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The burden of mental comorbidity in multiple sclerosis: frequent, underdiagnosed, and undertreated

Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada rmarrie{at}hsc.mb.ca

R Horwitz

Department of Medicine, Stanford University, Stanford, California, USA

G Cutter

Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA

T Tyry

Division of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA

D Campagnolo

Division of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA

T Vollmer

Department of Neurology, University of Colorado, Denver, Colorado, USA

Background

Mental comorbidity is common in multiple sclerosis (MS), but some studies suggest that mental comorbidity may be underrecognized and undertreated.

Objective

Using the North American Research Committee on MS Registry, we assessed the frequency of mental comorbidities in MS and sociodemographic characteristics associated with diagnosis and treatment of depression.

Methods

We queried participants regarding depression, anxiety, bipolar disorder, and schizophrenia. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD); a score 21 indicated probable major depression.

Results

Mental comorbidity affected 4264 (48%) responders; depression most frequently (4012, 46%). Among participants not reporting mental comorbidity, 751 (16.2%) had CESD scores 21 suggesting undiagnosed depression. Lower socioeconomic status was associated with increased odds of depression (Income $15,000–30,000 vs >$100,000 OR 1.34; 1.11–1.62), undiagnosed depression (Income $15,000–30,000 vs >$100,000 OR 1.52; 1.08–2.13), and untreated depression (<high school vs postgraduate degree OR 3.13; 1.65–5.99).

Conclusions

Mental comorbidity remains underdiagnosed and undertreated in MS. Patients of lower socioeconomic status bear a disproportionate share of the burden of depression.

Key Words: comorbidity • depression • multiple sclerosis • psychiatry • socioeconomic status

This version was published on March 1, 2009

Multiple Sclerosis, Vol. 15, No. 3, 385-392 (2009)
DOI: 10.1177/1352458508099477


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