Polick Carri S, Darwish Hala, de Olivera Leo Pestillo, Watson Ali, Vissoci Joao Ricardo Nickenig, Calhoun Patrick S, Ploutz-Snyder Robert, Connell Cathleen M, Braley Tiffany J, Stoddard Sarah A
School of Nursing, Duke University, Durham, NC, USA.
VA Healthcare System, Durham, NC, USA.
medRxiv. 2024 Feb 7:2024.02.06.24302405. doi: 10.1101/2024.02.06.24302405.
Lifetime stressors (e.g., poverty, violence, discrimination) have been linked to Multiple Sclerosis (MS) features; yet mechanistic pathways and relationships with cumulative disease severity remain nebulous. Further, protective factors like resilience, that may attenuate the effects of stressors on outcomes, are seldom evaluated.
To deconstruct pathways between lifetime stressors and cumulative severity on MS outcomes, accounting for resilience.
Adults with MS (N=924) participated in an online survey through the National MS Society listserv. Structural Equation Modeling was used to examine the direct and indirect effect of lifetime stressors (count/severity) on MS severity (self-reported disability, relapse burden, fatigue, pain intensity and interference), via resilience, mental health (anxiety and depression), sleep disturbance, and smoking.
The final analytic model had excellent fit (GFI=0.998). Lifetime stressors had a direct relationship with MS severity (β=0.27, p<.001). Resilience, mental health, sleep disturbance, and smoking significantly mediated the relationship between lifetime stressors and MS severity. The total effect of mediation was significant (β=0.45).
This work provides foundational evidence to inform conceptualization of pathways by which stress could influence MS disease burden. Resilience may attenuate effects of stressors, while poor mental health, smoking, and sleep disturbances may exacerbate their impact. Parallel with usual care, these mediators could be targets for early multimodal therapies to improve disease course.
终生应激源（如贫困、暴力、歧视）与多发性硬化症（MS）的特征有关；然而，其作用机制以及与累积疾病严重程度的关系仍不明确。此外，很少评估诸如心理韧性等可能减轻应激源对结局影响的保护因素。
剖析终生应激源与MS结局累积严重程度之间的途径，并考虑心理韧性的影响。
患有MS的成年人（N = 924）通过国家MS协会的邮件列表参与了一项在线调查。采用结构方程模型来检验终生应激源（数量/严重程度）通过心理韧性、心理健康（焦虑和抑郁）、睡眠障碍和吸烟对MS严重程度（自我报告的残疾、复发负担、疲劳、疼痛强度和干扰）的直接和间接影响。
最终分析模型拟合良好（GFI = 0.998）。终生应激源与MS严重程度直接相关（β = 0.27，p <.001）。心理韧性、心理健康、睡眠障碍和吸烟显著介导了终生应激源与MS严重程度之间的关系。中介的总效应显著（β = 0.45）。
本研究提供了基础证据，有助于明确应激可能影响MS疾病负担的途径的概念。心理韧性可能减轻应激源的影响，而心理健康不佳、吸烟和睡眠障碍可能会加剧其影响。与常规护理并行，这些中介因素可成为早期多模式治疗的靶点，以改善疾病进程。
