Review Gives ‘Cautious Support’ to Childhood Trauma as MS Risk Factor
Problems, but relevance, seen in past studies linking early life abuse with disease
Most available studies suggest a connection between childhood trauma and multiple sclerosis (MS), from earlier symptom onset to potentially poorer outcomes, but more research is needed to understand this association, a review paper highlights.
While several high-quality studies have been published, the scientists noted “considerable heterogeneity [variability] in methodology, including inconsistencies in traumatic stressor measurement and MS classification,” the researchers wrote.
Still, “most studies cautiously support a significant relationship between traumatic childhood stressors and either MS prevalence or clinical outcomes, which warrants further investigation,” they added.
The study, “Relationships between childhood trauma and multiple sclerosis: A systematic review,” was published in the Journal of Psychosomatic Research.
MS is thought to be driven by a combination of genetic and environmental factors. Exposure to traumatic situations during childhood, including abuse, neglect, and a chaotic home life, have been suggested to increase the risk of the disease, but whether childhood stressors might also worsen outcomes remains to be fully explored.
Childhood stressor link to MS of growing interest
“Studies examining the relationship between traumatic childhood stressors and adult health outcomes continue to garner much interest. This review contributes to the field by examining the state of the peer reviewed literature linking these stressors and multiple sclerosis and its disease features,” the researchers wrote.
A team led by scientists at the University of Michigan conducted a review of the scientific literature to determine how childhood trauma impacted MS onset and outcomes.
Their analysis included a total of 12 studies. About half specifically focused on MS, while the others included other autoimmune and/or neurological conditions.
The researchers noted “inconsistencies of categorizing MS in some studies” that included MS alongside other conditions. For example, some studies analyzing both autoimmune and neurological diseases would categorize MS as one or the other, when it could fit in both categories.
These studies used a range of measures to assess childhood trauma — some used standardized assessments like the Childhood Trauma Questionnaire–Short Form (CTQ) or the Stress and Adversity Inventory (STRAIN), while others used their own questionnaires or analyzed information available in databases. Each study reported on two to nine specific forms of adverse childhood experiences, most commonly physical or sexual abuse.
“Many of the studies in this review examined a limited number of traumatic stressors and did not capture additional information such as the severity, duration, or frequency. Thus, they are likely under-estimating relationships between childhood trauma and MS,” the scientists wrote.
“Researchers should be careful to include a comprehensive assessment of traumatic stressors in future studies,” they added.
Most studies defined childhood as the entire period before age 18, though some considered childhood and adolescence as separate entities and included experiences up to age 20.
About half of the studies either assessed only one gender, or analyzed all patients together regardless of gender. The researchers noted that this risks significant associations among people of one gender being missed due to non-significant results in another gender.
“Further, a large majority of the studies did not give a non-binary gender option,” potentially introducing “more variability if the most accurate gender option is not available for participants,” the scientists wrote.
“Considering that rates of both MS and traumatic stressors vary by gender, it should be expected that gender data be collected with a non-binary option, and when sample size allows for it, all genders should be evaluated separately in sub-analyses to give more granular information,” they added.
In analyses of the results, most studies made statistical adjustments to account for variations in age and ethnicity. However, only one controlled for latitude of birth and residence, and only one accounted for smoking — both of which are well-established risk factors for MS. Additionally, none of the studies accounted for disease-modifying treatments that patients were using to manage their MS.
“Future work should consider confounders, covariates, and other biopsychosocial clinical features such as sleep, substance use, and comprehensive mental health comorbidity,” the researchers wrote.
Earlier MS onset, poorer outcomes possible
In terms of the results, most of the studies assessed in the review “cautiously support a relationship between childhood trauma and MS or its clinical features,” the researchers said.
The specific associations varied from study to study and depending on the specific type of analysis. For example, one study found a 17% increase in MS risk after experiencing a stressful life event in childhood. Another found that emotional neglect increased the likelihood of MS by twofold, while emotional abuse increased it by 3.4 times.
Some studies also suggested that people with MS who had experienced childhood abuse tended to have an earlier age at symptom onset, higher relapse rates, and a greater tendency toward various mental health problems.
“These findings suggest that there may be significant relationships between childhood trauma and MS risk and physical clinical features. Yet, additional rigorous studies are needed to support these preliminary findings, address the gaps, and expand to other features,” the scientists concluded.
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