title: Relationship between stress and relapse in multiple sclerosis: Part I. Important features.
abstract: OBJECTIVE
  The aim of this two-year prospective study was to examine the relationship between multiple aspects of life-event stress and relapse in multiple sclerosis (MS) patients.
  
  
  BACKGROUND
  Few studies have defined the critical features of this life-event stress; for example, stressor duration, frequency, severity, disease-dependency, valency, or stressor constructs, such as the propensity to cause emotional distress/threat or the frustration of life goals.
  
  
  METHODS
  101 consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. Stressful life events were assessed at study-entry and at three-monthly intervals for two years. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria.
  
  
  RESULTS
  Acute events, but not chronic difficulties (CDs), predicted relapse occurrence: acute stressor frequency counts predicted greater relapse risk, along with low disability score (EDSS) and being male. We also confirmed the bi-directional stress-illness hypothesis: stressors predicted relapse, and relapse separately predicted stressors.
  
  
  CONCLUSIONS
  Life-event stress impacts to a small degree on MS relapse. The number and not the severity of acute stressors are most important; chronic stressors do not predict later relapse. Males and those with early stage disease are also at greater risk of relapse. MS patients should be encouraged to reduce acute stressors during times of high stress, and feel reassured that disease-related chronic stressors do not increase their relapse risk.
authors.affiliation: Department of Psychology, University of New England, Armidale, NSW 2351, 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: D000208:Acute Disease; D000328:Adult; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008016:Life Change Events; 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; D013315:Stress, Psychological / Q000453:epidemiology*