title: Stress and multiple sclerosis: A systematic review considering potential moderating and mediating factors and methods of assessing stress.
abstract: Research about the effects of stress on multiple sclerosis has yielded contradictory results. This study aims to systematically review the evidence focusing on two possible causes: the role of stress assessment and potential moderating and mediating factors. The Web of Knowledge (MEDLINE and Web of Science), Scopus, and PsycINFO databases were searched for relevant articles published from 1900 through December 2014 using the terms "stress*" AND "multiple sclerosis." Twenty-three articles were included. Studies focused on the effect of stress on multiple sclerosis onset (n= 9) were mostly retrospective, and semi-structured interviews and scales yielded the most consistent associations. Studies focused on multiple sclerosis progression (n= 14) were mostly prospective, and self-reported diaries yielded the most consistent results. The most important modifying factors were stressor duration, severity, and frequency; cardiovascular reactivity and heart rate; and social support and escitalopram intake. Future studies should consider the use of prospective design with self-reported evaluations and the study of moderators and mediators related to amount of stress and autonomic nervous system reactivity to determine the effects of stress on multiple sclerosis.
authors.affiliation: Centre d'Estudis Sanitaris i Socials (CESS),Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Briones-Buixassa
authors.affiliation: Centre d'Estudis Sanitaris i Socials (CESS),Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Spain.
authors.forename: Raimon
authors.initials: R
authors.lastname: Milà
authors.affiliation: Consorci Hospitalari de Vic, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Mª Aragonès
authors.affiliation: Consorci Hospitalari de Vic, Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Bufill
authors.affiliation: Parc Sanitari Sant Joan de Déu, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Olaya
authors.affiliation: Centre d'Estudis Sanitaris i Socials (CESS),Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Spain; Consorci Hospitalari de Vic, Spain.
authors.forename: Francesc Xavier
authors.initials: FX
authors.lastname: Arrufat
keywords: moderating and mediating factors; multiple sclerosis; stress; stress evaluation