Stress May Play Role in Multiple Sclerosis Disability, Study Suggests
The research, which highlighted stressors occurring in both childhood and adult stages contributing to MS disability, could inform conversations regarding stress reduction techniques for patients with MS.
Carri Polick, PhD, RN
Cross-sectional findings from a recently published study showed that stressors across the lifespan are commonly reported for patients with multiple sclerosis (MS), and contribute to disability in children and adults, and relapse burden in adults. These data could potentially help inform research design and analysis to mitigate or prevent adverse outcomes associated with stressors across the lifespan.
In the study, stressors were measured with the Stress and Adversity Inventory (STRAIN), which captured the cumulative count and severity of 55 stressors over the lifespan. Examples included physical/sexual abuse, neglect, poverty, divorce, neighborhood violence, and witnessing domestic abuse. Disability severity was measured with the Patient Determined Disease Steps (PDDS), a 1-item ordinal 0-8 scale commonly converted into 3 categories of mild (0-1), moderate (2-4), and severe (5-8) disability.
Led by Carri Polick, PhD, RN, a postdoctoral fellow and veterans affairs scholar at Duke University, likelihood ratio (LR) tests and Akaike information criterion (AIC) were used to evaluate additional predictive variance and model fit. Of the 713 participants included in either of the final analytical models, most had relapsing-remitting MS (79%), were on a second-line disease-modifying therapy (44%), had mild disability (52%), and on average, experienced 2.6 (SD, 1.96) childhood stressors with a severity of 9.8 (SD, 8.8) and 23.6 (SD, 14) adulthood stressors with a severity of 55.4 (SD, 30.8).
The base model including demographic and MS history predictors contributed significantly to estimates of disability level (R2 = .256; P <.001; AIC = 1066). Adult stressor predictors significantly contributed over the prior nested models (R2 = .2725; P <.001; AIC = 1051; LR, P <.001), meaning all predictor blocks significantly related to disability, and collectively contributed 27.3% of variance to this outcome.
"Stressor timing may impact MS outcomes differently, based on mechanisms and competing factors," the study authors wrote. "For example, disability could be in part triggered by longer term maladaptive coping behaviors such as earlier smoking or habits that contribute to obesity secondary to childhood stressors. However, adult stressors may be more likely to trigger aberrant immune responses."
Certain individual predictors were also significant in the final model. Individuals born in the Spring had 39% higher odds of disability compared with those born in the Summer (OR, 0.61; P <.05) and Winter (OR, 0.61; P <.05), which was consistent with how birth season influences the risk for MS at higher latitudes.
In a model specifically assessing relapse burden change since the COVID-19 pandemic onset, childhood stressors were found to increase the variance over the base model (R2 = 0.48; AIC = 1580) and it was an overall significant model; however, LR testing revealed that it was not significant compared with the previous nested base model (LR, P = .08). The adult stressors contributed significantly more information over the prior nested model (R2 = 0.534; P <.001; AIC = 1572; LR, P <.01); therefore, only the base demographics/covariates and adult stressor blocks of predictors remined in the final analytic model for relapse burden change since the pandemic.
Polick et al concluded that, "These findings could help inform research design and analysis in this growing field to mitigate or prevent adverse outcomes associated with stressors across the lifespan. This work may also inform clinical conversations regarding stress reduction techniques for PwMS, and may facilitate quicker referrals to resources that may aid these efforts such as mental health, coping, or substance use support, thus providing more personalized care for PwMS."
