We investigated the risks of depression/anxiety in patients with multiple sclerosis (pwMS) or patients with neuromyelitis optica spectrum disorder (pwNMOSD).
Objectives:
MS/NMOSD cohorts were collected from Korean National Health Insurance Service, using the International Classification of Diseases-10th and information on Rare Intractable Disease program. Patients who were younger than 20 years, had a previous depression/anxiety, or died in the index year were excluded.
Methods:
Hazard ratios (HRs) of depression/anxiety in pwMS and pwNMOSD from controls matched 1:5 for age, sex, hypertension, diabetes, and dyslipidemia were calculated using Cox regressions with a 1-year lag period and estimated over time.
Results:
During a mean follow-up of 4.1 years, adjusted hazard ratios (aHR) for depression were 3.25 (95% confidence interval (CI) = 2.59–4.07) in MS and 2.17 (1.70–2.76) in NMOSD, and aHRs for anxiety were 1.83 (1.49–2.23) in MS and 1.56 (1.26–1.91) in NMOSD. The risks of anxiety/depression did not differ between MS and NMOSD and were highest in the second year after diagnosis of MS/NMOSD. The relative risk of depression was higher in younger pwMS/pwNMOSD, and the relative risk of anxiety was higher in pwMS who was male, had low income, or lived in a non-urban area.
Conclusion:
The risk of depression and anxiety was increased in pwMS/pwNMOSD.
MarrieRAFiskJDYuBN, et al. Mental comorbidity and multiple sclerosis: Validating administrative data to support population-based surveillance. BMC Neurol2013; 13: 16.
2.
BarzegarMMirmosayyebONehzatN, et al. Frequency of comorbidities in neuromyelitis optica spectrum disorder. Mult Scler Relat Disord2021; 48: 102685.
3.
RaskindMA. Diagnosis and treatment of depression comorbid with neurologic disorders. Am J Med2008; 121: S28–S37.
4.
FeinsteinA. An examination of suicidal intent in patients with multiple sclerosis. Neurology2002; 59: 674–678.
5.
FernándezVCAlonsoNMelamudL, et al. Psychiatric comorbidities and suicidality among patients with neuromyelitis optica spectrum disorders in Argentina. Mult Scler Relat Disord2018; 19: 40–43.
6.
HauerLPerneczkyJSellnerJ. A global view of comorbidity in multiple sclerosis: A systematic review with a focus on regional differences, methodology, and clinical implications. J Neurol2021; 268(11): 4066–4077.
7.
JohanssonVLundholmCHillertJ, et al. Multiple sclerosis and psychiatric disorders: Comorbidity and sibling risk in a nationwide Swedish cohort. Mult Scler2014; 20(14): 1881–1891.
8.
HoangHLaursenBStenagerEN, et al. Psychiatric co-morbidity in multiple sclerosis: The risk of depression and anxiety before and after MS diagnosis. Mult Scler2016; 22(3): 347–353.
9.
HuangYCChienWCChungCH, et al. Risk of psychiatric disorders in multiple sclerosis: A nationwide cohort study in an Asian population. Neuropsychiatr Dis Treat2021; 17: 587–604.
10.
ChavarroVSMealyMASimpsonA, et al. Insufficient treatment of severe depression in neuromyelitis optica spectrum disorder. Neurol Neuroimmunol Neuroinflamm2016; 3(6): e286.
11.
NakazawaKNodaTIchikuraK, et al. Resilience and depression/anxiety symptoms in multiple sclerosis and neuromyelitis optica spectrum disorder. Mult Scler Relat Disord2018; 25: 309–315.
12.
ShiZChenHLianZ, et al. Factors that impact health-related quality of life in neuromyelitis optica spectrum disorder: Anxiety, disability, fatigue and depression. J Neuroimmunol2016; 293: 54–58.
13.
De VausJHornseyMJKuppensP, et al. Exploring the East-West divide in prevalence of affective disorder: A case for cultural differences in coping with negative emotion. Pers Soc Psychol Rev2018; 22(3): 285–304.
14.
ShinDWChoBGuallarE. Korean National Health Insurance database. JAMA Intern Med2016; 176: 138.
15.
IwagamiMShinozakiT. Introduction to matching in case–control and cohort studies. Ann Clin Epidemiol2022; 4: 33–40.
16.
KimJEParkSHHanK, et al. Prevalence and incidence of neuromyelitis optica spectrum disorder and multiple sclerosis in Korea. Mult Scler2020; 26(14): 1837–1844.
17.
KwonSJungSYHanKD, et al. Risk of Parkinson’s disease in multiple sclerosis and neuromyelitis optica spectrum disorder: A nationwide cohort study in South Korea. J Neurol Neurosurg Psychiatry. Epub ahead of print 28 July 2022. DOI: 10.1136/jnnp-2022-329389
18.
ChoEBYeoYJungJH, et al. Risk of stroke in multiple sclerosis and neuromyelitis optic spectrum disorder: A nationwide cohort study in South Korea. J Neurol Neurosurg Psychiatry. Epub ahead of print 26 August 2022. DOI: 10.1136/jnnp-2022-329628
19.
PolmanCHReingoldSCEdanG, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald criteria.”Ann Neurol2005; 58(6): 840–846.
20.
WingerchukDMBanwellBBennettJL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology2015; 85: 177–189.
