title: The impact of stressful life events on risk of relapse in women with multiple sclerosis: a prospective study.
abstract: OBJECTIVE
  The aims of this study were first, to examine the general relation between stressful life events (SLEs) and clinical relapses in women with multiple sclerosis (MS) and second, to investigate the relations of the specific stressor attributes of duration, type, and severity on MS exacerbations.
  
  
  METHODS
  Twenty six ambulating women with relapsing-remitting MS were followed-up for a mean of 56.3 weeks. Patients documented SLEs weekly in self report diaries which were then collected at regular pre-scheduled clinic visits every 4 weeks. SLEs were classified as short-term if they had subjectively no lasting effect and long-term if they had a subjectively felt psychological impact that lasted at least 10-14 days after the event. The severity of SLEs was determined using the Recent Life Change Questionnaire.
  
  
  RESULTS
  Experiencing three or more SLEs, during a 4-week period, was associated with a 5-fold increase of MS relapse rate (95% CI 1.7-16.4, p=0.003). The presence of at least one long-term SLE was associated with three times (95% CI 1.01-9.13, p<0.05) the rate of MS exacerbation during the following 4 weeks. There was no significant association between the severity (95% CI 0.99-1.01, p>0.05) or the type (chi2=7.29, df=5, p>0.05) of stressor and the risk for relapse.
  
  
  CONCLUSIONS
  Ambulatory women with relapsing-remitting MS who experience cumulative SLEs may be at a greater risk for relapse. Duration is the only stress attribute that seems to increase the risk for relapsing in contrast to stress type and stress severity that were not found to interact with MS exacerbation.
authors.affiliation: 1st Department of Psychiatry, Athens University Medical School, Eginition Hospital, 7, Metamorfoseos Street, GR-15234 Halandri, Athens, Greece. ectorcenter@yahoo.gr
authors.forename: Charalampos I
authors.initials: CI
authors.lastname: Mitsonis
authors.forename: Iannis M
authors.initials: IM
authors.lastname: Zervas
authors.forename: Panagiotis A
authors.initials: PA
authors.lastname: Mitropoulos
authors.forename: Nikolaos P
authors.initials: NP
authors.lastname: Dimopoulos
authors.forename: Constantin R
authors.initials: CR
authors.lastname: Soldatos
authors.forename: Constantin M
authors.initials: CM
authors.lastname: Potagas
authors.forename: Constantin A
authors.initials: CA
authors.lastname: Sfagos
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires