Stressful life events and the risk of initial central nervous system demyelination.
BACKGROUND
There is substantial evidence that stress increases multiple sclerosis disease activity, but limited evidence on its association with the onset of multiple sclerosis.


OBJECTIVE
To examine the association between stressful life events and risk of first demyelinating event (FDE).


METHODS
This was a multicentre incident case-control study. Cases ( n = 282 with first diagnosis of central nervous system (CNS) demyelination, including n = 216 with 'classic FDE') were aged 18-59 years. Controls without CNS demyelination ( n = 558) were matched to cases on age, sex and study region. Stressful life events were assessed using a questionnaire based on the Social Readjustment Rating Scale.


RESULTS
Those who suffered from a serious illness in the previous 12 months were more likely to have an FDE (odds ratio (OR) = 2.35 (1.36, 4.06), p = 0.002), and when we limited our reference group to those who had no stressful life events, the magnitude of effect became stronger (OR = 5.41 (1.80, 16.28)). The total stress number and stress load were not convincingly associated with the risk of an FDE.


CONCLUSIONS
Cases were more likely to report a serious illness in the previous 12 months, which could suggest that a non-specific illness provides an additional strain to an already predisposed immune system.
Menzies Institute for Medical Research, Hobart, TAS, Australia.
Alice
A
Saul
Murdoch Childrens Research Institute, Parkville, VIC, Australia.
Anne-Louise
AL
Ponsonby
Research School of Population Health, National Centre for Epidemiology & Population Health, Australian National University, Canberra, ACT, Australia.
Robyn M
RM
Lucas
Menzies Institute for Medical Research, Hobart, TAS, Australia.
Bruce V
BV
Taylor
Menzies Institute for Medical Research, Hobart, TAS, Australia.
Steve
S
Simpson
QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
Patricia
P
Valery
International Agency for Research on Cancer, Lyon, France.
Terence
T
Dwyer
Centre for Neuroscience, The University of Melbourne, Parkville, VIC, Australia.
Trevor J
TJ
Kilpatrick
School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
Michael P
MP
Pender
Menzies Institute for Medical Research, Hobart, TAS, Australia.
Ingrid Af
IA
van der Mei
D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D016022:Case-Control Studies; D003711:Demyelinating Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000523:psychology*; D005260:Female; D006801:Humans; D015994:Incidence; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000523:psychology*; D016017:Odds Ratio; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
First demyelinating event; first clinical diagnosis; multiple sclerosis; risk factors; stress; stressful life events