Chronic stress, depression and personality type in patients with myasthenia gravis

A. Bogdan, C. Barnett, A. Ali, M. AlQwaifly, A. Abraham, S. Mannan, E. Ng, V. Bril*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background and purpose: Stress is a known risk factor for the onset and modulation of disease activity in autoimmune disorders. The aim of this cross-sectional study was to determine any associations between myasthenia gravis (MG) severity and chronic stress, depression and personality type. Methods: In all, 179 consecutive adult patients with confirmed MG attending the Neuromuscular Clinic between March 2017 and December 2017 were included. At baseline, patients were assessed clinically and they completed self-administered scales for disease severity, perceived stress, depression and personality type. Results: Higher disease severity [Myasthenia Gravis Impairment Index (MGII)] showed a moderate correlation with depression score (Beck's Depression Inventory, Second Edition, r = 0.52, P < 0.001) and a lower correlation with chronic stress (Trier Inventory for Assessment of Chronic Stress, r = 0.28, P = 0.001). Chronic stress scores were different according to personality types (anova, P = 0.02). The linear regression model with MGII score as the dependent variable showed R2 = 0.34, likelihood ratio chi-squared 74.55, with P < 0.0001. The only variables that predicted disease severity were depression scores (P < 0.0001) and female sex (P = 0.003). Conclusions: A significant association of MG severity with depression and chronic stress was found, as well as with female gender. These findings should raise awareness that the long-term management of MG should address depression and potential stress and consider behavioural management to prevent stress-related immune imbalance.

Original languageEnglish
Pages (from-to)204-209
Number of pages6
JournalEuropean Journal of Neurology
Issue number1
StatePublished - 1 Jan 2020


  • depression
  • myasthenia gravis
  • personality
  • stress


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