Document Type : Original Article

Authors

1 Department of Neurology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Faculty of Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Yazd Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Abstract

Background: Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system that occurs when a person is genetically predisposed and exposed to possible environmental factors. Stressful life events have been mentioned as effective factors in the incidence of MS, but the nature of this relationship has not been properly understood yet. The aim of this study is to determine the amount of exposure to stress before the onset of the disease.
Methods: This case-control study was performed on 34 recently diagnosed MS patients in Yazd, Iran during 2019-2020. Their demographic information and scores on the Paykel questionnaire were collected.
Results: In the study population, the women with MS were 26% more than the men. The mean age of catching the disease in the case group was 31.70 ± 8.03. In this study, no significant relationship was found between marital status and the incidence of MS (P = 0.15). Those with an under-diploma level of education obtained a higher stress score. In terms of life stressors in general (P = 0.001), psychosocial stressors (P = 0.011), grief-disappointment (P = 0.013) and individual-family problems (P= 0.0001), there were significant differences between the cases and the controls.
Conclusion: In summary, this study shows that stressful life events are more common in MS patients than in healthy individuals. In addition to stress, other factors such as anxiety, coping mechanisms, attitudinal aspects (optimism and pessimism), and the amount of social support should be taken into consideration when dealing with MS.

Keywords

Main Subjects

  1. Jiang X, Olsson T, Hillert J, Kockum I, Alfredsson L. Stressful life events are associated with the risk of multiple sclerosis. Eur J Neurol. 2020;27(12):2539-48. doi: 10.1111/ene.14458.
  2. Li J, Johansen C, Brønnum-Hansen H, Stenager E, Koch- Henriksen N, Olsen J. The risk of multiple sclerosis in bereaved parents: a nationwide cohort study in Denmark. Neurology. 2004;62(5):726-9. doi: 10.1212/01.wnl.0000113766.21896. b1.
  3. Liu XJ, Ye HX, Li WP, Dai R, Chen D, Jin M. Relationship between psychosocial factors and onset of multiple sclerosis. Eur Neurol. 2009;62(3):130-6. doi: 10.1159/000226428.
  4. Khedr MA, El Sayed HG, El Wakil A. Perceived stress in multiple sclerosis patients: relationship with mood states and pain experience. Mult Scler Relat Disord. 2022;59:103650. doi: 10.1016/j.msard.2022.103650.
  5. Abdollahpour I, Nedjat S, Mansournia MA, Eckert S, Weinstock-Guttman B. Stress-full life events and multiple sclerosis: a population-based incident case-control study. Mult Scler Relat Disord. 2018;26:168-72. doi: 10.1016/j. msard.2018.09.026.
  6. Milo R, Kahana E. Multiple sclerosis: geoepidemiology, genetics and the environment. Autoimmun Rev. 2010;9(5):A387-94. doi: 10.1016/j.autrev.2009.11.010.
  7. Grant I, Brown GW, Harris T, McDonald WI, Patterson T, Trimble MR. Severely threatening events and marked life difficulties preceding onset or exacerbation of multiple sclerosis. J Neurol Neurosurg Psychiatry. 1989;52(1):8-13. doi: 10.1136/jnnp.52.1.8.
  8. Warren S, Greenhill S, Warren KG. Emotional stress and the development of multiple sclerosis: case-control evidence of a relationship. J Chronic Dis. 1982;35(11):821-31. doi: 10.1016/0021-9681(82)90047-9.
  9. Riise T, Mohr DC, Munger KL, Rich-Edwards JW, Kawachi I, Ascherio A. Stress and the risk of multiple sclerosis. Neurology. 2011;76(22):1866-71. doi: 10.1212/ WNL.0b013e31821d74c5.
  10. Braceland FJ, Giffin ME. The mental changes associated with multiple sclerosis (an interim report). Res Publ Assoc Res Nerv Ment Dis. 1950;28:450-5.
  11. Brown RF, Tennant CC, Sharrock M, Hodgkinson S, Dunn SM, Pollard JD. Relationship between stress and relapse in multiple sclerosis: part II. Direct and indirect relationships. Mult Scler. 2006;12(4):465-75. doi: 10.1191/1352458506ms1296oa.
  12. Khoosfi H, Monirpoor N, Birashk B, Peighambari MM. A comparative study of perssonality factors, stressful life events, and social support in coronary heart patients and non-patients. Contemporary Psychology, Biannual Journal of the Iranian Psychological Association. 2007;2(1):41-8. [Persian].
  13. Mohr DC, Hart SL, Julian L, Cox D, Pelletier D. Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis. BMJ. 2004;328(7442):731. doi: 10.1136/bmj.38041.724421.55.
  14. Paykel ES. The interview for recent life events. Psychol Med. 1997;27(2):301-10. doi: 10.1017/s0033291796004424.
  15. Cook JE, Germano AL, Stadler G. An exploratory investigation of social stigma and concealment in patients with multiple sclerosis. Int J MS Care. 2016;18(2):78-84. doi: 10.7224/1537- 2073.2015-021.
  16. Naeeni R, Soltanzadeh Z, Salimipour H, Vahhabi Z, Yadegari S. The association of sever stressful life events and multiple sclerosis. Iran South Med J. 2015;18(1):222-8. [Persian].
  17. Hamarat E, Thompson D, Aysan F, Steele D, Matheny K, Simons C. Age differences in coping resources and satisfaction with life among middle-aged, young-old, and oldest-old adults. J Genet Psychol. 2002;163(3):360-7. doi: 10.1080/00221320209598689.
  18. Marchant DC, Polman RCJ, Clough PJ, Jackson JG, Levy AR, Nicholls AR. Mental toughness: managerial and age differences. J Manag Psychol. 2009;24(5):428-37. doi: 10.1108/02683940910959753.
  19. Sadovnick AD. European Charcot Foundation Lecture: the natural history of multiple sclerosis and gender. J Neurol Sci. 2009;286(1-2):1-5. doi: 10.1016/j.jns.2009.09.005.
  20. Wendebourg MJ, Heesen C, Finlayson M, Meyer B, Pöttgen J, Köpke S. Patient education for people with multiple sclerosis-associated fatigue: a systematic review. PLoS One. 2017;12(3):e0173025. doi: 10.1371/journal.pone.0173025.
  21. Feizi A, Aliyari R, Roohafza H. Association of perceived stress with stressful life events, lifestyle and sociodemographic factors: a large-scale community-based study using logistic quantile regression. Comput Math Methods Med. 2012;2012:151865. doi: 10.1155/2012/151865.