Adverse Childhood Experiences More Common in MS, Study Says

A recent study presented at a multiple sclerosis meeting explored whether adverse childhood experiences (ACEs) are linked with multiple sclerosis (MS) and other immune-mediated inflammatory diseases (IMID).

ACEs encompass exposure to abuse, neglect, violence, mental illness, substance abuse, or parental divorce early in life, or at any time up to age 17. It is already known that ACEs may increase the risk of negative physical and psychiatric health outcomes as adults and worse educational and career opportunities.

The study illustrated that having a history of ACEs is more common in MS and other IMID than in health controls.

A previous study showed a link between MS and ACEs, but the impact of ACEs on psychiatric comorbidity in MS and other IMID is not well-defined, the researchers noted. The present study wanted to see if abuse and neglect are linked with MS and other IMID, including inflammatory bowel disease (IBD) and rheumatoid arthritis (RA).

They also wanted to investigate the relationship between ACEs and psychiatric comorbidity in patients with IMID, and if these relationships differed between MS and other IMID.

The study had 925 participants in 5 cohorts: 232 with MS; 216 with IBD; 130 with RA; 244 with anxiety and depression; and 103 healthy controls.

A structured psychiatric interview was used to identify psychiatric disorders. The validated Childhood Trauma Questionnaire was used to evaluate 5 types of ACEs: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. The associations between ACE, IMID and psychiatric comorbidity were evaluated using multivariable binary and ordinal logistic regression models.

Overall, 66.2% of the participants had ≥1 category of ACE. Healthy controls had an ACEs prevalence of 45.6%, while across the different IMID groups, prevalence was similar (MS, 63.8%; IBD, 61.6%; RA, 62.3%; anxiety/depression, 83.2%).

Only emotional abuse was associated with increased odds of having an IMID (adjusted odds ratio [aOR] 2.37; 1.15-4.89). Presence of any ACE was linked with psychiatric comorbidity in the IMID cohort (OR 2.24; 1.58-3.16), but this association did not change among MS, IBD, and RA.

In those with IMID, total number of ACEs (aOR 1.36; 1.17-1.59) and emotional abuse (aOR 2.64; 1.66-4.21) were independently associated with increased odds of psychiatric diseases.

“Given the high burden of psychiatric disorders in the MS population, clinicians should be aware of the possible contribution of ACE, and the potential need for trauma-informed care strategies in these patients,” the researchers concluded.

Reference

Wan A, Bernstein C, Graff L, et al. Adverse childhood experiences and psychiatric comorbidity in multiple sclerosis and other immune mediated inflammatory disorders. Presented at MSVirtual2020: 8th Joint ACTRIMS-ECTRIMS Meeting; September 11–13, 2020. Poster PO429.