The Relationship Between Psychosocial Factors And The Onset Of Multiple Sclerosis

BackgroundMultiple Sclerosis(MS) is a T cell-mediated autoimmune diseases which resulted from the interaction of genetic susceptibility individuals and environmental factor, characterized by demyelination pathological changes in white matter in central nervous system.To date,its etiology and pathogenesis remains unclear.The results showed that both at home and abroad,MS genetic susceptibility may be the weak role of the majority of genes the result of the interaction is one of the reasons why the incidence. In addition,the same environmental factors play an important role.Environmental factors including biological and psychosocial two broad categories.Biological environmental factors have viral infections,such as high-latitude cold regions; psycho-social factors,including changes in his life,psychological conflict,such as mental stress.In recent years,domestic and foreign scholars on the MS have a concern on the psychological state of mind,especially in MS patients with depressive symptoms.However,scholars at home and abroad are generally the "psychological barrier as an MS phenomenon of co-morbidity,or one of the symptoms of MS are" as the entry point to study,and in the social and psychological factors in MS onset and relapse of the role research are few.In recent years,,domestic and foreign scholarshave a concern on the relationship between the stress and the onset of MS.But it is obviously too mechanical to attempt reflecting the theory of the working course of many stress factors by one direction or one kind of theory.Anyone will be inevitable affected by related life events.And all the effects are as the degree of stress response at the individual,they are not easily correlate positively to with the number and intensity of stressors.It is more complex for the different individual personal cognitive appraisal,coping style,social support, personality characteristics.According to the cognitive stress theory,the life events is the source of the process.And the psychological stress is neither a simple stimulus, nor a simple reaction,it is a reaction process to affect the individual by the individual cognitive appraisal,social support,coping strategies and other factors.According to the Folkman stress model,the stress process involving in the "stressor","intermediate factor" and the "stress response" that the three factors are interrelated and the constraints each other.In the pathogenesis of MS,psychosocial factors and symptoms are often intertwined with each other and impact on the disease processing and prognosis.In recent years,a growing number of studies have shown that psychosocial factors can mitigate or aggravate the symptoms of diseases by affecting the patient's psychological states,and affecting the progress relapse,prognosis and the prognosis of MS,and finally affect patients health-related life quality and social quality of life quality.It is good for the treatment of psychological intervention the next step to alleviate the symptoms of the MS patients by studying the role on psycho-social factors in occurrence and development of MS.The role of psycho-social factors is extremely complex in the pathogenesis of MS,it can be involved in the pathogenesis of MS as a predisposing factor,but also play an important role in the development of the disease.The stress response occurs as a whole,including the physiological stress response and psychological stress response.The psychological stress response is mainly expressed in the emergence of negative emotion.The physiological stress response is expressed to the physical performance of a series of changes in the process such as physiological, biochemical,endocrine,metabolic and immune.Recent researches on animal model of autoimmune encephalomyelitis of MS show that stress can trigger the occurrence of disease that may work by psychology-nerve intermediation, psychology-nerve-endocrone,psychology-nerve-immune intermediation.The stress not only makes the individual show anxiety,fear,depression,anger,stress and other negative psychological reactions,but also plays a role primarily through the mechanisms such as stimulating activative T cells through the blood-brain barrier, inducing the glucocorticoid resistance that led to the role of anti-inflammatory effects of glucocorticoid is become weakening,it may lead to diseases.The clinical research on the role of psychosocial factors as an independent risk factors or predisposing factor in onset of MS is rarely.The psychological test is based on the theory in this study.To further confirm the above speculation and research prior to a variety of variables about the onset of MS-related,we use standardized psychological tests and multi-factor analysis methods to study the relations between the psychological factors and intermediary factors,study the inherent laws in them.Then we will filter out the relevant risk factors to understand the relationship between the life case,personality characteristics,social support and other psychosocial variables and the mental health of MS,and onset of MS.This will provide a theoretical basis and a direction for the harmless treatment of tress.ObjectTo explore the impact of social and psychological variables on the incidence of patients with multiple sclerosis.All MS patients were consecutively recruited from in-patients in Nanfang Hospital affiliated from Southern Medical University between 2003/4-2009/2. Patients were included in the study only if they fit the criteria and had a definite diagnosis of MS according to McDonald(2001) criteria,not less than 15 years old. They were excluded if they were＜15 years of age,or had a diagnosed psychotic illness(e.g.bipolar disorder),organic brain syndrome(except MS),Cognitive dysfunction or unable to complete questionnaires and interviews.The selected standards