21.
WingerchukDMLennonVAPittockSJ, et al. Revised diagnostic criteria for neuromyelitis optica. Neurology2006; 66: 1485–1489.
22.
SkiltonMRMoulinPTerraJL, et al. Associations between anxiety, depression, and the metabolic syndrome. Biol Psychiatry2007; 62: 1251–1257.
23.
MarazzitiDRutiglianoGBaroniS, et al. Metabolic syndrome and major depression. CNS Spectr2014; 19: 293–304.
24.
ParkMJYooJHanK, et al. High body weight variability is associated with increased risk of depression: A nationwide cohort study in South Korea. Psychol Med2023; 53: 3719–3727.
25.
JungWKimMJeonHJ, et al. Assessment of disability and depression following amputation among adults in Korea. JAMA Netw Open2023; 6: e2320873.
26.
BarzegarMBadihianSMirmosayyebO, et al. Comparative study of quality of life, anxiety, depression, and fatigue among patients with neuromyelitis optica spectrum disorder and multiple sclerosis: The first report from Iran. Mult Scler Relat Disord2018; 22: 161–165.
27.
PattenSBBeckCAWilliamsJV, et al. Major depression in multiple sclerosis: A population-based perspective. Neurology2003; 61: 1524–1527.
28.
Sabanagic-HajricSSuljicEMemic-SerdarevicA, et al. Quality of life in multiple sclerosis patients: Influence of gender, age and marital status. Mater Sociomed2022; 34(1): 19–24.
29.
NajjarSPearlmanDMAlperK, et al. Neuroinflammation and psychiatric illness. J Neuroinflammation2013; 10: 43.
30.
SteinerJBogertsBSarnyaiZ, et al. Bridging the gap between the immune and glutamate hypotheses of schizophrenia and major depression: Potential role of glial NMDA receptor modulators and impaired blood-brain barrier integrity. World J Biol Psychiatry2012; 13(7): 482–492.
31.
PucakMLCarrollKAKerrDA, et al. Neuropsychiatric manifestations of depression in multiple sclerosis: Neuroinflammatory, neuroendocrine, and neurotrophic mechanisms in the pathogenesis of immune-mediated depression. Dialogues Clin Neurosci2007; 9(2): 125–139.
32.
OrmstadHSimonsenCSBrochL, et al. Chronic fatigue and depression due to multiple sclerosis: Immune-inflammatory pathways, tryptophan catabolites and the gut-brain axis as possible shared pathways. Mult Scler Relat Disord2020; 46: 102533.
33.
LonginettiEFrisellTEnglundS, et al. Risk of depression in multiple sclerosis across disease-modifying therapies. Mult Scler2022; 28(4): 632–641.
34.
BrownESChandlerPA. Mood and cognitive changes during systemic corticosteroid therapy. Prim Care Companion J Clin Psychiatry2001; 3(1): 17–21.
35.
MakhaniNTremlettH. The multiple sclerosis prodrome. Nat Rev Neurol2021; 17: 515–521.
36.
MarrieRAWalldRBoltonJM, et al. Rising incidence of psychiatric disorders before diagnosis of immune-mediated inflammatory disease. Epidemiol Psychiatr Sci2019; 28(3): 333–342.
37.
DisantoGZeccaCMacLachlanS, et al. Prodromal symptoms of multiple sclerosis in primary care. Ann Neurol2018; 83(6): 1162–1173.
38.
TheaudinMRomeroKFeinsteinA. In multiple sclerosis anxiety, not depression, is related to gender. Mult Scler2016; 22: 239–244.
39.
KorostilMFeinsteinA. Anxiety disorders and their clinical correlates in multiple sclerosis patients. Mult Scler2007; 13(1): 67–72.
40.
SternBZStroberLDeLucaJ, et al. Subjective well-being differs with age in multiple sclerosis: A brief report. Rehabil Psychol2018; 63(3): 474–478.
41.
KarimiSAndayeshgarBKhatonyA. Prevalence of anxiety, depression, and stress in patients with multiple sclerosis in Kermanshah-Iran: A cross-sectional study. BMC Psychiatry2020; 20: 166.
42.
BeiskeAGSvenssonESandangerI, et al. Depression and anxiety amongst multiple sclerosis patients. Eur J Neurol2008; 15(3): 239–245.
43.
AyzenbergIRichterDHenkeE, et al. Pain, depression, and quality of life in neuromyelitis optica spectrum disorder: A cross-sectional study of 166 AQP4 antibody-seropositive patients. Neurol Neuroimmunol Neuroinflamm2021; 8(3): e985.
44.
Brønnum-HansenHStenagerENylev StenagerE, et al. Suicide among Danes with multiple sclerosis. J Neurol Neurosurg Psychiatry2005; 76(10): 1457–1459.
45.
HyunJWLeeHLJeongWK, et al. Comparison of MOG and AQP4 antibody seroprevalence in Korean adults with inflammatory demyelinating CNS diseases. Mult Scler2021; 27(6): 964–967.
46.
KimSHMealyMALevyM, et al. Racial differences in neuromyelitis optica spectrum disorder. Neurology2018; 91: e2089–e2099.
47.
AmezcuaLMcCauleyJL. Race and ethnicity on MS presentation and disease course. Mult Scler2020; 26(5): 561–567.
