Lifelong Stress Could Contribute to Worse MS Health, Outcomes

Stressors experienced across the lifespan, including poverty, abuse, and divorce, have been linked with worse health and functional outcomes for people living with multiple sclerosis (MS). Results from a cross-sectional survey study were published in Brain and Behavior.

"Adverse Childhood Experiences, which we call ACEs, and other childhood stressors could impact immune, inflammatory and behavioral processes throughout life, and reduce resilience to adult stress," said first author Carri Polick, PhD, RN, postdoctoral fellow, National Clinician Scholars Program, Duke University. "It is important to use a lifespan approach in future work to better understand patterns and inform symptom management.

The study authors sought to examine the relationship between lifetime stressors (Stress and Adversity Inventory; STRAIN) and 2 self-reported MS outcomes: disability (Patient Determined Disease Steps; PDDS) and relapse burden changes in the post-COVID-19 pandemic period. Data was collected from a nationally distributed survey of US-based adults living with MS via the US National MS Society listserv.

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Researchers then utilized hierarchical block regressions to sequentially evaluate contributions to both disability and relapse outcomes. Likelihood ratio tests and Akaike information criterion were used to evaluate additional predictive variance and model fit.

Of 713 participants, most were female (84%), 79% had relapse remitting MS, and the mean age was 49 years old (SD=12.7). Childhood (R² = .261, p < .001; AIC = 1063, LR p < .05) and adulthood stressors (R² = .2725, p < .001, AIC = 1051, LR p < .001) contributed significantly to disability, above and beyond prior nested models. Only adulthood stressors (R² = .0534, p < .001; AIC = 1572, LR p < .01) significantly contributed above the nested model for relapse burden changes since COVID-19.

“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,” the authors wrote in the study conclusion. “This work may also inform clinical conversations regarding stress reduction techniques for [people with MS], 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 [people with MS].”

References

Life stressors may contribute to multiple sclerosis flares, disability. News release. University of Michigan. Published online May 24, 2023. Accessed June 20, 2023.

Polick CS, Ploutz-Snyder R, Braley TJ, et al. Associations among stressors across the lifespan, disability, and relapses in adults with multiple sclerosis. Brain Behav. Published online May 21, 2023. doi: 10.1002/brb3.3073