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      A Large-Scale Study of Anxiety and Depression in People with Multiple Sclerosis: A Survey via the Web Portal of the UK MS Register

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          Abstract

          Introduction

          Studies have found that people with Multiple Sclerosis experience relatively high rates of anxiety and depression. Although methodologically robust, many of these studies had access to only modest sample sizes (N<200). The aims of this study were to use responses gained via the web portal of the UK MS Register (N>4000) to: describe the depression and anxiety profiles of people with MS; to determine if anxiety and depression are related to age or disease duration; and to assess whether the levels of anxiety and depression differ between genders and types of MS.

          Methods

          From its launch in May 2011 to the end of December 2011, 7786 adults with MS enrolled to take part in the UK MS Register via the web portal. The responses to the Hospital Anxiety and Depression Scale (HADS) were collated with basic demographic and descriptive MS data provided at registration and the resulting dataset was analysed in SPSS (v.16).

          Results

          The mean HADS score among the 4178 respondents was 15.7 (SE 0.117, SD 7.55) with a median of 15.0 (IQR 11). Anxiety and depression rates were notably high, with over half (54.1%) scoring ≥8 for anxiety and 46.9% scoring ≥8 for depression. Women with relapsing-remitting MS were more anxious than men with this type ( p<0.001), and than women with other types of MS ( p = 0.017). Within each gender, men and women with secondary progressive MS were more depressed than men or women with other types of MS ( p<0.001, p<0.001).

          Conclusions

          This largest known study of its kind has shown that anxiety and depression are highly prevalent in people with MS, indicating that their mental health needs could be better addressed. These findings support service planning and further research to provide the best care for people with MS to help alleviate these debilitating conditions.

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          Most cited references8

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          The Multiple Sclerosis Impact Scale (MSIS-29): a new patient-based outcome measure.

          J. Höbart (2001)
          Changes in health policy have underlined the importance of evidence-based clinical practice and rigorous evaluation of patient-based outcomes. As patient-based outcome measurement is particularly important in treatment trials of multiple sclerosis, a number of disease-specific instruments have been developed recently. One limitation of these instruments is that none was developed using the standard psychometric approach of reducing a large item pool generated from people with multiple sclerosis. Consequently, an outcome measure for clinical trials of multiple sclerosis that is disease specific and combines patient perspective with rigorous psychometric methods will complement existing instruments. The aim of this study was to develop such a measure. Standard psychometric methods were used. A pool of 129 questionnaire items was generated from interviews with 30 people with multiple sclerosis, expert opinion and literature review. The questionnaire was administered by postal survey to 1530 people selected randomly from the Multiple Sclerosis Society membership database. Redundant items and those with limited measurement properties were removed. The remaining items (n = 41) were grouped into scales using factor analysis, and then refined to form the Multiple Sclerosis Impact Scale (MSIS-29), an instrument measuring the physical (20 items) and psychological (nine items) impact of multiple sclerosis. Five psychometric properties of the MSIS-29 (data quality, scaling assumptions, acceptability, reliability and validity) were examined in a separate postal survey of 1250 Multiple Sclerosis Society members. A preliminary responsiveness study of the MSIS-29 was undertaken in 55 people admitted for rehabilitation and intravenous steroid treatment of relapses. The MSIS-29 satisfied all psychometric criteria. Data quality was excellent, missing data were low (maximum 3.9%), item test-re-test reliability was high (r = 0.65-0.90) and scale scores could be generated for >98% of respondents. Item descriptive statistics, item convergent and discriminant validity, and factor analysis indicated that it was legitimate to generate scores for MSIS-29 scales by summing items. MSIS-29 scales showed good variability, small floor and ceiling effects, high internal consistency (Cronbach's alpha
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            Validation of the Hospital Anxiety and Depression Scale for use with multiple sclerosis patients.

