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. 2024 Dec;2(4):341-354.
doi: 10.3390/sclerosis2040022. Epub 2024 Oct 30.

Resilience, Mental Health, Sleep, and Smoking Mediate Pathways Between Lifetime Stressors and Multiple Sclerosis Severity

Carri S Polick  1   2 , Hala Darwish  3   4 , Leonardo Pestillo de Oliveira  5 , Ali Watson  6 , Joao Ricardo Nickenig Vissoci  7 , Patrick S Calhoun  2   8 , Robert J 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. Sclerosis. 2024 Dec.

Abstract

Introduction: Lifetime stressors (e.g., poverty, violence, discrimination) have been linked to features of multiple sclerosis (MS); 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 effects 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 an excellent fit (GFI = 0.998). Lifetime stressors had a direct relationship with MS severity (β = 0.27, p < 0.001). Resilience, mental health, sleep disturbance, and smoking significantly mediated the relationship between lifetime stressors and MS severity. The total effect of the mediation was significant (β = 0.45).

Conclusions: This work provides foundational evidence to inform the conceptualization of pathways by which stress could influence MS disease burden. Resilience may attenuate the 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 the disease course.

Keywords: mental health; multiple sclerosis; resilience; sleep; smoking; stress.

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Conflict of interest statement

Conflicts of Interest: The authors declare 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. * p < 0.05. Dotted line means a non-significant relationship.
See this image and copyright information in PMC

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