Psychiatric–Medical ComorbidityValidation study of prevalence and correlates of depressive symptomatology in multiple sclerosis
Introduction
Affecting approximately 400,000 people in the United States and 1 million worldwide, multiple sclerosis (MS) is a chronic, often disabling disease of the central nervous system typically diagnosed between the ages of 20 and 40 [1]. In MS, inflammation, demyelination and neurodegeneration typically lead to combinations of motor, cognitive and/or sensory impairments. Common symptoms can include pain, debilitating fatigue, bowel and bladder incontinence, cognitive impairment, limitations in mobility, spasticity and emotional changes [2].
In a meta-analysis of studies of depression and MS, depressive symptoms were found to be more prevalent among people with MS compared to the general population and individuals with other neurological conditions [3]. In studies of patients with MS at specialty clinics, estimates of the lifetime prevalence of major depressive disorder (MDD) have ranged from 22.8% to 54% [4], [5], [6]. In one of the few epidemiologic studies conducted on this topic, MDD had a 12-month period prevalence of 15.7% in persons with MS, double the prevalence in persons without MS (7.4%) [7]. Although the relationship between depressive symptoms and severity, duration and clinical course of MS is controversial [8], [9], [10], a number of studies have linked depression in MS to a variety of biological, psychosocial and demographic factors: greater neuropathology in the left anterior temporal/parietal regions [11], autoimmune dysregulation [12], [13], endocrine function [14], [15], age less than 35 years and female gender [6]. Disease severity, lack of social support [8], [16], [17], unemployment [6], stress [6], [16], [18] and fatigue [6], [19], [20] have also been associated with depression in MS. Given that depression is known to amplify symptoms in other medical populations [21], it is reasonable to assume this occurs in MS as well, with depressive symptoms adversely affecting cognitive and functional status in MS patients, potentially making it more difficult to manage the disease.
The increased risk of depression in persons with MS has been firmly established, but prevalence of clinically significant depressive symptomatology in MS has primarily been studied in specialty clinics and/or inpatient settings [9]. Hence, many of the reported prevalence estimates and predictors of depression in MS may not accurately represent the true population prevalence or the risk factors in the general population of persons living with MS. Furthermore, little is known about the prevalence and risk factors associated with depression in community dwelling samples from areas/regions outside of MS specialty care centers. Recently, we surveyed a large community sample of individuals with MS living in Western Washington (WW), a primarily urban and suburban region, and found that 41.8% of the sample endorsed a clinically significant level of depressive symptoms and 29.1% had moderate to severe depression symptomology [8]. A clinically significant level of depressive symptoms was associated with higher disease severity, shorter duration of MS, less education, lower age and lack of social support.
Since the publication of our findings in Western Washington, we have administered a similar survey to a large community sample of individuals living in Eastern Washington. Unlike Western Washington, a much higher percentage of Eastern Washington (EW) is defined as rural, small town or large town as defined by the Rural Urban Commuting Area system [22]. This urban–rural difference is important, as there are often many differences between rural and urban residents in terms of demographics, health status and access to specialty health care [23]. The purpose of this study was to validate our previous research findings regarding depressive symptoms and MS by estimating the prevalence of depressive symptoms and identifying the associated disease and social factors in a more rural and geographically distinct community sample.
Section snippets
Participants
A mail survey was sent to 1453 members of the Multiple Sclerosis Association of King County (MSA) between 1999 and 2000 and to 1347 members of the National Multiple Sclerosis Society (NMSS) Inland Northwest Chapter between 2002 and 2003. Information on nonrespondents was not available as surveys were mailed by the MSA and NMSS. Individuals who returned completed surveys and reported having a positive diagnosis of MS were eligible for inclusion. Surveys were completed by 738 eligible individuals
Population differences
The MSA Western Washington and NMSS Eastern Washington samples were significantly different on a number of demographic and disease-related characteristics (Table 1). Of the demographic factors, individuals recruited through the NMSS, who resided in Eastern Washington, were slightly older (P=.0001), more likely to be living in a rural community (P<.0001) or married or living with a significant other (P<.0001), less likely to be employed (P=.001) and less educated (P=.0001) compared to
Discussion
The main objective of this study was to validate previous findings regarding correlates with and prevalence of depressive symptoms in geographically and demographically distinct populations of community-dwelling individuals with MS. The sample examined in this study primarily resided in Eastern Washington, a more rural population than previously studied by Chwastiak et al. [8]. A comparison of the two populations determined that they were different on a number of demographic and disease
Acknowledgments
This project was supported by grants from the National Institute on Disability and Rehabilitation Research (#H133B980017 and #H133B031129).
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2018, PsychosomaticsCitation Excerpt :Without premorbid PHQ-9 scores to serve as comparators, we cannot discern whether or not our results are simply capturing the effect of sex on odds of having depression. It is important to note that although a previous study of risk for depression among patients with neurological diseases in a general medical setting found that women were more likely to develop depression than men,3 these sex difference are not consistently observed in cohorts of patients with epilepsy,32 MS,33,34 or stroke.13 Both stroke and MS patients showed lower predicted probabilities of depression with increasing age; the strength of this association also increased with disease severity.