Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis

AbstractObjective To quantify the association between stressful life events and exacerbations of multiple sclerosis.Data sources PubMed, PsychInfo, and Psychological Abstracts searched for empirical papers from 1965 to February 2003 with terms “stress”, “trauma”, and “multiple sclerosis”.Review methods Three investigators independently reviewed papers for inclusion/exclusion criteria and extracted the relevant data, including methods, sample statistics, and outcomes.Results Of 20 studies identified, 14 were included. The meta-analysis showed a significant increase in risk of exacerbation in multiple sclerosis after stressful life events, with a weighted average effect size of d = 0.53 (95% confidence interval 0.40 to 0.65), P < 0.0001. The studies were homogenous, q = 16.62, p = 0.22, i2 = 21.8%. Neither sampling nor study methods had any effect on study outcomes.Conclusions There is a consistent association between stressful life events and subsequent exacerbation in multiple sclerosis. However these data do not allow the linking of specific stressors to exacerbations nor should they be used to infer that patients are responsible for their exacerbations. Investigation of the psychological, neuroendocrine, and immune mediators of stressful life events on exacerbation may lead to new behavioural and pharmacological strategies targeting potential links between stress and exacerbation.

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ASSOCIATION BETWEEN STRESSFUL LIFE EVENTS AND AUTOIMMUNE DISEASES: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RETROSPECTIVE CASE-CONTROL STUDIES

10.26226/morressier.56e174d4d462b8028d88a7cd ◽

2016 ◽

Author(s):

Brunetta Porcelli

Keyword(s):

Systematic Review ◽

Autoimmune Diseases ◽

Life Events ◽

Stressful Life Events ◽

Meta Analysis ◽

Case Control ◽

Stressful Life ◽

Case Control Studies ◽

Retrospective Case

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Stressful Life Events Precede Exacerbations of Multiple Sclerosis

Psychosomatic Medicine ◽

10.1097/00006842-200211000-00009 ◽

2002 ◽

Vol 64 (6) ◽

pp. 916-920 ◽

Cited By ~ 2

Author(s):

Kurt D. Ackerman ◽

Rock Heyman ◽

Bruce S. Rabin ◽

Barbara P. Anderson ◽

Patricia R. Houck ◽

...

Keyword(s):

Multiple Sclerosis ◽

Life Events ◽

Stressful Life Events ◽

Stressful Life

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The relation between stressful life events and breast cancer: a systematic review and meta-analysis of cohort studies

Breast Cancer Research and Treatment ◽

10.1007/s10549-019-05231-x ◽

2019 ◽

Vol 176 (1) ◽

pp. 53-61 ◽

Cited By ~ 2

Author(s):

Narjes Bahri ◽

Tahereh Fathi Najafi ◽

Fatemeh Homaei Shandiz ◽

Hamid Reza Tohidinik ◽

Abdoljavad Khajavi

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Cohort Studies ◽

Life Events ◽

Stressful Life Events ◽

Meta Analysis ◽

Stressful Life

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Relationship of cardiovascular reactivity, stressful life events, and multiple sclerosis disease activity

Brain Behavior and Immunity ◽

10.1016/s0889-1591(03)00047-3 ◽

2003 ◽

Vol 17 (3) ◽

pp. 141-151 ◽

Cited By ~ 32

Author(s):

Kurt D Ackerman ◽

Angela Stover ◽

Rock Heyman ◽

Barbara P Anderson ◽

Patricia R Houck ◽

...

Keyword(s):

Multiple Sclerosis ◽

Disease Activity ◽

Life Events ◽

Cardiovascular Reactivity ◽

Stressful Life Events ◽

Stressful Life ◽

Multiple Sclerosis Disease ◽

Relationship Of

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Are stressful life events prospectively associated with increased suicidal ideation and behaviour? A systematic review and meta-analysis

Journal of Affective Disorders ◽

10.1016/j.jad.2020.01.171 ◽

2020 ◽

Vol 266 ◽

pp. 731-742 ◽

Cited By ~ 3

Author(s):

Emma J. Howarth ◽

Daryl B. O'Connor ◽

Maria Panagioti ◽

Alexander Hodkinson ◽

Sarah Wilding ◽

...

Keyword(s):

Systematic Review ◽

Suicidal Ideation ◽

Life Events ◽

Stressful Life Events ◽

Meta Analysis ◽

Stressful Life

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A temporal framework for understanding the effects of stressful life events on inflammation in patients with multiple sclerosis

Brain Behavior and Immunity ◽

10.1016/j.bbi.2005.03.011 ◽

2006 ◽

Vol 20 (1) ◽

pp. 27-36 ◽

Cited By ~ 50

Author(s):

David C. Mohr ◽

Daniel Pelletier

Keyword(s):

Multiple Sclerosis ◽

Life Events ◽

Stressful Life Events ◽

Stressful Life

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Do positive or negative stressful events predict the development of new brain lesions in people with multiple sclerosis?

