Fear of relapse and subjective well-being in patients with multiple sclerosis: a cross-sectional study

Abstract Multiple Sclerosis (MS) imposes a significant psychological burden that adversely affects patients’ subjective well-being (SWB). A primary psychological stressor in this population is the Fear of Relapse (FoR), a persistent concern that diminishes quality of life. While the association between FoR and general health outcomes is known, its direct, quantitative relationship with SWB as a distinct psychological construct remains underexplored. This study aimed to determine the nature and strength of the relationship between FoR and SWB in a sample of Iranian patients with MS. This cross-sectional study included 262 patients with a confirmed diagnosis of Relapsing-Remitting Multiple Sclerosis (RRMS), recruited via purposive sampling from a specialized neurology clinic in Tehran, Iran. Data were collected using self-administered questionnaires, including the Fear of Relapse (FoR) Scale and the Subjective Well-Being Questionnaire (SWBQ), alongside a demographic and clinical information sheet. The association between variables was assessed using Pearson’s correlation, and predictors of FoR were identified through hierarchical multiple linear regression analysis. A strong and statistically significant negative correlation was found between the total FoR score and general SWB ( r = -0.753, p < 0.001). In the hierarchical regression analysis, SWB showed the strongest independent association with FoR, accounting for an additional 48.0% of the explained variance (ΔR² = 0.480, p < 0.001). In the final adjusted model, SWB remained the only variable independently associated with FoR (β = -0.732, p < 0.001), whereas the associations of other variables, including age, were no longer statistically significant. Fear of relapse was strongly and inversely associated with subjective well-being in patients with multiple sclerosis. Among the variables included in the adjusted regression model, subjective well-being showed the strongest independent association with fear of relapse. Although the cross-sectional design precludes causal inference, these findings highlight fear of relapse and subjective well-being as clinically relevant psychological constructs that may warrant routine assessment in patients with MS. Future longitudinal and interventional studies are needed to determine whether interventions targeting fear of relapse improve psychological outcomes.