1. HEALTH PROMOTION, INTEGRAL CARE AND SOCIAL INCLUSION
Grup de Recerca en Salut Mental i Innovació Social (SaMIS) - Centre d’Estudis Sanitaris i Socials – Uvic-UCC
Consorci Hospitalari de Vic
Parc Sanitari Sant Joan de Deu
Stress and Multiple Sclerosis: a systematic review considering potential moderating factors and methods of assessing stress
Briones-Buixassa, L.
Milà, R.
Aragonès, J.M.
Bufill, E.
Olaya, B.
Arrufat, F.X.
Background
Methodology
Conclusions
Multiple Sclerosis (MS) is a chronic, progressive, auto- immune disease that affects 2,3 million people around the world. It is a complex disease that probably involves multiple genes and environmental factors like stress (Artemiadis, 2011).
Research about the effects of stress on MS has yielded contradictory results. Some studies have reviewed articles published on the relationship between stress and MS finding a consistent association but insufficient for reasonable medical certainty (Artemiadis et al., 2011; Mohr et al., 2004).
All these reviews focused on the main results of the studies, but none examined the results in function of the way stress was measured or of potential moderators and mediators.
The Web of Knowledge (MEDLINE AND Web of Science), Scopus, and PsychINFO databases were searched for relevant articles published from 1900 through December 2014 using the terms «stress*» and «multiple sclerosis». To obtain additional eligible articles, we also examined the reference lists of the articles located.
The process was done following PRISMA statements (Moher et al. 2009)
Selection criteria: flow diagram
Prospective studies with self-reported evaluations are the best approach.
Patients’ subjective appraisal of the stress could be an important predictor of MS relapse and onset.
The greatest amplifying or buffering effects on stress come from factors directly related to the amount of stress and Autonomic Nervous System reactivity.
Future studies should clarify the biological mechanisms involved with biofeedback technology and genetic evaluation.
Including moderating factors in stress-MS studies can provide information that might be useful for treating patients, since some factors are potentially modifiable.
Identification
Screening
Eligibility
Included
Records identified through database searching
(n = 5,030)
Additional records identified through other sources
(n = 11)
Full-text articles assessed for eligibility
(n = 212)
Studies included in qualitative synthesis
(n = 23)
Records excluded (full-text not available, book chapters, abstracts of conference, reviews, and dissertations)
(n = 124)
Records screened
(n = 336)
Records after duplicates removed
(n = 4,605)
Records excluded (titles not relevant)
(n = 4,269)
Full-text articles excluded
(n = 189)
5 were published in other languages
122 did not measure psychosocial stress
53 did not evaluate MS
2 was stress-interventional study
7 were animal studies
Bibliography
Artemiadis et al Stress as a risk factor for multiple sclerosis onset or relapse: A systematic review. Neuroepidemiology;36:109–20.
Moher, D., & The Prisma Group Preferred reporting items for systematic reviews and meta-analyses: The Prisma statement. PLoS Med 6(7).
Mohr, D.C. et al Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis. BMJ;328:731.
Objective
The present study aims to review the evidence on the association between stress and MS, focusing on the methods used to evaluate whether stress affects MS and the role of potential moderator and mediator factors on this association. This knowledge can be useful for the design of future studies and for developing better interventions in MS patients.
Findings
Twenty-three articles were included. Studies focused on the effect of stress on MS onset (n=9) were mostly retrospective and semi- structured interviews and scales yielded the most consistent associations. Studies focused on MS progression (n=14) were mostly prospective, and self-reported diaries yielded the most consistent results.
The most important moderating and mediating factors were stressor duration, severity, and frequency, cardiovascular reactivity and heart rate, and social support and escitalopram intake.