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

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.