{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T13:10:11Z","timestamp":1782997811428,"version":"3.54.5"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,9,5]],"date-time":"2019-09-05T00:00:00Z","timestamp":1567641600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Stress is a known risk factor for the onset and modulation of disease activity in autoimmune disorders. The aim of this cross\u2010sectional study was to determine any associations between myasthenia gravis (<jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content>) severity and chronic stress, depression and personality type.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In all, 179 consecutive adult patients with confirmed <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content> attending the Neuromuscular Clinic between March 2017 and December 2017 were included. At baseline, patients were assessed clinically and they completed self\u2010administered scales for disease severity, perceived stress, depression and personality type.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Higher disease severity [Myasthenia Gravis Impairment Index (MGII)] showed a moderate correlation with depression score (Beck's Depression Inventory, Second Edition, <jats:italic>r<\/jats:italic>\u00a0=\u00a00.52, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) and a lower correlation with chronic stress (Trier Inventory for Assessment of Chronic Stress, <jats:italic>r<\/jats:italic>\u00a0=\u00a00.28, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.001). Chronic stress scores were different according to personality types (<jats:sc>anova<\/jats:sc>,<jats:italic> P<\/jats:italic>\u00a0=\u00a00.02). The linear regression model with <jats:styled-content style=\"fixed-case\">MGII<\/jats:styled-content> score as the dependent variable showed <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 0.34, likelihood ratio chi\u2010squared 74.55, with <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.0001. The only variables that predicted disease severity were depression scores (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.0001) and female sex (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.003).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A significant association of <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content> severity with depression and chronic stress was found, as well as with female gender. These findings should raise awareness that the long\u2010term management of <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content> should address depression and potential stress and consider behavioural management to prevent stress\u2010related immune imbalance.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.14057","type":"journal-article","created":{"date-parts":[[2019,8,13]],"date-time":"2019-08-13T19:04:16Z","timestamp":1565723056000},"page":"204-209","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Chronic stress, depression and personality type in patients with myasthenia gravis"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6167-9019","authenticated-orcid":false,"given":"A.","family":"Bogdan","sequence":"first","affiliation":[{"name":"Division of Neurology Department of Medicine Ellen and Martin Prosserman Centre for Neuromuscular Diseases University Health Network University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5546-0221","authenticated-orcid":false,"given":"C.","family":"Barnett","sequence":"additional","affiliation":[{"name":"Division of Neurology Department of Medicine Ellen and Martin Prosserman Centre for Neuromuscular Diseases University Health Network University of Toronto Toronto ON Canada"},{"name":"Institute of Health Policy, Management and Evaluation Dalla Lana School of Public Health University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Ali","sequence":"additional","affiliation":[{"name":"National Neuroscience Institute King Fahad Medical City Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"AlQwaifly","sequence":"additional","affiliation":[{"name":"College of Medicine Qassim University Buraidah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9020-2399","authenticated-orcid":false,"given":"A.","family":"Abraham","sequence":"additional","affiliation":[{"name":"Neuromuscular Diseases Unit Department of Neurology Tel Aviv Sourasky Medical Center Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Mannan","sequence":"additional","affiliation":[{"name":"Division of Neurology Department of Medicine Ellen and Martin Prosserman Centre for Neuromuscular Diseases University Health Network University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Ng","sequence":"additional","affiliation":[{"name":"Division of Neurology Department of Medicine Ellen and Martin Prosserman Centre for Neuromuscular Diseases University Health Network University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5805-4883","authenticated-orcid":false,"given":"V.","family":"Bril","sequence":"additional","affiliation":[{"name":"Division of Neurology Department of Medicine Ellen and Martin Prosserman Centre for Neuromuscular Diseases University Health Network University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,9,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmd.2015.10.009"},{"key":"e_1_2_7_3_1","unstructured":"Myasthenia Gravis Foundation of America JamesFHJrMyasthenia gravis \u2013 a summary;2015. 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