This longitudinal study is aimed at a holistic assessment of stress experienced by the multiple sclerosis (MS) patient. Specific objectives are: (A) to identify intrapersonal (physiological, psychological, sociocultural, and developmental) stressors experienced by the patient; (b) to identify interpersonal stressors occurring for the patient with MS; (c) to identify extrapersonal stressors in the MS patient's micro- and macroenvironment; and (d) to examine identified stressors singly, and in combination, for their effects on symptom exacerbation in the MS patient. Seventy-five voluntary community residents with definitive diagnoses of MS will be interviewed to obtain information about overall adjustment to MS and perceived stressful life experiences and will be re-interviewed during each of the following three years. As subjects will serve as their own controls, a repeated measures design will be used. On a monthly basis, subjects will be interviewed by telephone to elicit information about habitat, diet, emotional responses, recent medical history, changes in MS symptoms, date of last physician visit, and identify their greatest problem area or stress. Information pertaining to anticipated problems or stressors will also be elicited. In the event of MS symptom increase, confirmation from the examining neurologist will be sought. After matching subjects by age, sex, location and diagnostic type, a stepwise regression analysis using group membership as the dependent variable (i.e., those who have had, as opposed to those who did not have, an exacerbation) will be used to identify predictors of the MS event. Dates of MS exacerbations will also be used to determine recurrent weather phenomena via time series analysis and computer cartographic techniques. The results of this study should yield data that give indications of what stressors could be patient-managed and those which should be referred to others. These data should assist nurses to anticipate behavioral and biological mechanisms underlying human responses to actual, or potential, problems in the MS patient. Additionally, it will have important implications for the patients themselves. Once stressor types are identified, educational programs utilizing knowledge generated from this study may contribute to maintenance of the MS patient's current mobility status and possibly extend quality of life.