Psychological Medicine ◽

10.1017/s0033291713000755 ◽

2013 ◽

Vol 44 (2) ◽

pp. 349-359 ◽

Cited By ~ 28

Author(s):

M. N. Burns ◽

E. Nawacki ◽

M. J. Kwasny ◽

D. Pelletier ◽

D. C. Mohr

Keyword(s):

Multiple Sclerosis ◽

Depressive Symptoms ◽

Life Events ◽

Perceived Stress ◽

Stressful Life Events ◽

Brain Lesions ◽

Stressful Events ◽

Stressful Life ◽

Increased Risk ◽

Mri Scans

BackgroundStressful life events have long been suspected to contribute to multiple sclerosis (MS) disease activity. The few studies examining the relationship between stressful events and neuroimaging markers have been small and inconsistent. This study examined whether different types of stressful events and perceived stress could predict the development of brain lesions.MethodThis was a secondary analysis of 121 patients with MS followed for 48 weeks during a randomized controlled trial comparing stress management therapy for MS (SMT-MS) to a waitlist control (WLC). Patients underwent magnetic resonance imaging (MRI) scans every 8 weeks. Every month, patients completed an interview measure assessing stressful life events and self-report measures of perceived stress, anxiety and depressive symptoms, which were used to predict the presence of gadolinium-enhancing (Gd+) and T2 lesions on MRI scans 29–62 days later. Participants classified stressful events as positive or negative. Negative events were considered ‘major’ if they involved physical threat or threat to the patient's family structure, and ‘moderate’ otherwise.ResultsPositive stressful events predicted decreased risk for subsequent Gd+ lesions in the control group [odds ratio (OR) 0.53 for each additional positive stressful event, 95% confidence interval (CI) 0.30–0.91] and less risk for new or enlarging T2 lesions regardless of group assignment (OR 0.74, 95% CI 0.55–0.99). Across groups, major negative stressful events predicted Gd+ lesions (OR 1.77, 95% CI 1.18–2.64) and new or enlarging T2 lesions (OR 1.57, 95% CI 1.11–2.23) whereas moderate negative stressful events, perceived stress, anxiety and depressive symptoms did not.ConclusionsMajor negative stressful events predict increased risk for Gd+ and T2 lesions whereas positive stressful events predict decreased risk.

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Modifiable factors influencing relapses and disability in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458510367721 ◽

2010 ◽

Vol 16 (7) ◽

pp. 773-785 ◽

Cited By ~ 46

Author(s):

MB D'hooghe ◽

G. Nagels ◽

V. Bissay ◽

J. De Keyser

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

Life Events ◽

Strong Evidence ◽

Stressful Life Events ◽

Stressful Life ◽

Fertility Treatment ◽

Increased Risk ◽

Vitamin D Levels ◽

Modifiable Factors

A growing body of literature indicates that the natural course of multiple sclerosis can be influenced by a number of factors. Strong evidence suggests that relapses can be triggered by infections, the postpartum period and stressful life events. Vaccinations against influenza, hepatitis B and tetanus appear to be safe. Surgery, general and epidural anaesthesia, and physical trauma are not associated with an increased risk of relapses. Factors that have been associated with a reduced relapse rate are pregnancy, exclusive breastfeeding, sunlight exposure and higher vitamin D levels. A number of medications, including hormonal fertility treatment, seem to be able to trigger relapses. Factors that may worsen progression of disability include stressful life events, radiotherapy to the head, low levels of physical activity and low vitamin D levels. Strong evidence suggests that smoking promotes disease progression, both clinically and on brain magnetic resonance imaging. There is no evidence for an increased progression of disability following childbirth in women with multiple sclerosis. Moderate alcohol intake and exercise might have a neuroprotective effect, but this needs to be confirmed.

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Association between stress and breast cancer in women: a meta-analysis

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2009001500010 ◽

2009 ◽

Vol 25 (suppl 3) ◽

pp. S453-S463 ◽

Cited By ~ 17

Author(s):

Míria Conceição Lavinas Santos ◽

Bernardo Lessa Horta ◽

João Joaquim Freitas do Amaral ◽

Paula Frassinetti Castelo Branco Camurça Fernandes ◽

Cristina Maria Galvão ◽

...

Keyword(s):

Breast Cancer ◽

Life Events ◽

Stressful Life Events ◽

Meta Analysis ◽

Breast Cancer Incidence ◽

Stressful Events ◽

Stressful Life ◽

Cochrane Library ◽

Relative Risks ◽

Rule Out

The objective of the current meta-analysis was to verify the association between stressful life events and primary breast cancer incidence in women. A total of 618 studies from 1982-2007 were found in the PubMed, LILACS, and Cochrane Library databases. Methodological quality was evaluated according to the Downs & Black criteria. Eight studies were selected (six case-controls and two cohorts). The studies were grouped in three analyses, two of which based on the categories widowhood and divorce and the other based on self-rated intensity and frequency of stressful events. Relative risks were: widowhood 1.04 (95%CI: 0.75-1.44; p = 0.800); divorce 1.03 (95%: 0.72-1.48; p = 0.850); and intensity/frequency of stress 1.73 (95%CI: 0.98-3.05; p = 0.059). We conclude that stressful life events as a whole are not associated with risk of breast cancer in women. However, it is not possible to rule out high-intensity stress as a risk factor for breast cancer.

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