Is psychological stress a predisposing factor for amyotrophic lateral sclerosis (ALS)? An online international case-control study of premorbid life events, occupational stress, resilience and anxiety

Psychological stress has been suggested to be relevant to the pathogenesis of neurodegenerative disorders, possibly via the generation of oxygen free radicals. We therefore sought to determine whether people with amyotrophic lateral sclerosis (ALS) had been subjected to more potentially stressful life events or occupations than controls, and whether they had differences in resilience or trait anxiety that would moderate their responses to these stressors. An online anonymous multilingual questionnaire was used to collect data on significant life events from people with and without ALS, using items from a modified Social Readjustment Rating Scale and from self-described significant events, which were combined to create a Life Events Inventory. Inventory scores were subdivided into 0–20 years and 21–40 years age ranges, and for the preceding 2, 5 and 10 years. Respondents also rated levels of stress experienced during different occupations. Resilience was measured using the Connor-Davidson Resilience Scale, and trait anxiety with a modified Geriatric Anxiety Inventory. Scores were compared using nonparametric statistics. Data from 400 ALS (251 male, 149 female) and 450 control (130 male, 320 female) respondents aged 40 years and over showed that Life Events Inventory scores were similar in male ALS respondents and controls, but lower in female ALS respondents than female controls for the preceding 5-year and 10-year periods. Occupational stress did not differ between ALS respondents and controls. Both male and female ALS respondents had higher resilience scores than controls. Anxiety scores did not differ between ALS and control groups. In conclusion, people with ALS reported no raised levels of potentially stressful premorbid life events or occupational stress, and did not have reduced levels of resilience, or increased levels of anxiety, that would augment the deleterious effects of stressors. On the contrary, ALS respondents had higher resilience than controls, though this conclusion relies on ALS respondents recalling their premorbid status. These results do not support the hypothesis that psychological stress from significant life events or occupational stress plays a role in the pathogenesis of ALS.