Relationship between stress and relapse in multiple sclerosis: part II. Direct and indirect relationships

Abstract

Objective The aim of this two-year prospective study was to determine which factors were: (i) directly related and/or (ii) indirectly related to multiple sclerosis (MS) relapse. These factors included life-event stressors, disease, demographic, psychosocial and lifestyle factors.

Background Relatively little attention has been paid to the role of non-clinical relapse predictors (other than stressful life-events) in MS, or factors that indirectly impact on the stress-relapse relationship.

Methods A total of 101 consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. Stressful life-events, depression, anxiety and fatigue were assessed at study-entry and at three-monthly intervals for two years. Disease, demographic, psychosocial and lifestyle factors were assessed at baseline. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria.

Results MS relapse was predicted by acute stressor frequency counts, coping responses that utilized social support, and being born in Australia, but not by chronic stressors, disease, demographic, psychosocial or lifestyle factors. No factors were found to indirectly impact on the stress-relapse relationship.

Conclusions The number rather than severity of stressors was most important in relation to MS relapse risk, along with coping responses that utilized social support, suggesting that MS patients should avoid situations that are likely to generate multiple stressors or which provide few avenues for social support.

Keywords

coping gender multiple sclerosis relapse stressors

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References

Mohr DC , Hart SL , Julian L , Cox D , Pelletier D. Association between stressful life-events and exacerbation in multiple sclerosis: a meta-analysis . Br Med J 2004; 328: 731-731 .

Warren S , Warren KG , Cockerill R. Emotional stress and coping in multiple sclerosis exacerbations . J Psychosom Res 1991; 35: 37-47 .

Dalos NP , Rabins PV , Brooks BR , O’Donnell P. Disease activity and emotional state in multiple sclerosis . Ann Neurol 1983; 13: 573-577 .

Noy S , Achiron A , Gabbay U , Barak Y , Rotstein Z , Laor N et al. A new approach to affective symptoms in relapsing-remitting multiple sclerosis . Comp Psychiatry 1995; 36: 390-395 .

VanderPlate C. Psychological aspects of multiple sclerosis and its treatment: towards a biopsychosocial perspective . Health Psychol 1984; 3: 253-272 .

McIvor GP , Riklan M , Reznikoff M. Depression in multiple sclerosis as a function of length and severity of illness, age, remissions and perceived social support . J Clin Psychol 1984; 40: 1028-1033 .

Fassbender K , Schmidt R , Mossner R , Kischka U , Kuhnen J , Schwartz A et al. Mood disorders and dysfunction of the hypothalamic-pituitary-adrenal axis in multiple sclerosis: association with cerebral inflammation . Arch Neurol 1998; 55: 66-72 .

Rabins PV , Brooks BR , O’Donnell P , Pearlson GD , Moberg P , Jubelt B et al. Structural brain correlates of emotional disorder in multiple sclerosis . Brain 1986; 109: 585-597 .

Jean VM , Beatty WW , Paul RH , Mullins L. Coping with general and disease-related stressors by patients with multiple sclerosis: relationships to psychological distress . Mult Scler 1997; 3: 191-196 .

10.

Mohr DC , Goodkin DE , Nelson S , Cox D , Weiner M. Moderating effects of coping on the relationship between stress and the development of new brain lesions in multiple sclerosis . Psychosom Med 2002; 64: 803-809 .

11.

Wassem R. A test of the relationship between health locus of control and the course of multiple sclerosis . Rehab Nurs 1991; 16: 189-193 .

12.

Scheier MF , Matthews KA , Owens JF , Magovern GJ Sr , Lefebvre RC , Abbott RA et al. Dispositional optimism and recovery from coronary artery bypass surgery: the beneficial effects on physical and psychological well-being . J Pers Soc Psychol 1989; 57: 1024-1040 .

13.

Robbins AS , Spence JT , Clark H. Psychological determinants of health and performance: the tangled web of desirable and undesirable characteristics . J Pers Soc Psychol 1991; 61: 755-765 .

14.

Scheier MF , Carver CS , Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery and self-esteem): a reevaluation of the Life Orientation Test . J Pers Soc Psychol 1994; 67: 1063-1078 .

