title: Stressful life events precede exacerbations of multiple sclerosis.
abstract: 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.
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. ackermankd@msx.upmc.edu
authors.forename: Kurt D
authors.initials: KD
authors.lastname: Ackerman
authors.forename: Rock
authors.initials: R
authors.lastname: Heyman
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Rabin
authors.forename: Barbara P
authors.initials: BP
authors.lastname: Anderson
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Houck
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.forename: Andrew
authors.initials: A
authors.lastname: Baum
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors