*4.1. Demographic and Social Factors*

In the study group, the perceived level of stress was higher in younger and female patients, and the latter used emotion-focused coping strategies more often than males. Similar relationship between age and distress caused by the pandemic was observed in MS subjects [1,11,12,29] and in healthy adults [15,16]. Although elderly persons are regarded to be at greater risk of severe COVID-19 infection, their perception of stress is probably modified by memory of past experiences and regulation of emotion [16,29]. Moreover, in comparison with young adults, they are less burdened with work or family obligations and less frequently use internet social media as a source of information about the pandemic [1,12]. It is worth considering that both higher PSS-10 score and lower mean age were found in those who responded to the online version of our survey, in comparison with respondents to the printed version. Sex differences in perception of pandemic stress were consistently reported for general populations [15,16,27]. Although female and male MS subjects presented with a similar level of depression and anxiety [11], women more often expressed fear of COVID-19 infection and tended to avoid exposure [30]. It should be

noted that due to greater disease prevalence in women, they constitute the majority of all the investigated MS groups, which may affect the findings.

Other demographic factors, including residence and education level, did not affect the level of stress or coping model in our MS group. Apart from the lower level of anxiety in MS patients with academic degree [11], no such relationships were found by other authors, either. However, a high proportion of those with completed university education among the respondents to our survey might have had some impact upon the results, e.g., with regard to coping. Although vocational status was not related to stress or coping, those of our respondents who experienced work-related or financial problems (ca. 1/3) due to epidemic restrictions declared significantly higher levels of stress. The pandemic's impact on the employment situation of our respondents included changes in type or schedule of work, as well as loss of job. Even more detrimental consequences were reported for MS patients in U.S. [30,31]. In the Italian MS subjects, unemployment during the pandemic significantly contributed to depression and anxiety [2]. Changes in employment (including remote work) and lower income level were considered as factors substantially mediating pandemic stress in healthy adults [15]. Vocational activity is an important element of MS patients' social functioning, often adversely affected by the disease. Current but also long-term work-related problems, resulting from pandemic restrictions, might significantly worsen their economic situation as well as psychosocial condition [31]. These issues should be addressed with adequate system of support and counseling.

Similar observations concerned a family situation of MS subjects in the study group. Level of stress and coping preferences did not depend on marital status or dependents, but the pandemic impact upon family life, reported by almost half of the respondents, caused an increased level of stress. Family-related concerns included emotional issues, as well as logistic problems with consequences of lockdown. A forced social distance which prevented relationships was shown to affect stress and well-being in MS patients [14]. On the other hand, more time spent at home with family or partners resulted in positive impacts on their mood and sexual satisfaction [23].