15.

Carver CS , Pozo C , Harris SD , Noriega V , Scheier MF , Robinson DS et al. How coping mediates the effect of optimism on distress: a study of women with early stage breast cancer . J Pers Soc Psychol 1993; 65: 375-390 .

16.

Finger S. A happy state of mind: a history of mild elation, denial of disability, optimism, and laughing in multiple sclerosis . Arch Neurol 1998; 55: 241-250 .

17.

Long DD , Miller BJ. Suicidal tendency and multiple sclerosis . Health Soc Work 1991; 16: 104-109 .

18.

Pakenham KI. Adjustment to multiple sclerosis: application of a stress and coping model . Health Psychol 1999; 18: 383-392 .

19.

Matthews WB , McAlpine D. Some aspects of the natural history. McAlpine’s multiple sclerosis, second edition. Churchill Livingstone , 1991.

20.

Krupp LB , Rizvi SA. Symptomatic therapy for under-recognized manifestations of multiple sclerosis . Neurology 2002; 58S: S32-S39 .

21.

McAlpine DA. Clinical studies. In McAlpine DA , Lumsden CE , Acheson ED eds. Multiple sclerosis: a reappraisal, second edition. Churchill Livingstone , 1972.

22.

Bakshi R , Shaikh ZA , Miletich RS , Czarnecki D , Dmochowski J , Henschel K et al. Fatigue in multiple sclerosis and its relationship to depression and neurologic disability . Mult Scler 2000; 6: 181-185 .

23.

Giovannoni G , Thompson AJ , Miller DH , Thompson EJ. Fatigue is not associated with raised inflammatory markers in multiple sclerosis . Neurology 2001; 57: 676-681 .

24.

Bakshi R , Miletich RS , Henschel K , Shaikh ZA , Janardhan V , Wasay M et al. Fatigue in multiple sclerosis: cross-sectional correlation with brain MRI findings in 71 patients . Neurology 1999; 53: 1151-1153 .

25.

Zeldow PB , Pavlou M. Physical disability, life stress and psychosocial adjustment in multiple sclerosis . J Nerv Ment Dis 1984; 172: 80-84 .

26.

Schwartz CE , Foley FW , Rao SM , Bernardin LJ , Lee H , Genderson MW. Stress and course of disease in multiple sclerosis . Behav Med 1999; 25: 110-116 .

27.

Poser CM , Paty DW , Scheinberg L , McDonald WI , Davis FA , Ebers GC et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols . Ann Neurol 1983; 13: 227-231 .

28.

Beatty WW , Paul RH , Wilbanks SL , Hames KA , Blanco CR , Goodkin DE. Identifying multiple sclerosis patients with mild or global cognitive impairment using the Screening Examination for Cognitive Impairment . Neurology 1995; 45: 718-723 .

29.

Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an Expanded Disability Status Scale . Neurology 1983; 33: 1444-1452 .

30.

Brown RF , Tennant CC , Sharrock M , Hodgkinson S , Dunn SM , Pollard JD. The relationship between stress and relapse in multiple sclerosis. I. Important features . Mult Scler. 2006; Online ahead of print.

31.

Brown GW , Harris T. Social origins of depression: a study of psychiatric disorders in women. Tavistock , 1978.

32.

Fisk JD , Ritvo PG , Ross L , Haase DA , Marrie TJ , Schlech WF. Measuring the functional impact of fatigue: initial validation of the Fatigue Impact Scale . Clin Infect Dis 1994; 18: S79-S83 .

33.

Beck AT. Beck Depression Inventory-II. The psychological corporation. Harcourt Brace & Co. , 1996.

34.

Nyenhuis DL , Rao SM , Zajecka JM , Luchetta T , Bernardin L , Garron DC. Mood disturbance versus other symptoms of depression in multiple sclerosis . J Int Neuropsychol Soc 1995; 1: 291-296 .

35.

Aikens JE , Reinecke MA , Pliskin NH , Fischer JS , Wiebe JS , McCracken LM et al.

Assessing depressive symptoms in multiple sclerosis: is it necessary to omit items from the original Beck Depression Inventory?

