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Abstract

Objective:

Several studies have shown that stressful life events are associated with a subsequent significant increase in risk of multiple sclerosis (MS) exacerbations. We wanted to study prospectively whether stress can increase the risk of developing the disease itself.

Methods:

We studied 2 cohorts of female nurses: the Nurses' Health Study (NHS) (n = 121,700) followed from 1976 and the Nurses' Health Study II (NHS II) (n = 116,671) followed from 1989. The risk of MS after self-report on general stress at home and at work in the NHS in 1982 was studied prospectively using Cox regression. Logistic regression was used to retrospectively estimate the effects of physical and sexual abuse in childhood and adolescence collected in the NHS II 2001. We identified 77 cases of MS in the NHS by 2005 and 292 in the NHS II by 2004. All analyses were adjusted for age, ethnicity, latitude of birth, body mass index at age 18, and smoking.

Results:

We found no increased risk of MS associated with severe stress at home in the NHS (hazard ratio 0.85 [95% confidence interval (CI)] 0.32–2.26). No significantly increased risk of MS was found among those who reported severe physical abuse during childhood (odds ratio [OR] 0.68, 95% CI 0.41–1.14) or adolescence (OR 0.77, 95% CI 0.46–1.28) or those having been repeatedly forced into sexual activity in childhood (OR 1.47, 95% CI 0.87–2.48) or adolescence (OR 1.21, 95% CI 0.68–2.17).

Conclusions:

These results do not support a major role of stress in the development of the disease, but repeated and more focused measures of stress are needed to firmly exclude stress as a potential risk factor for MS.

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Information & Authors

Information

Published In

Neurology®
Volume 76Number 22May 31, 2011
Pages: 1866-1871
PubMed: 21624985

Publication History

Received: August 19, 2010
Accepted: February 18, 2011
Published online: May 30, 2011
Published in print: May 31, 2011

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Disclosure

Dr. Riise has received funding for a 1-year research stay at Harvard School of Public Health from the Norwegian Research Council. Dr. Mohr receives research support from the NIH and US Department of Veterans Affairs/HSR&D. Dr. Munger has received funding for travel and speaker honoraria from the Consortium of MS Centers and the National MS Society. Dr. Rich-Edwards receives research support from the NIH and the Society for Epidemiologic Research Developmental Origins of Health and Disease. Dr. Kawachi serves as Senior Editor in Social Epidemiology for Social Science & Medicine and on the editorial board of the American Journal of Epidemiology. Dr. Ascherio served on a scientific advisory board for the Michael J. Fox Foundation; serves on the editorial boards of Neurology®, Annals of Neurology, and the American Journal of Epidemiology; has received speaker honoraria from Merck Serono; and receives research support from the NIH, the US Department of Defense, the Michael J. Fox Foundation, and the National Multiple Sclerosis Society.

Authors

Affiliations & Disclosures

T. Riise, PhD
From the Department of Public Health and Primary Health Care (T.R.), University of Bergen, Bergen; The Norwegian Multiple Sclerosis Competence Centre (T.R.), Haukeland University Hospital, Bergen, Norway; Department of Preventive Medicine (D.C.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Departments of Nutrition (K.L.M., A.A.), Epidemiology (J.W.R.-E., A.A.), and Society, Human Development & Health (I.K.), Harvard School of Public Health, Boston; and Connors Center for Women's Health and Gender Biology (J.W.R.-E.) and Channing Laboratory (A.A.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
D.C. Mohr, PhD
From the Department of Public Health and Primary Health Care (T.R.), University of Bergen, Bergen; The Norwegian Multiple Sclerosis Competence Centre (T.R.), Haukeland University Hospital, Bergen, Norway; Department of Preventive Medicine (D.C.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Departments of Nutrition (K.L.M., A.A.), Epidemiology (J.W.R.-E., A.A.), and Society, Human Development & Health (I.K.), Harvard School of Public Health, Boston; and Connors Center for Women's Health and Gender Biology (J.W.R.-E.) and Channing Laboratory (A.A.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
K.L. Munger, ScD
From the Department of Public Health and Primary Health Care (T.R.), University of Bergen, Bergen; The Norwegian Multiple Sclerosis Competence Centre (T.R.), Haukeland University Hospital, Bergen, Norway; Department of Preventive Medicine (D.C.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Departments of Nutrition (K.L.M., A.A.), Epidemiology (J.W.R.-E., A.A.), and Society, Human Development & Health (I.K.), Harvard School of Public Health, Boston; and Connors Center for Women's Health and Gender Biology (J.W.R.-E.) and Channing Laboratory (A.A.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
J.W. Rich-Edwards, PhD
From the Department of Public Health and Primary Health Care (T.R.), University of Bergen, Bergen; The Norwegian Multiple Sclerosis Competence Centre (T.R.), Haukeland University Hospital, Bergen, Norway; Department of Preventive Medicine (D.C.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Departments of Nutrition (K.L.M., A.A.), Epidemiology (J.W.R.-E., A.A.), and Society, Human Development & Health (I.K.), Harvard School of Public Health, Boston; and Connors Center for Women's Health and Gender Biology (J.W.R.-E.) and Channing Laboratory (A.A.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
I. Kawachi, MD
From the Department of Public Health and Primary Health Care (T.R.), University of Bergen, Bergen; The Norwegian Multiple Sclerosis Competence Centre (T.R.), Haukeland University Hospital, Bergen, Norway; Department of Preventive Medicine (D.C.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Departments of Nutrition (K.L.M., A.A.), Epidemiology (J.W.R.-E., A.A.), and Society, Human Development & Health (I.K.), Harvard School of Public Health, Boston; and Connors Center for Women's Health and Gender Biology (J.W.R.-E.) and Channing Laboratory (A.A.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
A. Ascherio, MD
From the Department of Public Health and Primary Health Care (T.R.), University of Bergen, Bergen; The Norwegian Multiple Sclerosis Competence Centre (T.R.), Haukeland University Hospital, Bergen, Norway; Department of Preventive Medicine (D.C.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Departments of Nutrition (K.L.M., A.A.), Epidemiology (J.W.R.-E., A.A.), and Society, Human Development & Health (I.K.), Harvard School of Public Health, Boston; and Connors Center for Women's Health and Gender Biology (J.W.R.-E.) and Channing Laboratory (A.A.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.

Notes

Address correspondence and reprint requests to Dr. T. Riise, Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, N-5018 Bergen, Norway
Study funding: Supported by the NIH/NINDS (NS042194 and NS046635).

Author Contributions

Statistical analysis was conducted by Dr. T. Riise and Dr. K. Munger.

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