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Moderating Effects of Coping on the Relationship Between Stress and the Development of New Brain Lesions in Multiple Sclerosis

From the University of California, San Francisco, CA.

Address reprint requests to: David C. Mohr, University of California at San Francisco, VAMC, 4150 Clement Street (116-A), San Francisco, CA 94121. Email: dmohr{at}itsa.ucsf.edu

OBJECTIVE: Many patients with multiple sclerosis (MS) report that stress can trigger disease exacerbations. Considerable research has supported a relationship between stress and both clinical exacerbation and the development of new brain lesions. However, these relationships are not always consistent either within patients or across patients, suggesting the presence of moderators. This study examined the hypothesis that coping moderates the subsequent relationship between stress and the development of new brain lesions in MS.

METHODS: Thirty-six patients (mean age = 44.4; 22 women, 14 men) with relapsing forms of MS were assessed once every 4 weeks for 28–100 weeks. New brain lesions were identified using monthly Gd+ MRI. Stress was measured within 24 hours before MRI using a modified version of the Social Readjustment Rating Scale that assessed Conflict and Disruption in Routine. Coping was measured at baseline using the Coping with Health Injuries and Problems questionnaire, which produces four scales: distraction, instrumental, palliative, and emotional preoccupation. Data were analyzed using mixed effects logistic regression to account for within-subject correlations. Analyses were lagged such that stress assessments predicted new Gd+ MRI brain lesions 8 weeks later.

RESULTS: As reported previously, stress was significantly related to the development of new Gd+ brain lesions 8 weeks later (OR = 1.62, p = .009). Greater use of distraction was found to be a significant moderator of the relationship between stress and new Gd+ lesions (OR = 0.69, p = .037) such that greater use of distraction was associated with a decreased relationship between stress and new Gd+ lesions. Increased instrumental coping was marginally associated with a decreased relationship between stress and new Gd+ lesions (OR = 0.77, p = .081), while increased emotional preoccupation was marginally associated with an increased relationship between stress and new Gd+ lesions (OR = 1.46, p = .088). There was no significant moderating effect for palliative coping (p = .27) and no significant main effects for any coping variables and the subsequent development of new Gd+ brain lesions (p values > .21).

CONCLUSIONS: These findings provide modest support for the hypothesis that coping can moderate the relationship between stress and the MS disease activity. Several limitations in this study are discussed. While these findings suggest areas of potentially fruitful research, readers are cautioned that these are preliminary results; inferences regarding the clinical importance of these findings are premature.

Key Words: stress, • multiple sclerosis, • coping, • mind-body.

Abbreviations: CHIP = Coping with Health Injuries and Problems;; CNS = central nervous system;; EAE = experimental autoimmune encephalomyelitis;; EDSS = Expanded Disability Scale Score;; Gd+ = gadolinium enhancing;; IFNß-1b = interferon beta-1b;; MRI = magnetic resonance imaging;; MS = multiple sclerosis;; OR = odds ratio;; RRMS = relapsing-remitting MS;; SPMS = secondary-progressive MS;; SRRS = Social Readjustment Rating Scale.

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