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Psychosomatic Medicine 64:916-920 (2002)
© 2002 American Psychosomatic Society

ORIGINAL ARTICLES

Stressful Life Events Precede Exacerbations of Multiple Sclerosis

Kurt D. Ackerman, MD, PhD, Rock Heyman, MD, Bruce S. Rabin, MD, PhD, Barbara P. Anderson, PhD, Patricia R. Houck, MSH, Ellen Frank, PhD and Andrew Baum, PhD

From the Departments of Psychiatry (K.D.A., B.P.A., P.R.H., E.F., A.B.), Neurology (R.H.), Pathology (B.S.R.), and Psychology (A.B.), University of Pittsburgh, Pittsburgh, Pennsylvania.

Address reprint requests to: Kurt D. Ackerman, MD, PhD, Western Psychiatric Institute and Clinic, 3811 O’Hara St., Pittsburgh, PA 15213. Email: ackermankd{at}msx.upmc.edu

OBJECTIVE: We longitudinally monitored life events and health changes in patients with multiple sclerosis (MS) to determine whether stressful events may trigger exacerbation of MS.

METHODS: Twenty-three women with MS were followed for 1 year. Each subject completed the Psychiatric Epidemiologic Research Interview on a weekly basis. Further information on potentially stressful events was acquired using the Life Events and Difficulties Schedule. Neurologic symptoms were also monitored on a weekly basis throughout the year. Potential MS exacerbations were confirmed by a neurologist who was blind to the presence and timing of stressors.

RESULTS: Eighty-five percent of MS exacerbations were associated with stressful life events in the preceding 6 weeks. Stressful life events occurred an average of 14 days before MS exacerbations, compared with 33 days before a randomly selected control date (p < .0001). Survival analysis confirmed that an increase in frequency of life events was associated with greater likelihood of MS exacerbations (hazard ratio = 13.18, p < .05).

CONCLUSIONS: These results are consistent with the hypothesis that stress is a potential trigger of disease activity in patients with relapsing-remitting MS.

Key Words: multiple sclerosis, • psychological stress, • Life Events and Difficulties Schedule.

Abbreviations: EDSS = Expanded Disability Status Scale;; LEDS = Life Events and Difficulties Schedule;; MS = multiple sclerosis.




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