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

Abstract

OBJECTIVE

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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  • Authors+Show Affiliations

    ,

    Department of Psychiatry, University of California, San Francisco, CA 94142, USA. dmohr@itsa.ucsf.edu

    , , ,

    Source

    BMJ (Clinical research ed.) 328:7442 2004 Mar 27 pg 731

    MeSH

    Humans
    Life Change Events
    Multiple Sclerosis
    Risk Factors
    Stress, Psychological
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.
    Review

    Language

    eng

    PubMed ID

    15033880

    Citation

    Mohr, David C., et al. "Association Between Stressful Life Events and Exacerbation in Multiple Sclerosis: a Meta-analysis." BMJ (Clinical Research Ed.), vol. 328, no. 7442, 2004, p. 731.
    Mohr DC, Hart SL, Julian L, et al. Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis. BMJ. 2004;328(7442):731.
    Mohr, D. C., Hart, S. L., Julian, L., Cox, D., & Pelletier, D. (2004). Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis. BMJ (Clinical Research Ed.), 328(7442), p. 731.
    Mohr DC, et al. Association Between Stressful Life Events and Exacerbation in Multiple Sclerosis: a Meta-analysis. BMJ. 2004 Mar 27;328(7442):731. PubMed PMID: 15033880.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis. AU - Mohr,David C, AU - Hart,Stacey L, AU - Julian,Laura, AU - Cox,Darcy, AU - Pelletier,Daniel, Y1 - 2004/03/19/ PY - 2004/3/23/pubmed PY - 2004/4/13/medline PY - 2004/3/23/entrez SP - 731 EP - 731 JF - BMJ (Clinical research ed.) JO - BMJ VL - 328 IS - 7442 N2 - OBJECTIVE: 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. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/15033880/full_citation L2 - http://www.bmj.com/cgi/pmidlookup?view=long&amp;pmid=15033880 DB - PRIME DP - Unbound Medicine ER -