When does distress disclosure help? Anticipated stigma and the moderating role of perceived social support in depression and anxiety among individuals with multiple sclerosis.

OBJECTIVES: Depression and Anxiety are pervasive in multiple sclerosis (MS), yet the psychosocial mechanisms associated with these outcomes in this neurological condition remain insufficiently specified. Guided by the Disclosure Processes Model, this study examined how functional disability and anticipated stigma are associated with depression and anxiety indirectly through distress disclosure, and whether these pathways are moderated by perceived social support. METHODS: In a sample of 272 Iranian adults with MS diagnosis (79.4% women; Mage = 42.5 years), participants completed the Chronic Illness Anticipated Stigma Scale, Distress Disclosure Index, Multidimensional Scale of Perceived Social Support, Hospital Anxiety and Depression Scale, and Expanded Disability Status Scale. By Structural Equation Modeling (SEM), a mediation-moderation model was tested. RESULTS: Anticipated stigma was positively associated with anxiety and depression, whereas functional disability was positively associated with depression only. Distress disclosure partially mediated the association between anticipated stigma and anxiety and depression, with higher stigma being associated with greater disclosure, and greater disclosure being associated with lower distress. Perceived social support moderated several of these associations. Specifically, disclosure was negatively associated with affective outcomes under low social support but was positively associated under high social support, yielding robust crossover interactions. CONCLUSIONS: Anxiety and depression in MS are shaped not by disability alone but by how stigma and disclosure are embedded within social contexts. This suggests that interventions may benefit from prioritizing stigma reduction and strategically tailored disclosure, rather than uniformly encouraging openness, to support psychological adjustment.