Patients with multiple sclerosis in a war zone: coping strategies associated with reduced risk for relapse

The objective of this article is to examine the role of coping strategies in multiple sclerosis outcomes among civilians under a military attack during the 2006 war between Hezbollah and Israel. Participants were 156 patients with relapsing-remitting multiple sclerosis. We analysed the relationships between coping and emotional distress and between coping and multiple sclerosis exacerbation. We also assessed a model of the relationship between perceived stress, event-related stress, and coping with increased risk of multiple sclerosis exacerbations using multivariate logistic regression. Ways of coping and subjective stress were evaluated by means of structured interviews using questionnaires previously validated. The more distressed our respondents were during the war, the more likely they were to employ a variety of ways of coping. Correlation coefficients between coping scores and perceived war stress ranged from 0.2 to 0.44 (p < 0.001-0.01). Correlation coefficients between the various coping scores and broader indices of distress ranged from 0.28 to 0.5 (p < 0.001). Of the remitting patients during and following the war, 47.1% reported the use of 'direct coping and planning', compared to 16.7% of patients who relapsed during the same period (p = 0.014). 'Direct coping and planning' was negatively related to exacerbation of multiple sclerosis symptoms (OR = 0.1, 95% CI = 0.02-0.5). The Nagelkerke R(2) was 0.26. Our findings point to an association between 'direct coping and planning' and reduced multiple sclerosis relapse rate during wartime. Further research should explore whether the employment of specific ways of coping can reduce the risk for relapse among patients with multiple sclerosis during periods of distress.