Stress-reducing activities in multiple sclerosis: Determinants of engagement and associations with 5-year clinical outcomes and quality of life.

Abstract

Stress may exacerbate neuroinflammation and symptom burden in people with multiple sclerosis (pwMS). Engaging in stress-reducing activities (SRAs), such as meditation and mind-body practices, may reduce inflammation thereby improve health outcomes. The objective of the study was to assess determinants of SRAs use and prospective associations with health outcomes. Data from 952 pwMS were analysed over a 5-year follow-up. Meditation and other SRAs were queried as a part of a survey of demographic, clinical, and lifestyle factors and categorised as: meditation; other SRAs; meditation + SRAs; or none. Baseline determinants of SRAs engagement at 5-year were examined using multivariable models. Prospective associations between baseline SRAs use and 5-year disability, fatigue, depression, and quality of life (QoL), were estimated using log-binomial and linear regression, adjusted for relevant covariates. University education, both lower than average and higher than average socioeconomic status, high quality diet, regular physical activity, vitamin D exposure, non-smoking, and clustering of ≥3 healthy behaviours predicted higher engagement with SRAs. Employment and obesity predicted lower use. Meditation practice alone was associated with a reduced 5-year risk of depression (aRR = 0.49, 95% CI: 0.24-0.97), and when combined with SRAs were associated with higher emotional QoL (aβ = 3.22, 95% CI: 0.21-6.23). Engagement in meditation and other SRAs is socially patterned and prospectively associated with improved mental health outcomes in pwMS. Addressing barriers to engagement may support more equitable integration of stress-management strategies within MS care.