Dec 3, 2002
Depressive symptoms are common among patients with multiple sclerosis (MS) and tend to worsen as the severity of the illness increases, researchers at the University of Washington, Seattle, report.
In the American Journal of Psychiatry for November, Dr. Lydia Chwastiak and associates recommend that clinicians treating MS patients routinely evaluate symptoms of depression just as they would for other aspects of functioning.
Dr. Chwastiak's team mailed surveys to 1374 members of the Multiple Sclerosis Association of King County. Survey responses were obtained from 739 individuals.
The prevalence of depressive symptoms was estimated using the Center for Epidemiological Study Scale for Depression (CES-D Scale). The investigators defined mild depressive symptoms as a score of 16 to 20, moderate symptoms as a score of 21 to 25, and severe depression as a score of 26 to 60. Severity of illness was based on scores on the Expanded Disability Status Scale.
Clinically significant depressive symptoms were seen in 41.8% of responders, and severity of illness was the most significant factor associated with these symptoms.
Compared with those with minimal MS, the odds of reporting symptoms of depression were 3 times higher among those with intermediate illness and 6 times higher for those with advanced illness. About 20% of those with intermediate or advanced MS were judged to be severely depressed.
According to the authors, these rates are higher than those reported for persons with other chronic conditions, including HIV infection.
Based on their findings, Dr. Chwastiak's group believes that "clinicians should be particularly alert to the possibility of depression in patients with recent diagnoses of multiple sclerosis, at times of major change or loss of functioning, and in patients with limited social support."
They add that screening tools such as the CES-D Scale are easy to use and can detect clinically relevant alterations over time.
Am J Psychiatry 2002;159:1862-1868.
© 2002 Reuters Ltd