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The risk of multiple sclerosis in bereaved parents

A nationwide cohort study in Denmark

From the Danish Epidemiology Science Centre (Drs. Li and Olsen), Department of Epidemiology and Social Medicine, University of Aarhus; Department of Psychosocial Cancer Research (Dr. Johansen), Institute of Cancer Epidemiology, Danish Cancer Society, National Institute of Public Health (H. Brønnum–Hansen), and Danish Multiple Sclerosis Registry (Drs. Stenager and Koch–Henriksen), Rigshospitalet 7013, Copenhagen; MS Clinic in Esbjerg and Vejle (Dr. Stenager), Department of Neurology, Esbjerg; and Department of Neurology (Dr. Koch–Henriksen), Aarhus University Hospital, Aalborg, Denmark.

Address correspondence and reprint requests to Dr. J. Li, Danish Epidemiology Science Centre, University of Aarhus, Vennelyst Boulevard 6, DK-8000, Denmark; e-mail: jl{at}soci.au.dk

Background: Previous studies have suggested that psychological stress may play a role in the risk of multiple sclerosis (MS), but the evidence is very limited.

Objective: To examine the association between MS and a well-defined major stressful life event: the death of a child.

Methods: In this follow-up study based on nationwide and population-based registers, all 21,062 parents who lost a child younger than 18 years from 1980 to 1996 in Denmark were included in the exposed cohort and 293,745 matched parents who did not lose a child in the unexposed cohort. The two cohorts were followed for incident MS from 1980 to 1997. Hazard ratios (HR) with 95% CI were calculated as the measure of association between the exposure and MS, using the Cox proportional hazards regression model.

Results: Two hundred fifty-eight MS patients were identified (28 in the exposed cohort and 230 in the unexposed cohort). The exposed parents had an increased risk of MS (HR 1.56, 95% CI 1.05 to 2.31), which is significant only when follow-up was at least 8 years. The HR for definite/probable MS was 1.42 (95% CI 0.90 to 2.24). Parents who lost a child unexpectedly had an HR of 2.13 (95% CI 1.13 to 4.03) for all MS, which is higher than that for other bereaved parents (HR 1.33; 95% CI 0.81 to 2.16).

Conclusion: Psychological stress may play a role in the development of MS.

Received September 20, 2003. Accepted in final form November 13, 2003.

This work was performed in the Danish Epidemiology Science Centre, Department of Epidemiology and Social Medicine, University of Aarhus, Denmark.

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