title: Relationship between stress and relapse in multiple sclerosis: Part II. Direct and indirect relationships.
abstract: OBJECTIVE
  The aim of this two-year prospective study was to determine which factors were: (i) directly related and/or (ii) indirectly related to multiple sclerosis (MS) relapse. These factors included life-event stressors, disease, demographic, psychosocial and lifestyle factors.
  
  
  BACKGROUND
  Relatively little attention has been paid to the role of non-clinical relapse predictors (other than stressful life-events) in MS, or factors that indirectly impact on the stress-relapse relationship.
  
  
  METHODS
  A total of 101 consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. Stressful life-events, depression, anxiety and fatigue were assessed at study-entry and at three-monthly intervals for two years. Disease, demographic, psychosocial and lifestyle factors were assessed at baseline. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria.
  
  
  RESULTS
  MS relapse was predicted by acute stressor frequency counts, coping responses that utilized social support, and being born in Australia, but not by chronic stressors, disease, demographic, psychosocial or lifestyle factors. No factors were found to indirectly impact on the stress relapse relationship.
  
  
  CONCLUSIONS
  The number rather than severity of stressors was most important in relation to MS relapse risk, along with coping responses that utilized social support, suggesting that MS patients should avoid situations that are likely to generate multiple stressors or which provide few avenues for social support.
authors.affiliation: Department of Psychology, University of New England, Armidale, NSW, Australia. rhonda.brown@une.edu.au
authors.forename: R F
authors.initials: RF
authors.lastname: Brown
authors.forename: C C
authors.initials: CC
authors.lastname: Tennant
authors.forename: M
authors.initials: M
authors.lastname: Sharrock
authors.forename: S
authors.initials: S
authors.lastname: Hodgkinson
authors.forename: S M
authors.initials: SM
authors.lastname: Dunn
authors.forename: J D
authors.initials: JD
authors.lastname: Pollard
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D003071:Cognition; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000453:epidemiology* / Q000523:psychology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology*