The impact of child and adult stressors on multiple sclerosis biopsychosocial disease features

Background: Multiple Sclerosis (MS) is a neuroinflammatory demyelinating autoimmune disease of the central nervous system that disproportionately affects people in North America. Although the etiology and cure remain unknown, interactions among genetic, environmental (e.g., latitude), and behavioral (e.g., smoking) influences are considered contributing factors. The Social Safety Theory offers a pathway from stress to disease through the physiological responses of the inflammation cascade. Through this cascade, childhood stressors have been implicated in the development of many physical health conditions including heart disease, stroke, Alzheimer's disease, obesity, diabetes, and numerous autoimmune diseases. Childhood stressors are also linked with behavioral and mental health outcomes including perceived stress in adulthood and substance use. Adult stress has been associated with MS onset and relapses. Although traumatic stressors have been associated with the development of autoimmune diseases, remarkably few studies (n=5) have investigated the relationship between childhood stressors and MS disease features. Of these studies, none accounted for adult stressors, and few accounted for MS specific covariates.Purpose: The purpose of this cross-sectional study was to evaluate relationships among childhood adversity, adult stressors, and features of MS while accounting for MS specific confounders. Guided by the Social Safety Theory, this work posits that child and adult stressors are social threats which elicit neuroinflammatory responses contributing to MS symptoms.Methods: An electronic invitation was sent to the National MS Society listserv of 80,000 people with MS, and 924 participants successfully completed the survey. The aims of this dissertation include to examine the associations between: 1) cumulative child stressor characteristics (e.g., severity, duration), and cumulative adult stressor characteristics with individual MS disease outcome features;2) child stressor types, grouped by emotional, physical, and environmental, and MS disease features;and 3) individual lifetime stressor type characteristics (e.g., physical danger severity) and MS disease features. Hierarchical block modeling was used for aims 1 and 2 to assess the shared contribution of similar stressors, while multiple regression was used for aim 3.Results: For aim 1, hierarchical block modeling was used to sequentially assess childhood cumulative and adult cumulative stressors in relation to the six MS outcomes. Both child and adult stressors were associated with three outcomes, pain interference, disability, and mental health comorbidity. Only child stressors were associated with fatigue, while only adult stressors were associated with relapse burden changes since Covid-19. The age at symptom onset was not significantly associated with any stressors. For aim 2, hierarchical block modeling was used to sequentially assess childhood stressors, grouped by emotional, physical, and environmental stressors. At least two types of childhood stressors were significantly associated with all MS feature outcomes, except the relapse burden change since Covid-19 which was unaffected by stressors. For aim 3, multiple regression was used to assess cumulative stressors across the lifespan, grouped into five core social-psychological types, and the same six MS features. Stressors were significantly associated with four features, fatigue, pain interference, age at symptom onset, and mental health comorbidity. Stressors did not impact disability or relapse burden change.Conclusions: Findings across all aims fill gaps and advance knowledge in this field. This dissertation supports relationships between stressors experienced across the lifespan and common clinical features of MS. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Pain Interference, Resilience, and Perceived Well-Being During COVID-19: Differences Between Women With and Without Trauma Exposure Prior to the Pandemic.

Objectives: The aim of this study was to investigate the consequences of the COVID-19 pandemic in women with non-malignant chronic pain, and to determine whether women exposed to traumatic situations prior to the outbreak would be at a higher risk of negative health impacts. Methods: A total of 365 women were divided into three subgroups according to whether or not they had experienced a traumatic event prior to COVID-19. They completed an online survey. Results: Significant differences were found between groups during lockdown: 1) more psychological abuse was experienced by the group of women who had experienced an interpersonal traumatic event prior to the pandemic than in the other subgroups; 2) physical activity levels were higher and scores on pain interference were lower in women in the non-traumatized subgroup than in the other subgroups; 3) pain interference was predicted by pain intensity, decreased social support, and resilience, whereas perceived well-being was predicted by pain interference. Conclusion: Women who had experienced a traumatic event prior to the pandemic suffered worse consequences of the COVID-19 lockdown, particularly greater pain interference, although resilience was shown to both mitigate pain interference and enhance perceived well-being.

Introversion, Extraversion, and Worsening of Chronic Pain Impact during Social Isolation: A Mediation Analysis.

COVID-19 social distancing mandates increased social isolation, resulting in changes in pain severity and interference among individuals with chronic pain. Differences in personality (e.g., introversion/extraversion) may modulate responses to social isolation. We examined the influence of introversion on reported social distancing-related increases in pain interference and assessed for mediators of this relationship. Individuals with chronic pain (n = 150) completed validated questionnaires 4-8 weeks after implementation of social distancing mandates. Introversion/extraversion was measured using a subscale of the Myers-Briggs Type Indicator and changes in pain and psychosocial variables were calculated by comparing participants' recalled and current scores. Association between introversion/extraversion and other variables were assessed using linear regression. A parallel mediation was used to examine mediators of the association between introversion and change in pain interference. Higher introversion was associated with a decrease in pain interference after social distancing (Rho = - .194, p = .017). Parallel mediation analysis revealed that the relationship between introversion/extraversion and change in pain interference was mediated by changes in sleep disturbance and depression, such that higher introversion was associated with less isolation-induced sleep disruption and depression, and thereby less worsening of pain interference. These findings suggest that personality factors such as introversion/extraversion should be considered when personalizing treatment of chronic pain.

Profiles of Risk and Resilience in Chronic Pain: Loneliness, Social Support, Mindfulness, and Optimism Coming out of the First Pandemic Year.

OBJECTIVE: Individuals experience chronic pain differently, not only because of different clinical diagnoses, but also because of differing degrees of influence from biopsychosocial pain modulators. We aimed to cluster patients with chronic pain into distinct subgroups based on psychosocial characteristics and pain intensity, and we subsequently examined group differences in pain-related interference approximately 1 year later. METHODS: In this observational, longitudinal study, patients with chronic pain (n = 94) completed validated assessments of psychosocial characteristics and pain intensity at the beginning of COVID-19-related social distancing (April to June 2020). One year later (May to June 2021), patients completed a follow-up survey with assessments of pain interference, loneliness, social support, mindfulness, and optimism. RESULTS: A cluster analysis, using psychosocial factors and pain intensity, empirically produced three patient groups: 1) psychosocial predominant (PSP), characterized by high psychosocial distress and average pain intensity; 2) pain intensity predominant (PIP), characterized by average psychosocial distress and high pain intensity; and 3) less elevated symptoms (LES), characterized by low psychosocial distress and low pain intensity. At the 1-year follow-up, patients in the PSP and PIP clusters suffered greater pain interference than patients in the LES cluster, while patients in the PSP cluster also reported greater loneliness and lower mindfulness and optimism. CONCLUSIONS: An empirical psychosocial-based clustering of patients identified three distinct groups that differed in pain interference. Patients with high psychosocial modulation of pain at the onset of social distancing (the PSP cluster) suffered not only greater pain interference but also greater loneliness and lower levels of mindfulness and optimism, which suggests some potential behavioral targets for this group in the future.