DURHAM, N.C. – Childhood stress may predict pain, fatigue, and mental illness in adults with multiple sclerosis, according to a study led by a Duke Health researcher.

The findings, appearing online October 18 in the journal PLOS ONE, support efforts to integrate trauma-informed care and screenings for stressors into clinical practice. This could help providers better conceptualize patient backgrounds and potential disease trajectories to create personalized approaches to patient care.

“Since the original Adverse Childhood Experiences (ACEs) study in the late 90’s, childhood stress and adversity has been linked to numerous adult health outcomes, including many of the leading causes of mortality in the U.S.,” said lead author Carri Polick, Ph.D., a clinical associate in the Duke University School of Nursing. “This is, in part, due to the physiological stress response and how it sets the tone for how people experience stress and cope over their lifetime.”

Researchers analyzed data from 719 adults with MS who responded to an online self-report survey deployed by the National MS Society. Stressors were categorized into emotional stressors, physical stressors, and environmental stressors. They were then analyzed with hierarchical modeling to show accumulation while retaining insight into specific types of stressors.

This study is unique in that it moves beyond stressors that are traditionally measured, such as abuse and neglect, to capture environmental factors such as housing instability, discrimination, and the impact of living in an unsafe neighborhood. This is also the first study to include nuanced stressor data like duration and severity of exposures within the context of clinical symptoms of MS.

The study found childhood emotional and physical stressors were significantly associated with the presence and severity of both fatigue and pain in adulthood. Environmental, emotional, and physical stressors were significantly associated with mental health challenges including depression, anxiety, PTSD, and other psychiatric disorders.

“From a preventative perspective, teasing out which stressors are potentially most impactful during childhood is important to help inform intervention and policy efforts to decrease the stress experience and promote healthy trajectories from childhood into adulthood,” Polick said. 

Additional authors of the study include Robert Ploutz-Snyder, Tiffany Braley, Cathleen Connell, and Sarah Stoddard.

The study received funding support from the National Institutes of Health (T32NR016914).