Abstract
Background: Multiple sclerosis (MS) affects approximately 2.5 million individuals worldwide, with an increase in the annual incidence of the disease of seven new cases per 100,000. This study was conducted to identify the factors contributing to MS relapse in Saudi Arabia.
Methodology: The study was conducted throughout Saudi Arabia using an online survey with the help of a database for MS patients provided by “Arfa” MS Society in Saudi Arabia, from February to April 2019. A total of 378 MS patients were targeted. Susceptibility was verified by a positive history of an MS relapse with the help of the 2-part Assessing Relapse in MS questionnaire. This was a self-report assessment tool that was developed with the help of many expert MS nurses worldwide.
Results: Of 378 study participants, 51.92% of the patients mentioned that the reason for their relapse was stress and anxiety. Depression and low mood have been reported by 32.37% of the patients. Stopping medications became the cause of relapse in 19.23% of the patients, followed by seasonal changes in 14.74%, vitamin D deficiency in 15.20%, and physical effort 11.21% although 43.91% of the patients could not identify the cause of their relapse.
Conclusion: Stress and anxiety have been the most reported cause of MS, followed by depression and low mood. This emphasizes the rule of psychological factors on the progression of the disease and the need for a multidisciplinary team to help the patients cope with anxiety and depression.

Key words: Multiple sclerosis (MS), relapse, depression, anxiety, Saudi Arabia