Impact of comorbid post traumatic stress disorder on multiple sclerosis in military veterans: A population-based cohort study

Abstract

Background:

Very little is known regarding the impact of post traumatic stress disorder (PTSD) on the course of multiple sclerosis (MS).

Objectives:

To explore the impact of pre-existing PTSD on MS relapses, magnetic resonance imaging (MRI) activity, and disability in a large population-based cohort.

Methods:

Military Veterans with MS and PTSD prior to symptom onset (MS_PTSD, n = 96) were identified using the Department of Veterans Affairs MS databases. MS_PTSD cases were matched to MS controls without PTSD (n = 95). Number of relapses, number of new T2 lesions and new gadolinium lesions on brain MRI, and neurological disability were abstracted between 2015 and 2019.

Results:

The mean annualized relapse rate was greater in the MS_PTSD group versus controls (0.23 vs 0.06, respectively; p < 0.05), as was the annualized mean number of new T2 and gadolinium-enhancing lesions on brain MRI (0.52 vs 0.16 and 0.29 vs 0.08, respectively; p < 0.05). Disability accrual (time to Disability Status Scale 6.0) was more rapid (23.7 vs 29.5 years, p < 0.05) in relapsing MS patients with PTSD.

Conclusion:

Patients with MS_PTSD have higher disease activity and reach disability endpoints more rapidly than controls. This is the first study to show PTSD as a potentially modifiable risk factor for MS relapses, MRI activity, and disability.

Keywords

Post traumatic stress disorder PTSD multiple sclerosis relapse disability progression

Get full access to this article

View all access options for this article.

References

Wallin

Culpepper

Campbell

, et al. The prevalence of MS in the United States: A population-based estimate using health claims data. Neurology 2019; 92(10): e1029–e1040.

Goodin

DS.

The causal cascade to multiple sclerosis: A model for MS pathogenesis. PLoS ONE 2009; 4(2): e4565.

Buron

Chalmer

Sellebjerg

, et al. Initial high-efficacy disease-modifying therapy in multiple sclerosis: A nationwide cohort study. Neurology 2020; 95(8): e1041–e1051.

Marrie

Horwitz

RI.

Emerging effects of comorbidities on multiple sclerosis. Lancet Neurol 2010; 9(8): 820–828.

Marrie

Reingold

Cohen

, et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: A systematic review. Mult Scler 2015; 21(3): 305–317.

Wallin

Wilken

Turner

, et al. Depression and multiple sclerosis: Review of a lethal combination. J Rehabil Res Dev 2006; 43(1): 45–62.

Marrie

Horwitz

Cutter

, et al. The burden of mental comorbidity in multiple sclerosis: Frequent, underdiagnosed, and undertreated. Mult Scler 2009; 15(3): 385–392.

Marrie

Graff

Walker

, et al. Effects of psychiatric comorbidity in immune-mediated inflammatory disease: Protocol for a prospective study. JMIR Res Protoc 2018; 7(1): e15.

Kessler

Berglund

Demler

, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62(6): 593–602.

10.

Chalfant

Bryant

Fulcher

Posttraumatic stress disorder following diagnosis of multiple sclerosis. J Trauma Stress 2004; 17(5): 423–428.

11.

Carletto

Borghi

Scavelli

, et al. Prevalence of posttraumatic stress disorder in patients with multiple sclerosis. J Nerv Ment Dis 2018; 206(2): 149–151.

12.

Carletto

Borghi

Bertino

, et al. Treating Post-traumatic stress disorder in patients with multiple sclerosis: A randomized controlled trial comparing the efficacy of eye movement desensitization and reprocessing and relaxation therapy. Front Psychol 2016; 7: 526.

13.

Leekoff

Reddi

Wallin

, et al. Impact of comorbid post traumatic stress disorder on outcomes in multiple sclerosis patients: A pilot cross-sectional study. In: National multiple sclerosis Tykeson fellows conference, Atlanta, GA, 10 November 2019.

14.

Culpepper

Marrie

Langer-Gould

, et al. Validation of an algorithm for identifying MS cases in administrative health claims datasets. Neurology 2019; 92(10): e1016–28.

15.

Department of Veterans Affairs. Interactive US and map of VISNs facilities, https://www.va.gov/directory/guide/map.asp?dnum=1 (accessed 28 February 2021).

16.

Veterans Affairs. VA and disability compensation for PTSD, 2020, https://www.va.gov/disability/eligibility/ptsd/ (accessed 16 September 2021).

17.

Traboulsee

Simon

Stone

, et al. Revised recommendations of the Consortium of MS Centers Task Force for a standardized MRI protocol and clinical guidelines for the diagnosis and follow-up of multiple sclerosis. AJNR Am J Neuroradiol 2016; 37(3): 394–401.

18.

Kurtzke

JF.

Origin of DSS: To present the plan. Mult Scler 2007; 13(1): 120–123.

19.

Cyr

Guo

Marcil

M-J

, et al. Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 69: 81–93.

20.

Knowles

Sripada

Defever

, et al. Comorbid mood and anxiety disorders and severity of posttraumatic stress disorder symptoms in treatment-seeking veterans. Psychol Trauma 2019; 11(4): 451–458.

21.

Marx

Bovin

Szafranski

, et al. Validity of posttraumatic stress disorder service connection status in Veterans Affairs electronic records of Iraq and Afghanistan Veterans. J Clin Psychiatry 2016; 77(4): 517–522.

22.

Salter

Kowalec

Fitzgerald

, et al. Comorbidity is associated with disease activity in MS: Findings from the CombiRx trial. Neurology 2020; 95(5): e446–e456.

23.

Binzer

McKay

Brenner

, et al. Disability worsening among persons with multiple sclerosis and depression: A Swedish cohort study. Neurology 2019; 93(24): e2216–e2223.

24.

Gorman

Healy

Polgar-Turcsanyi

, et al. Increased relapse rate in pediatric-onset compared with adult-onset multiple sclerosis. Arch Neurol 2009; 66(1): 54–59.

25.

Gauthier

Glanz

Mandel

, et al. Incidence and factors associated with treatment failure in the CLIMB multiple sclerosis cohort study. J Neurol Sci 2009; 284(1–2): 116–119.

26.

Clinical course of multiple sclerosis: A and nationwide cohort study Ali Manouchehrinia Omid Beiki Jan Hillert, 2017, https://journals.sagepub.com/doi/10.1177/1352458516681197 (accessed 24 March 2021).

27.

Sherin

Nemeroff

CB.

Post-traumatic stress disorder: The neurobiological impact of psychological trauma. Dialogues Clin Neurosci 2011; 13(3): 263–278.

28.

Rajda

Bencsik

Vécsei

, et al. Catecholamine levels in peripheral blood lymphocytes from multiple sclerosis patients. J Neuroimmunol 2002; 124(1–2): 93–100.

29.

Lichtblau

Schmidt

Schumann

, et al. Cytokines as biomarkers in depressive disorder: Current standing and prospects. Int Rev Psychiatry 2013; 25(5): 592–603.

30.

Standardized MR imaging protocol for multiple sclerosis: Consortium of MS and Centers consensus guidelines, https://pubmed.ncbi.nlm.nih.gov/16484429/ (accessed 19 March 2021).

31.

Wallin

Whitham

Maloni

, et al. The Multiple Sclerosis Surveillance Registry: A novel interactive database within the Veterans Health administration. Fed Pract Health Care Prof VA DoD PHS 2020; 37(Suppl. 1):S18–S23.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.03 MB

0.53 MB

0.43 MB