Neurological disability,psychological distress,and health-related quality of life in MS patients within the first three years after diagnosis

Abstract

Background

Psychological distress and psychiatric co-morbidity are common in multiple sclerosis (MS) and is often associated with neurological disability as well as reduced quality of life.

Objectives

This study aimed to investigate psychological distress and the possible association with quality of life as well as neurological disability in MS patients within the first 3 years after diagnosis.

Methods

Psychological distress was measured using a standardized questionnaire (Symptom-Check-List-90-R; SCL-90-R) in 31 relapsing–remitting MS patients and 24 sex- and age-matched healthy controls.

Results

Psychological distress was significantly more pronounced in MS patients when compared to healthy controls. Interpersonal sensitivity and psychoticism were positively associated with neurological disability (Expanded Disability Status Scale [EDSS]). A high EDSS group (median split EDSS; 1.5) expressed significantly more psychological distress when compared to the low EDSS group and healthy controls. MS patients with minimal to no neurological disability (low EDSS group) also expressed significantly more emotional distress when compared to healthy controls. MS-related quality of life was positively associated with neurological disability as well as SCL-90-R scores. After adjusting for neurological disability, psychological distress was still significantly associated with quality of life.

Conclusions

Early stage MS patients significantly differ in their psychological distress when compared to healthy controls. Psychological distress in these patients is associated with neurological disability, but it is also present in patients with minimal to no neurological disability. Psychological distress was identified as an independent predictor for MS-related quality of life.

Keywords

anxiety depression EDSS multiple sclerosis neurological disability psychiatric symptoms psychological distress quality of life stress

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References

1 Ghaffar O Feinstein A . The neuropsychiatry of multiple sclerosis: a review of recent developments. Curr Opin Psychiatry 2007; 20: 278–285.

2 Figved N Klevan G Myhr KM . Neuropsychiatric symptoms in patients with multiple sclerosis. Acta Psychiatr Scand 2005; 112: 463–468.

3 Minden SL Orav J Reich P . Depression in multiple sclerosis. Gen Hosp Psychiatry 1987; 9: 426–434.

4 Chwastiak L Ehde DM Gibbons LE Sullivan M Bowen JD Kraft GH . Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am J Psychiatry 2002; 159: 1862–1868.

5 Sadovnick AD Remick RA Allen J . Depression and multiple sclerosis. Neurology 1996; 46: 628–632.

6 Alonso J Angermeyer MC Bernert S . ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders (ESEMeD) Project. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 2004; (Suppl.): 21–27.

7 Kanner AM . Depression in epilepsy: prevalence, clinical semiology, pathogenic mechanisms, and treatment. Biol Psychiatry 2003; 54: 388–398.

8 Korostil M Feinstein A . Anxiety disorders and their clinical correlates in multiple sclerosis patients. Mult Scler 2007; 13: 67–72.

9 Mohr DC Hart SL Fonareva I Tasch ES . Treatment of depression for patients with multiple sclerosis in neurology clinics. Mult Scler 2006; 12: 204–208.

10.

10 Feinstein A Feinstein K . Depression associated with multiple sclerosis. Looking beyond diagnosis to symptom expression. J Affect Disord 2001; 66: 193–198.

11.

11 Lobentanz IS Asenbaum S Vass K . Factors influencing quality of life in multiple sclerosis patients: disability, depressive mood, fatigue and sleep quality. Acta Neurol Scand 2004; 110: 6–13.

12.

12 Janssens AC van Doorn PA de Boer JB . Anxiety and depression influence the relation between disability status and quality of life in multiple sclerosis. Mult Scler 2003; 9: 397–403.

13.

13 Amato MP Ponziani G Rossi F Liedl CL Stefanile C Rossi L . Quality of life in multiple sclerosis: the impact of depression, fatigue and disability. Mult Scler 2001; 7: 340–344.

14.

14 D’Alisa S Miscio G Baudo S Simone A Tesio L Mauro A . Depression is the main determinant of quality of life in multiple sclerosis: a classification-regression (CART) study. Disabil Rehabil 2006; 28: 307–314.

15.

15 Janardhan V Bakshi R . Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. J Neurol Sci 2002; 205: 51–58.

16.

16 Fruehwald S Loeffler-Stastka H Eher R Saletu B Baumhackl U . Depression and quality of life in multiple sclerosis. Acta Neurol Scand 2001; 104: 257–261.

17.

17 McDonald WI Compston A Edan G . Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 2001; 50: 121–127.

18.

18 Kurtzke JF . Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33: 1444–1452.

19.

19 Franke GH; . Symptom-Checkliste von L.R. Derogatis. Deutsche Version. 2. Auflage. Beltz Test GmbH, Göttingen. 2002.

20.

20 Wells KB Golding JM Burnam MA . Psychiatric disorder in a sample of the general population with and without chronic medical conditions. Am J Psychiatry 1988; 145: 976–981.

21.

21 Penner IK Bechtel N Raselli C . Fatigue in multiple sclerosis: relation to depression, physical impairment, personality and action control. Mult Scler 2007; 13: 1161–1167.

22.

22 Smith SJ Young CA . The role of affect on the perception of disability in multiple sclerosis. Clin Rehabil 2000; 14: 50–54.

23.

23 Dalton EJ Heinrichs RW . Depression in multiple sclerosis: a quantitative review of the evidence. Neuropsychology 2005; 19: 152–158.

24.

24 Lynch SG Kroencke DC Denney DR . The relationship between disability and depression in multiple sclerosis: the role of uncertainty, coping, and hope. Mult Scler 2001; 7: 411–416.

25.

25 Beal CC Stuifbergen AK Brown A . Depression in multiple sclerosis: a longitudinal analysis. Arch Psychiatr Nurs 2007; 21: 181–191.

26.

26 Mohr DC Goodkin DE Gatto N Van der Wende J . Depression, coping and level of neurological impairment in multiple sclerosis. Mult Scler 1997; 3: 254–258.

27.

27 Millefiorini E Padovani A Pozzilli C . Depression in the early phase of MS: influence of functional disability, cognitive impairment and brain abnormalities. Acta Neurol Scand 1992; 86: 354–348.

28.

28 Katon W Lin EH Kroenke K . The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry 2007; 29: 147–155.

29.

29 Nortvedt MW Riise T Myhr KM Nyland HI . Quality of life as a predictor for change in disability in MS. Neurology 2000; 55: 51–54.

30.

30 Julian L Merluzzi NM Mohr DC . The relationship among depression, subjective cognitive impairment, and neuropsychological performance in multiple sclerosis. Mult Scler 2007; 13: 81–86.

31.

31 Tsivgoulis G Triantafyllou N Papageorgiou C . Associations of the Expanded Disability Status Scale with anxiety and depression in multiple sclerosis outpatients. Acta Neurol Scand 2007; 115: 67–72.

32.

32 Jones CA Pohar SL Warren S Turpin KV Warren KG . The burden of multiple sclerosis: a community health survey. Health Qual Life Outcomes 2008; 6: 1.

33.

33 Nortvedt MW Riise T Myhr KM Nyland HI . Quality of life in multiple sclerosis: measuring the disease effects more broadly. Neurology 1999; 53: 1098–1103.