of health group are that they are health in the past,there are no abnormal in heart,lung and abdominal checkup,their age≥15 years old.They were excluded if they were＜15 years of age,or had a diagnosed psychotic illness (e.g.bipolar disorder),organic brain syndrome,Cognitive dysfunction or unable to complete questionnaires and interviews. All SLE patients were consecutively recruited from in-patients in Nanfang Hospital between 2007/4-2008/7.Patients were had a definite diagnosis according to the revised chinese diagnostic criteria based on "the revised classification criteria of systemic lupus erythematosus by American Rheumatism Association in 1982".They were excluded if they were＜15 years of age,or had a diagnosed psychotic illness (e.g.bipolar disorder),organic brain syndrome(besides encephalopathy with lupus erythematosus),Cognitive dysfunction or unable to complete questionnaires and interviews.Total 67 MS patients participate in this study,27 males(40.30%) and 40 females (59.70%),aged 17-60 years,average 37.99±12.02(Mean±SD),The education level in MS patients is 2-19 years,average 11.78±7.38(Mean±SD);The duration of illness in MS is 0.08-12.67 years.The control group consists of 27 males(40.30%) and 40 females(59.70%),average age 36.48±10.64(Mean±SD),The education level in MS patients is 2-19 years,average 11.89±4.09(Mean±SD).There are no significance between the two groups in gender(t=-0.000,P=1.000),age(t=0.769,P=0.443), education level(t=0.443,P=0.908)(P＞0.05).There are 42 patients diagnosed with SLE in this study,11 males(26.19%) and 31 females(73.81%),aged 15-62 years,average 32.24±11.90(Mean±SD),The education level in MS patients is 5-16 years,average 11.19±3.44(Mean±SD);The duration of illness in MS is 0.08-11.58 years,average 3.08±3.06(Mean±SD).There are no significance between the MS and SLE groups in gender(t=-1.506,P=0.135), the duration of illness age(t=-1.265,P=0.209),education level(t=0.482,P=0.631) (P＞0.05).But there is significance in age(t=2.439,P=0.016).Evaluate objects of two groups using life event scale(LES),Eysenck Personality Questionnaire(EPQ),Social Support Scale(SSRS) and SCL(SCL-90).Statistics the cumulative scores of life events,positive life events scores,negative life events scores, family-related problem scores,study and work scores,social and other scores in 3 years prior to the onset of MS in Life Events Scale.Statistics P,E,N,L of four subscale scores in EPQ.Statistics social support scores,subjective support scores, objective support scores and Utilization of Social Support scores in SSRS.Statistics sharing scores and the nine factor scores such as mean scores of positive symptoms, somatization,obsessive-compulsive symptoms,interpersonal sensitivity,depression, anxiety,hostility,terror,paranoia,mental illness in SCL-90.SPSS 13.0 software was used to analysis simple t test and correlation between psychosocial factors and MS.A significance level is 0.05(2-tailed).The results express by P value.Since study on the comparison of various indicators between the two groups,there was no need to use the Bonferroni corrections to test the overallαlevel.Results1.The significant differences were found between the MS and healthy groups in their negative emotions and symptoms such as the mean socre of positive symptoms (P=0.000),somatization disorder(P=0.000),obsession(P=0.000),tense interpersonal relationship(P=0.000),depression(P=0.000),anxiety(P=0.000), hostile(P=0.000) and phobia(P=0.000);There are no significant differences in total mean(P=0.274),the mean socre of positive symptoms(P=0.726),obsession (P=0.117),tense interpersonal relationship(P=0.899),depression(P=0.329), anxiety(P=0.528),hostile(P=0.831),phobia(P=0.670),paranoid(P=0.603), psychotic(P=0.952) except somatization disorder(P=0.009) between MS and SLE groups;2.significant differences in total number of positive life events(6.04±10.25) and family problems(24.39±4.76) were found between the MS and healthy groups,the factor scores of life events and social support scale in MS group have no significantly differences Compared with the SLE group(P＞0.05);3.The scores for negative emotions in the MS group correlate positively with those for neuroticisms in personality type,and negatively with those for introverted and extroverted personality traits(Table 3)(P＜0.05);4.A variety of negative emotions in MS group correlate positively to their total number of life events,negative life events and family problems(P＜0.05);5.Many kinds of negative emotions in MS group correlate negatively to the utilization of social supports.But the Correlation coefficient was not high(the highest value is 0.175) and the P value＞0.05,there was no statistical significance between them.Conclusions1.The emotional instability and the tendency of character are related with the emergence of negative emotion in MS patients.2.The scores of negative life events experienced 3 years ago with diseaseare higher than healthy people,especially the effects become more pronounced that brought about by family problems in MS patients.3.There are less stimulating with positive events,less subjective social supports, and lack the capacity of social support for use in MS patients.When the individual is in a state of stress,it may reduce the ability to resist stress,increase the risk of morbidity for lack of the subjective social supportstress to help deal with stress,lack of the availability of external resources to reduce the stress.4.The similar problems exist in various aspects of the impact of stress response in MS patients and SLE patients.It suggested that psychosocial stress may be prompted the autoimmune diseases such as MS,SLE by some mechanism.It is worth further exploration whether this is a common phenomenon in autoimmune diseases,.5.The psychosocial factors are associated with the onset of MS.As one of main factors,it plays an important role on onset of MS.