            Detecting clinically significant symptoms of depression and anxiety in medically ill patients using self-report rating scales presents a challenge because of somatic confounders. The Hospital Anxiety and Depression Scale (HADS) was developed with this in mind, but has never been validated for a multiple sclerosis population. Our objective was to validate the HADS for multiple sclerosis patients. Multiple sclerosis patients were interviewed for the presence of major depression (n = 180) and anxiety disorders (n = 140) with the Structured Clinical Interview for DSM-IV disorders. A receiver operating characteristic (ROC) analysis was undertaken to assess which HADS cut-off scores give the best yield with respect to diagnoses of major depression and all anxiety disorders defined by the Structured Clinical Interview for DSM-IV. A threshold score of 8 or greater on the HADS depression subscale provides a sensitivity of 90% and specificity of 87.3% (ROC area under the curve 0.938). The same cut-off score gives a sensitivity of 88.5% and a specificity of 80.7% on the anxiety subscale (ROC area under the curve 0.913), but for generalized anxiety disorder only. The study confirms the usefulness of the HADS as a marker of major depression and generalized anxiety disorder, but not other anxiety disorders, in multiple sclerosis patients.
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              Depression and anxiety amongst multiple sclerosis patients.

              The aim of this study was to investigate the prevalence of symptoms of depression and anxiety amongst multiple sclerosis (MS) patients, and the associations with demographic and clinical characteristics. The current treatment for depression and anxiety was also evaluated amongst the MS patients. A total of 140 MS patients from Eastern Norway underwent neuropsychiatric and clinical examinations, with registration of symptoms of depression and anxiety (Hopkins Symptom Checklist-25), as well as information about any help seeking for depression were obtained. A total of 31.4% patients reported symptoms of depression, whilst 19.3% reported anxiety; both symptoms were significantly higher than that amongst the general population (P < 0.001). Fatigue and younger age at onset were significantly associated with symptoms of depression, whilst fatigue and pain, lower Expanded Disability Status Scale score and younger age at onset were associated with symptoms of anxiety. The proportion of reported treatment of depression was 15.9% and for anxiety 11.1%. Of untreated patients with symptoms, 18.2% expressed the need for treatment. A greater focus on depression and anxiety amongst MS patients is needed to establish the appropriate treatment for patients suffering from MS.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2012
                30 July 2012
                : 7
                : 7
                : e41910
                Affiliations
                [1 ]College of Medicine, Swansea University, Swansea, Wales, United Kingdom
                [2 ]Long Term and Chronic Conditions Centre, College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
                Innsbruck Medical University, Austria
                Author notes

                Conceived and designed the experiments: KHJ DVF PAJ AJ RMM HL-J LAO JGN. Performed the experiments: KHJ DVF PAJ AJ RMM HL-J LAO JGN. Analyzed the data: KHJ DVF PAJ AJ RMM HL-J LAO JGN. Contributed reagents/materials/analysis tools: DVF RMM HL-J. Wrote the manuscript with input and review by all authors: KHJ.

                Competing Interests: The authors have declared that no competing interests exist.

                Article
                PONE-D-12-12082
                10.1371/journal.pone.0041910
                3408498
                22860028
                564a0cd1-f38b-4251-876e-940edc7e3102
                Copyright @ 2012

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 26 April 2012
                : 27 June 2012
                Page count
                Pages: 10
                Funding
                The study is funded by the MS Society of Great Britain and Northern Ireland ( http://www.mssociety.org.uk/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine
                Clinical Research Design
                Cohort Studies
                Epidemiology
                Observational Studies
                Statistical Methods
                Survey Research
                Epidemiology
                Clinical Epidemiology
                Disease Informatics
                Epidemiological Methods
                Disease Mapping
                Lifecourse Epidemiology
                Social Epidemiology
                Survey Methods
                Mental Health
                Psychiatry
                Anxiety Disorders
                Mood Disorders
                Neuropsychiatric Disorders
                Neurology
                Demyelinating Disorders
                Multiple Sclerosis
                Public Health
                Disease Ecology

                Uncategorized
                Uncategorized

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