Posted by: Thixia | February 19, 2008

Impact on Patients’ Quality of Life and Cognition

Impact on Patients’ Quality of Life and Cognition

Studies examining the impact of stressful life events on MS exacerbations have given conflicting results. However, a study of war stress from the Carmel Medical Center in Haifa, Israel, after the Hezbollah-Israeli war in 2006, showed a significant increase in MS exacerbations compared with similar time periods prior to the war.  

The influence of psychological coping strategies was also examined.Participants in the study were 156 MS patients with relapsing-remitting MS, all residents of northern Israel who were followed regularly at the MS clinic.  The number of severe relapses treated with steroids during and following the war were compared with similar time periods at the preceding year.  

Exposure to war events, resulting subjective stress, and psychological coping strategies were evaluated by means of structured interviews.  The results of the study indicated that 18 relapses occurred compared with 1-7 relapses in similar time periods over the 13 months prior to the war (P = .001-.02, McNemar’s test).

The percentage of patients reporting intense stress among wartime relapse patients compared with remission patients was significant (44% vs 20%, P = .03).  
The percentage of patients reporting high levels of stress from rocket attacks was higher in relapsing patients (67% vs 42%, P = .05).  
Home evacuation stress was higher in relapsing patients (33% vs 11%, P = .02).
Active coping mechanisms, such as planning ahead for home displacement, were used less frequently by patients with relapses (17% vs 47%, P = .01).

Three variables were selected as predictors of wartime relapse by a logistic regression model: subjective sense of stress, distress associated with displacement, and MS relapse in the previous year. Active coping reduced the risk for an exacerbation.  

The conclusions of the study indicated that the risk for an exacerbation is increased by wartime stress but can be reduced with active coping measures. This suggests a role for preventive measures in dealing with stress-related exacerbations.

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