Association of adverse childhood experiences with the development of multiple sclerosis.

Objective: To study whether exposure to childhood emotional, sexual or physical abuse is associated with subsequent multiple sclerosis (MS) development.
Methods: A nationwide, prospective cohort study based on participants in the Norwegian Mother, Father and Child cohort study. Enrolment took place 1999-2008, with follow-up until 31 December 2018. Childhood abuse before age 18 years was obtained from self-completed questionnaires. We identified MS diagnoses through data-linkage with national health registries and hospital records. The Cox model was used to estimate HRs for MS with 95% CIs, adjusting for confounders and mediators.
Results: In this prospective cohort study, 14 477 women were exposed to childhood abuse and 63 520 were unexposed. 300 women developed MS during the follow-up period. 71 of these (24%) reported a history of childhood abuse, compared with 14 406 of 77 697 (19%) women that did not develop MS. Sexual abuse (HR 1.65, 95% CI 1.13 to 2.39) and emotional abuse (HR 1.40, 95% CI 1.03 to 1.90) in childhood were both associated with an increased risk of developing MS. The HR of MS after exposure to physical abuse was 1.31 (95% CI 0.83 to 2.06). The risk of MS was further increased if exposed to two (HR 1.66, 95% CI 1.04 to 2.67) or all three abuse categories (HR 1.93, 95% CI 1.02 to 3.67).
Interpretation: Childhood sexual and emotional abuse were associated with an increased risk of developing MS. The risk was higher when exposed to several abuse categories, indicating a dose-response relationship. Further studies are needed to identify underlying mechanisms.
Competing Interests: Competing interests: KE has received unrestricted research grant from Novartis. ØT has received speaker honoraria from and served on scientific advisory boards for Biogen, Sanofi-Aventis, Merck and Novartis. AB has received unrestricted research from Novartis. EGC has received honoraria for lecturing and advice from Biogen, Bristol Meyers Squibb, Janssen, Novartis, Merck, Roche and Sanofi, and her department has received grants from Novartis and Sanofi. AKD has received project funding from Pfizer. TH has received speaker honoraria from Biogen, Merck, Novartis, Roche, Bristol Myers Squibb, and Sanofi, and has participated in clinical trials organised by Biogen, Merck, and Roche. K-MM has received unrestricted research grants to his institution; scientific advisory board and speaker honoraria from Biogen, Merck, Novartis, Roche and Sanofi, and has participated in clinical trials organised by Biogen, Merck, Novartis, Roche and Sanofi. CFT has served on scientific advisory board for Astra Zeneca. SW has received honoraria from Biogen, Novartis and Sanofi. NEG has received honoraria from UCB, Ra, Argenx, Roche, Merck, Immunovant, Alexion. M-HB has received personal honoraria for lecturing from Teva, Lilly, Eisai and Novartis, and consultancy honoraria and unrestricted research support from Novartis. Institutional contract research fees from Sanofi.
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