Childhood trauma may affect treatment adherence in MS patients

Childhood trauma may make it harder for people with multiple sclerosis (MS) to consistently adhere to their treatment plans and establish a strong relationship with their physician, according to a study in Italy.

Researchers also found that much of the association between adverse experiences in early life and lower medication adherence was explained by a poorer physician-patient relationship.

Establishing a strong relationship between patients and their physicians could therefore help overcome that negative effect of childhood trauma, suggesting that communication and trust may be important targets for improving long-term MS care.

“Our results underscore the importance of considering relational and psychological dimensions within routine clinical management, as they may represent modifiable targets to improve adherence and optimize long-term care in this population,” researchers wrote.

The study, “Childhood trauma and treatment compliance in people with multiple sclerosis: The mediating role of physician–patient rapport,” was published in Multiple Sclerosis and Related Disorders.

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In MS, an autoimmune disease, consistently taking the prescribed treatments is key for controlling disease activity and improving long-term outcomes. However, cognitive, behavioral, and psychiatric symptoms may make it harder for patients to engage with their healthcare team and follow treatment plans.

“As in other neuroinflammatory and autoimmune diseases, [childhood trauma] is recognized as playing a possible role in determining the disease and its course, severity and management of MS, but this role has been scarcely studied,” the researchers wrote.

Childhood trauma has been linked to difficulties with trust, emotional regulation, and relationships with healthcare providers, all of which may also affect treatment decisions and follow-up. However, “there are still limited data on the role of [childhood trauma] and its relational consequences in influencing treatment adherence,” the researchers wrote.

To investigate this, a team of researchers in Italy conducted an observational study to assess whether childhood trauma affected treatment adherence, and whether the patient-physician relationship mediated this potential link.

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More severe childhood trauma linked to lower medication adherence

A total of 205 adults with MS, followed up at a single MS center in Rome between December 2024 and December 2025, were enrolled in the study. Participants had a mean age of 38.36 years, were mostly women (75.1%), and had relapsing forms of MS.

Almost 80% were receiving high-efficacy disease-modifying therapies, while 13.7% were given moderate- or low-efficacy medications and 6.8% were not receiving treatment. High-efficacy therapies are newer medications that more effectively reduce MS activity and slow disease progression, although they may carry greater safety risks.

Participants completed validated questionnaires assessing childhood trauma (The Childhood Trauma Questionnaire-Short Form, or CTQ-SF), the quality of the patient-physician relationship (relationship part of the Medical Interview Satisfaction Scale), and medication adherence (Morisky Medication Adherence Scale). CTQ-SF evaluates adverse experiences like emotional, physical, and sexual abuse, as well as emotional and physical neglect.

Overall, participants reported relatively low-to-moderate levels of childhood trauma, but a high chance of idealization of childhood or potential underreporting. Patients also reported generally positive relationships with their physicians, and medium to high adherence to their MS treatments.

Statistical analyses showed that more severe or more frequent childhood trauma was significantly associated with lower medication adherence and poorer physician-patient relationships. This meant that patients reporting more childhood trauma were significantly less likely to consistently take their medication and to report higher levels of trust and connection with their physicians.

Physicians should be increasingly aware of the potential presence of [childhood trauma] in patients with MS … and consider incorporating [childhood trauma] assessment into clinical evaluation to identify patients who may benefit from targeted psychological interventions.

In addition, better physician-patient relationships were significantly associated with higher treatment adherence.

Further analyses demonstrated that the quality of the physician-patient relationship partly explained the link between childhood trauma and low medication adherence, suggesting that early adverse experiences may influence treatment-taking behaviors by affecting trust and communication with healthcare providers.

According to the researchers, childhood trauma is likely underrecognized in routine MS care, yet it may influence how patients engage with healthcare providers and follow prescribed treatments. They suggested that recognizing these experiences could help identify people who may benefit from additional psychological support.

“Physicians should be increasingly aware of the potential presence of [childhood trauma] in patients with MS … and consider incorporating [childhood trauma] assessment into clinical evaluation to identify patients who may benefit from targeted psychological interventions,” the team wrote.

The use of self-reported measures, which prevent the establishment of a cause-and-effect relationship, was pointed out by the researchers as a limitation of this study.

“Future studies should investigate whether targeted psychological interventions for people with MS and a history of [childhood trauma] may improve treatment adherence and clinical outcomes,” they concluded.