and multiple linear regression) were used to analyze data. The findings revealed that 59.4% of the participants had moderate self-esteem, 50.9% to 47.3% had moderate hope, and 48.5% to 47.9% had moderate to high social support. More participants reported higher positive illness identity states (75.92% acceptance and 76.71% enrichment) than negative illness identity states (67.96% rejection and 58.08% engulfment). Marital status was associated with all subscales except engulfment (rejection p.b.r=−0.12, p < 0.05; acceptance p.b.r= −0.20, p < 0.001; enrichment p.b.r= −0.16, p < 0.01). Decreased self-esteem, social support, and hope were associated with increased rejection (r=−0.36, p < 0.001; r=−0.20, p < 0.001; r=−0.25, p < 0.001) and engulfment (r=-−0.57, p < 0.001; r=−0.42, p < 0.001; r=−0.54, p < 0.001). Increased hope was associated with increased acceptance (r = 0.34, p < 0.001) and enrichment (r = 0.25, p < 0.001). Regarding the rejection illness subscale, single participants and those who had the disease for a shorter time scored significantly higher (p.b.r=−0.12, p < 0.05; r= −0.11, p < 0.05) than their counterparts. Single participants and those with higher self-esteem scored significantly higher acceptance (p.b.r=−0.20, p < 0.001; r = 0.15, p < 0.01, respectively). Single participants scored significantly higher enrichment (p.b.r = 0.16, p < 0.01) than the others. Self-esteem was the main predictor for rejection (B= −0.398, p < 0.001, 95%CI: −0.464- −0.213), acceptance (B= −0.150, p < 0.01, 95%CI: 0.054–0.245), and engulfment (B= −0.340, p < 0.001, 95%CI: −0.790- −0.357). Hope was the main predictor for acceptance (B = 0.295, p < 0.001, 95%CI: 0.199–0.356), engulfment (B= −0.223, p < 0.001, 95%CI: 0.126–0.305), and enrichment (B= −0.165, p < 0.01, 95%CI: −2.973- −0.674). Marital status was the main predictor for rejection (B= −0.110, p < 0.05, 95%CI: −1.923- −0.061), acceptance (B= −0.255, p < 0.001, 95%CI: −2.280- −0.884), and enrichment (B = 0.251, p < 0.001, 95%CI:0.126–0.305). The effect size was the largest for the predictors of engulfment subscale including, self-esteem, social support, and hope (effect size = 0.60). The findings can help policymakers and healthcare professionals develop effective strategies and counseling programs concerning psychosocial aspects (self-esteem, hope, and social support) that positively affect the illness identity among patients with multiple sclerosis.