Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
[Preprint]. 2024 Feb 7:2024.02.06.24302405.
doi: 10.1101/2024.02.06.24302405.

Resilience, mental health, sleep, and smoking mediate pathways between lifetime stressors and Multiple Sclerosis severity

Carri S Polick  1   2 , Hala Darwish  3   4 , Leo Pestillo de Olivera  5 , Ali Watson  6 , Joao Ricardo Nickenig Vissoci  7 , Patrick S Calhoun  2   8 , Robert Ploutz-Snyder  4 , Cathleen M Connell  9 , Tiffany J Braley  3 , Sarah A Stoddard  4
Affiliations

Resilience, mental health, sleep, and smoking mediate pathways between lifetime stressors and Multiple Sclerosis severity

Carri S Polick et al. medRxiv. .

Update in

Abstract

Intro: Lifetime stressors (e.g., poverty, violence, discrimination) have been linked to Multiple Sclerosis (MS) features; yet mechanistic pathways and relationships with cumulative disease severity remain nebulous. Further, protective factors like resilience, that may attenuate the effects of stressors on outcomes, are seldom evaluated.

Aim: To deconstruct pathways between lifetime stressors and cumulative severity on MS outcomes, accounting for resilience.

Methods: Adults with MS (N=924) participated in an online survey through the National MS Society listserv. Structural Equation Modeling was used to examine the direct and indirect effect of lifetime stressors (count/severity) on MS severity (self-reported disability, relapse burden, fatigue, pain intensity and interference), via resilience, mental health (anxiety and depression), sleep disturbance, and smoking.

Results: The final analytic model had excellent fit (GFI=0.998). Lifetime stressors had a direct relationship with MS severity (β=0.27, p<.001). Resilience, mental health, sleep disturbance, and smoking significantly mediated the relationship between lifetime stressors and MS severity. The total effect of mediation was significant (β=0.45).

Conclusions: This work provides foundational evidence to inform conceptualization of pathways by which stress could influence MS disease burden. Resilience may attenuate effects of stressors, while poor mental health, smoking, and sleep disturbances may exacerbate their impact. Parallel with usual care, these mediators could be targets for early multimodal therapies to improve disease course.

PubMed Disclaimer

Conflict of interest statement

COI statement: The authors of this original work have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Measurement model: impact of Lifetime Stressors on MS Severity mediated by Resilience, Mental Health Issues, Sleep Disturbance and Smoking.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Hartung DM. Health economics of disease-modifying therapy for multiple sclerosis in the United States. Therapeutic Advances in Neurological Disorders. 2021;14:1756286420987031. - PMC - PubMed
    1. Artemiadis AK, Anagnostouli MC, Alexopoulos EC. Stress as a risk factor for multiple sclerosis onset or relapse: a systematic review. Neuroepidemiology. 2011;36(2):109–120. - PubMed
    1. Briones-Buixassa L, Montañés-Masias B, Milà-Villaroel R, et al. The bidirectional effect of stress and functionality in multiple sclerosis and the interaction role of anxiety, coping and social support. Journal of Psychosomatic Research. 2023;170:111375. - PubMed
    1. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine. 1998;14(4):245–258. - PubMed
    1. Grummitt LR, Kreski NT, Kim SG, Platt J, Keyes KM, McLaughlin KA. Association of childhood adversity with morbidity and mortality in US adults: a systematic review. JAMA pediatrics. 2021;175(12):1269–1278. - PMC - PubMed

Publication types