The stress effect and the role of psychosocial factors in multiple sclerosis: a prospective study

Abstract

Background: studies assessing the stress effect on Multiple Sclerosis (MS) progression yielded disparate results. Under a transactional approach this study aims to investigate: a) how stress and MS progression may be related over time; and b) the moderator effect of coping, social support, anxiety, alexithymia and early-life stress. Methods: twenty-six MS patients participated in this one year follow-up longitudinal observational study. The following data was collected. Stress: weekly, a self-reported diary; monthly, the Perceived Stress Scale (PSS). Psychosocial factors: at baseline, the Strategic Approach to Coping Scale (SACS), the Multidimensional Scale of Perceived Social Support (MSPSS), the State-Trait Anxiety Inventory (STAI), the Toronto Alexithymia Scale (TAS) and the Childhood Trauma Questionnaire (CTQ). Disease progression: trimonthly, the self-reported Functionality Assessment of MS (FAMS) questionnaire, at baseline and at the end, impairment (EDSS), and at any moment the relapse rate. Multiple hierarchical regression models were conducted to test the stress-MS relationship and the moderator effect of psychosocial factors. Findings: perceived stress and functionality were negatively related in both directions in the trimonthly assessments [PSS-FAMS: β=-1.38, CI(-2.21 to 0.56); p=.002; FAMS-PSS: β=-0.18, CI(-0.22 to -0.13); p<.001]. Impairment and relapses did not show any relationship with stress. Active coping and low anxiety showed a moderator effect between perceived stress and functionality [PSSxCoping: β=0.96, CI(0.19 to 1.72); p=.01; PSSxSTAI: β=-1.60, CI(-2.90 to -0.29); p=.01]. Discussion: the bidirectional hypothesis was confirmed only with self-reported measures. Psychotherapeutic interventions should be implemented at early stages of MS focusing on coping and anxiety as they are potentially modifiable factors.