A resource-based approach to symptom burden, marital adjustment, and health-related quality of life among patients with multiple sclerosis: a cross-sectional study

This cross-sectional study aimed to investigate the relationships between multiple sclerosis (MS)-related symptom burden, marital adjustment, and health-related quality of life (HRQoL) in married individuals with MS, from the patient’s perspective. MS is a chronic autoimmune disease that impairs not only physical functioning but also psychological well-being and interpersonal relationships. Framed within Conservation of Resources (COR) theory and Affective Events Theory (AET), chronic symptom burden may be viewed as a continuous stressor that is related to both marital adjustment and HRQoL; however, the associations between cumulative symptom burden and marital dynamics remain insufficiently addressed within holistic nursing frameworks. A descriptive, cross-sectional design was employed. A convenience sample of 190 married patients with MS was recruited from a tertiary neurology clinic. Symptom burden (MS-RS), marital adjustment (RDAS), and HRQoL (EQ-5D-3 L) were assessed using validated scales; data were analyzed using correlation analyses and simple and two-predictor linear regression models with 95% confidence intervals (CIs). A higher MS-related symptom burden was associated with lower marital adjustment (β = -0.30, 95% CI -0.43 to -0.17) and lower HRQoL (EQ-5D index: β = -0.74, 95% CI -0.80 to -0.67; EQ-VAS: β = -0.52, 95% CI -0.62 to -0.41). Higher marital adjustment was associated with better HRQoL (EQ-5D index: β = 0.31, 95% CI 0.18 to 0.43; EQ-VAS: β = 0.33, 95% CI 0.20 to 0.45; all p < 0.001). After accounting for symptom burden, marital adjustment remained associated with the EQ-VAS (β = 0.19, 95% CI 0.06 to 0.32) but not with the EQ-5D index (β = 0.09, 95% CI -0.01 to 0.19). Symptom burden was associated with both lower marital adjustment and poorer HRQoL, and marital adjustment was positively associated with HRQoL. Consistent with COR theory and AET, these findings suggest that marital adjustment may be a relevant interpersonal resource in MS; however, the cross-sectional design does not allow causal or directional inferences. Assessing relational functioning alongside symptoms may help nurses identify patients who could benefit from family-centered support, an approach that should be evaluated in longitudinal and interventional studies.