Polick Carri S, Braley Tiffany J, Ploutz-Snyder Robert, Connell Cathleen M, Watson Ali, Stoddard Sarah A
School of Nursing, Duke University, Durham, NC 27710, USA.
Durham VA Medical Center, Durham, NC 27705, USA.
Explor Neuroprotective Ther. 2024;4(2):158-171. doi: 10.37349/ent.2024.00077. Epub 2024 Apr 22.
Childhood stressors can increase adult stress perception and may accumulate over the lifespan to impact symptoms of multiple sclerosis (MS). Growing evidence links childhood stressors (e.g., abuse, neglect) to fatigue, pain, and psychiatric morbidity in adults with MS; yet literature in this area is lacking a comprehensive lifespan approach. The aim of this cross-sectional study was to examine contributions of childhood and adulthood stressor characteristics (i.e., count, severity), on three individual outcomes: fatigue, pain interference, and psychiatric morbidity in People with MS (PwMS).
An online survey was distributed through the National MS Society. Hierarchical block regression modeling was used to sequentially assess baseline demographics, childhood stressors, and adult stressors per outcome. We hypothesized that child and adult stressors would significantly contribute to fatigue, pain interference, and psychiatric morbidity.
Overall, 713 PwMS informed at least one final analytic model. Both childhood and adult stressors significantly contributed to pain interference and psychiatric morbidity. Adult stressor severity independently correlated with psychiatric morbidity ( < 0.0001). Childhood stressors significantly contributed to fatigue (LR test < 0.0001). Childhood stressor severity independently significantly correlated with both fatigue likelihood ( = 0.03) and magnitude ( < 0.001).
This work supports a relationship between stressors across the lifespan and fatigue, pain, and psychiatric morbidity in PwMS. Stressor severity may have an important role which may not be captured in count-based trauma measurement tools. Clinicians and researchers should consider lifetime stress when addressing fatigue, pain, and psychiatric morbidity among PwMS.
童年期应激源可增加成人的应激感知，且可能在整个生命周期中累积，从而影响多发性硬化症（MS）的症状。越来越多的证据表明，童年期应激源（如虐待、忽视）与成年MS患者的疲劳、疼痛及精神疾病发病率有关；然而，该领域的文献缺乏一种全面的生命周期研究方法。这项横断面研究的目的是检验童年期和成年期应激源特征（即数量、严重程度）对MS患者（PwMS）的三个个体结局的影响：疲劳、疼痛干扰和精神疾病发病率。
通过美国国家MS协会开展了一项在线调查。采用分层块回归模型依次评估每个结局的基线人口统计学特征、童年期应激源和成年期应激源。我们假设儿童期和成年期应激源会显著导致疲劳、疼痛干扰和精神疾病发病率。
总体而言，713名PwMS患者至少为一个最终分析模型提供了信息。童年期和成年期应激源均显著导致疼痛干扰和精神疾病发病率。成年期应激源的严重程度与精神疾病发病率独立相关（<0.0001）。童年期应激源显著导致疲劳（似然比检验<0.0001）。童年期应激源的严重程度与疲劳可能性（=0.03）和程度（<0.001）均独立显著相关。
这项研究支持了整个生命周期中的应激源与PwMS患者的疲劳、疼痛和精神疾病发病率之间的关系。应激源的严重程度可能具有重要作用，这可能无法在基于计数的创伤测量工具中体现出来。临床医生和研究人员在处理PwMS患者的疲劳、疼痛和精神疾病发病率时应考虑一生的应激情况。
