Mohr David C, Hart Stacey L, Julian Laura, Cox Darcy, Pelletier Daniel
Department of Psychiatry, University of California, San Francisco, CA 94142, USA.
BMJ. 2004 Mar 27;328(7442):731. doi: 10.1136/bmj.38041.724421.55. Epub 2004 Mar 19.
To quantify the association between stressful life events and exacerbations of multiple sclerosis.
PubMed, PsychInfo, and Psychological Abstracts searched for empirical papers from 1965 to February 2003 with terms "stress", "trauma", and "multiple sclerosis".
Three investigators independently reviewed papers for inclusion/exclusion criteria and extracted the relevant data, including methods, sample statistics, and outcomes.
Of 20 studies identified, 14 were included. The meta-analysis showed a significant increase in risk of exacerbation in multiple sclerosis after stressful life events, with a weighted average effect size of d = 0.53 (95% confidence interval 0.40 to 0.65), P < 0.0001. The studies were homogenous, Q = 16.62, P = 0.22, I2 = 21.8%. Neither sampling nor study methods had any effect on study outcomes.
There is a consistent association between stressful life events and subsequent exacerbation in multiple sclerosis. However these data do not allow the linking of specific stressors to exacerbations nor should they be used to infer that patients are responsible for their exacerbations. Investigation of the psychological, neuroendocrine, and immune mediators of stressful life events on exacerbation may lead to new behavioural and pharmacological strategies targeting potential links between stress and exacerbation.
量化生活应激事件与多发性硬化症病情加重之间的关联。
检索了PubMed、PsychInfo和《心理学文摘》，查找1965年至2003年2月期间发表的有关“应激”“创伤”和“多发性硬化症”的实证研究论文。
三名研究人员独立审查论文是否符合纳入/排除标准，并提取相关数据，包括研究方法、样本统计数据和研究结果。
在检索到的20项研究中，14项被纳入。荟萃分析显示，生活应激事件后多发性硬化症病情加重的风险显著增加，加权平均效应量d = 0.53（95%置信区间0.40至0.65），P < 0.0001。这些研究具有同质性，Q = 16.62，P = 0.22，I² = 21.8%。抽样方法和研究方法均未对研究结果产生任何影响。
生活应激事件与多发性硬化症随后的病情加重之间存在一致的关联。然而，这些数据无法将特定应激源与病情加重联系起来，也不应据此推断患者应对其病情加重负责。研究生活应激事件对病情加重的心理、神经内分泌和免疫调节因素，可能会带来针对应激与病情加重之间潜在联系的新行为和药理学策略。
