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 [CI95% = 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.