J Behav Med 1999; 22: 127-142 .

36.

Pujol J , Bello J , Deus J , Marti-Vilalta JL , Capdevila A. Lesions in the left arcuate fasciculus region and depressive symptoms in multiple sclerosis . Neurology 1997; 49: 1105-1110 .

37.

Spielberger CD , Gorusch RL , Luschene RE , Volberg, Jacobs GA. State-Trait Anxiety Inventory for adults (Form Y). Mind Garden , 1983.

38.

Vleugels L , Pfennings L , Pouwer F , Cohen L , Ketelaer P , Polman C et al. Psychological functioning in 1 progressive versus 2 progressive MS . Br J Med Psychol 1998; 71: 99-106 .

39.

Folkman S , Lazarus RS. Ways of Coping Questionnaire sampler set: manual, test booklet, scoring key. Mind Garden , 1988.

40.

Lazarus RS , Folkman S. Stress, appraisal, and coping. Springer , 1984.

41.

Fournier M , de Ridder D , Bensing J.

Optimism and adaptation to multiple sclerosis: what does optimism mean?

J Behav Med 1999; 22: 303-326 .

42.

Wallston KA , Wallston BS , DeVellis R. Development of the Multidimensional Health Locus of Control (MHLC) Scales . Health Educ Monogr 1978; 6: 160-170 .

43.

Wallston KA , Wallston BS. Health Locus of Control Scales. In Lefcourt HM ed. Research with the Locus of Control construct: assessment methods. Academic Press , 1981: 189-243.

44.

Sarason IG , Sarason BR , Shearin EH , Pierce GR. A brief measure of social support: practical and theoretical implications . J Soc Pers Rel 1987; 4: 497-510 .

45.

Buysse DJ , Reynolds CF , Monk TH , Berman SR , Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research . Psychiatry Res 1989; 28: 193-213 .

46.

Liang KY , Zeger SL. Longitudinal data analysis using generalised linear models . Biometrika 1986; 73: 13-22 .

47.

Robins JM , Rotnitzky A , Zhao LP. Analysis of semiparametric regression models for repeated outcomes in the presence of missing data . J Am Stat Assoc 1995; 90: 106-121 .

48.

Robins JM , Rotnitzky A , Scharfstein DO. Semiparametric regression for repeated outcomes with non-ignorable non-response . J Am Stat Assoc 1998; 93: 1321-1339 .

49.

Brown GW , Adler Z , Bifulco AL. Life-events, difficulties and recovery from chronic depression . Br J Psychiatry 1988; 152: 487-498 .

50.

Moller A , Wiedemann G , Rohde U , Backmund H , Sonntag A. Correlates of cognitive impairment and depressive mood disorder in multiple sclerosis . Acta Psychiatr Scand 1994; 89: 117-121 .

51.

Zorzon M , de Masi R , Nasuelli D , Ukmar M , Mucelli RP , Cazzato G et al. Depression and anxiety in multiple sclerosis: a clinical and MRI study in 95 subjects . J Neurol 2001; 248: 416-421 .

52.

Amato MP , Ponziani G , Pracucci G , Bracco L , Siracusa G , Amaducci L. Cognitive impairment in early-onset multiple sclerosis: pattern, predictors and impact of everyday life in a 4-year follow up . Arch Neurol 1995; 52: 168-172 .

53.

Foong J , Rozenwicz L , Quaghebeur G , Thompson AJ , Miller DH , Ron MA. Neuro-psychological deficits in multiple sclerosis after acute relapse . Psychol Bull 1998; 64: 529-532 .

54.

Fruehwald S , Loeffler-Stastka H , Eher R , Saletu B , Baumhackl U. Depression and quality of life in multiple sclerosis . Acta Neurol Scand 2001; 104: 257-261 .

55.

Gilchrist AC , Creed FH. Depression, cognitive impairment and social stress in multiple sclerosis . J Psychosom Res 1994; 38: 193-201 .

56.

Logsdail SJ , Callanan MM , Ron MA. Psychiatric morbidity in patients with clinically isolated lesions of the type seen in multiple sclerosis: a clinical and MRI study . Psychol Med 1988; 18: 355-364 .