Social identity in people with multiple sclerosis: a social identity approach to the role of the family in identity reconstruction

People with multiple sclerosis (MS) undergo changes to their identity and this might have an effect on mood. The subjective experience of this identity change is currently not well understood. Past research highlights that social groups, established prior to diagnosis, might protect against the harmful effects of identity change. No studies have specifically investigated this and the implications this may have for psychological interventions for mood in people with MS.

This thesis first presents a systematic review of the efficacy of group based psychological interventions for low mood in people with MS compared to individual based interventions. Group based interventions were found to be more effective as treatments for depression in people with MS and this may be due to the peer support available. Previous research has highlighted that people may be more willing to accept peer support from people with whom they share a social identity. People undergo changes to identity due to MS, this thesis focuses on identity change following diagnosis. The family is seen as an important source of social support. A meta-synthesis of the role of the family in acting as a secure base for identity reconstruction was undertaken. The family may provide a secure base for identity reconstruction, as long as the coping strategies used by the person with MS and the family are aligned. Sixteen interviews were conducted with people with MS to examine changes to identity over time and what factors might have influenced this. Social support was important for incorporating the MS identity into overall sense of self. A survey study (n = 203) was then conducted to examine whether family identity may have an effect on mood through social support and connectedness to others, as hypothesized on the basis of the Social Identity Model of Identity Change. Family identity was directly negatively correlated to mood; however, it had an increased effect on mood through the mediators of social support and connectedness to others.

This research in this thesis found that, if coping strategies are aligned, the family provides a secure base for identity reconstruction through social support, which can lead to self reflected appraisals in the person with MS. Identifying with the family group can have a positive effect on mood and can lead to increased interaction with other people with MS following adjustment. The implications of this research are that people do experience changes to their identity following a diagnosis of MS and that social support can help a person to incorporate this into their sense of self. The family can provide a secure base for identity reconstruction. Identifying with the family group can have a direct positive effect on a person’s mood, in line with the SIMIC. Family identity can also have an indirect effect on a person’s mood through the parallel mediators of family social support and willingness to join new social groups. Group psychological interventions have a greater effect on depression and anxiety in people with MS compared to individual interventions. People may be more willing to engage in-group interventions after an initial period of adjustment. Further research should investigate the SIMIC in people with other chronic conditions. The increased inclusion of the family in support for the person with MS could facilitate the adjustment process.