Symptom overlap in anxiety and multiple sclerosis

Abstract

Background:

The validity of self-rated anxiety inventories in people with multiple sclerosis (pwMS) is unclear. However, the appropriateness of self-reported depression scales has been widely examined. Given somatic symptom overlap between depression and MS, research emphasises caution when using such scales.

Objective:

This study evaluates symptom overlap between anxiety and MS in a group of 33 individuals with MS, using the Beck Anxiety Inventory (BAI).

Methods:

Participants underwent a neurological examination and completed the BAI.

Results:

A novel procedure using hierarchical cluster analysis revealed three distinct symptom clusters. Cluster one (‘wobbliness’ and ‘unsteady’) grouped separately from all other BAI items. These symptoms are well-recognised MS-related symptoms and we question whether their endorsement in pwMS can be considered to reflect anxiety. A modified 19-item BAI (mBAI) was created which excludes cluster one items. This removal reduced the number of MS participants considered ‘anxious’ by 21.21% (low threshold) and altered the level of anxiety severity for a further 27.27%.

Conclusion:

Based on these data, it is suggested that, as with depression measures, researchers and clinicians should exercise caution when using brief screening measures for anxiety in pwMS.

Keywords

Multiple sclerosis anxiety Beck Anxiety Inventory symptom overlap neuropsychology

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References

Johnson

The neuropsychology of multiple sclerosis. Dis Mon 2007; 53: 172–176.

Siegert

Abernethy

Depression in multiple sclerosis: a review. J Neurol Neurosurg Psychiatry 2005; 76: 469–475.

Patten

Metz

Depression in multiple sclerosis. Psychother Psychosom 1997; 66: 286–292.

Beck

Steer

. Manual for the Beck Depression Inventory. San Antonio, TX: Psychological Corporation, 1993.

Mohr

Goodkin

Likosky

. Identification of Beck Depression Inventory items related to multiple sclerosis. J Behav Med 1997; 20: 407–414.

Benedict

RHB

Fishman

McClellan

. Validity of the Beck Depression Inventory-Fast Screen in multiple sclerosis. Mult Scler 2003; 9: 393–396.

Beck

Steer

Brown

BDI-Fast Screen for medical patients: manual. San Antonio, TX: Psychological Corporation, 2000.

Honarmand

Feinstein

Validation of the Hospital Anxiety and Depression Scale for use with multiple sclerosis patients. Mult Scler 2009; 15: 1518–1524.

Zigmond

Snaith

The Hospital Anxiety and Depression Scale. Acta Neurol Scand 1983; 67: 361–370.

10.

Nyenhuis

Rao

Zajecka

. Mood disturbance versus other symptoms of depression in multiple sclerosis. J Int Neuropsychol Soc 1995; 1: 291–296.

11.

Nyenhuis

Rao

Zajecka

. The development and initial validation of the Multiscale Depression Inventory for use with multiple sclerosis patients. Paper presented at the meeting of the International Neuropsychological Society, Galveston, TX, 1993.

12.

Beiske

Svensson

Sandanger

. Depression and anxiety amongst multiple sclerosis patients. Eur J Neurol 2008; 15: 239–245.

13.

Korostil

Feinstein

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

14.

Galeazzi

Ferrari

Giaroli

. Psychiatric disorders and depression in multiple sclerosis outpatients: impact of disability and interferon beta therapy. Neurol Sci 2005; 26: 255–262.

15.

Kessler

The national comorbidity survey of the United States. Int Rev Psychiatry 1994; 6: 365–376.

16.

Feinstein

O’Connor

Gray

. The effects of anxiety on psychiatric morbidity in patients with multiple sclerosis. Mult Scler 1999; 5: 323–326.

17.

Beck

Epstein

Brown

. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56: 893–897.

18.

Nicholl

Lincoln

Francis

. Assessment of emotional problems in people with multiple sclerosis. Clin Rehabil 2001; 15: 657–668.

19.

Nicholl

Lincoln

Francis

. Assessing quality of life in people with multiple sclerosis. Disabil Rehabil 2001; 23: 597–603.

20.

Beck

Steer

. Relationship between the Beck Anxiety Inventory and the Hamilton Anxiety Rating Scale with anxious outpatients. J Anxiety Disord 1991; 5: 213–223.

21.

Morin

Landreville

Colecchi

. The Beck Anxiety Inventory: Psychometric Properties with Older Adults. J Clin Geropsychol 1991; 5: 19–29.

22.

Creamer

Foran

Bell

The Beck Anxiety Inventory in a non-clinical sample. Behav Res Ther 1995; 33: 477–485.

23.

Beeney

Arnett

Endorsement of self-report neurovegetative items of depression is associated with multiple sclerosis disease symptoms. J Int Neuropsychol Soc 2008; 14: 1057–1062.

24.

Aitkens

Reinecke

Pliskin

. Assessing depressive symptoms in multiple sclerosis: is it necessary to omit items from the original Beck Depression Inventory? J Behav Med 1999; 22: 127–142.

25.

Strober

Arnett

Assessment of depression in multiple sclerosis: development of a ‘trunk’ and ‘branch’ model. Clin Neuropsychol 2010; 24: 1146–1166.

26.

Beck

Steer

. Manual for the Beck Anxiety Inventory. San Antonio, TX: Psychological Corporation, 1993.

27.

Kurtzke

Rating neurologic impairment in multiple sclerosis. Neurology 1983; 33: 1444–1452.

28.

Hair

Black

Babin

. Multivariate data analysis: a global perspective. 7th ed. New Jersey: Pearson Education, 2010.

29.

Polman

Reingold

Edan

. Diagnostic criteria for multiple sclerosis: 2005 revisions to the ‘McDonald Criteria’. Ann Neurol 2005; 58: 840–846.

30.

Frzovic

Morris

Vowels

Clinical tests of standing balance: performance of persons with multiple sclerosis. Arch Phys Med Rehab 2000; 81: 215–221.

31.

Sharrack

Hughes

The Guy’s Neurological Disability Scale (GNDS): a new disability measure for multiple sclerosis. Mult Scler 1999; 5: 223–233.