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

• Published in: Multiple sclerosis Vol. 15; no. 3; pp. 385 - 392
• Main Authors: Marrie, RA, Horwitz, R, Cutter, G, Tyry, T, Campagnolo, D, Vollmer, T
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-03-2009; Sage Publications; Sage Publications Ltd
• Subjects: Adult; Anxiety Disorders - diagnosis; Anxiety Disorders - epidemiology; Anxiety Disorders - therapy; Biological and medical sciences; Bipolar Disorder - diagnosis; Bipolar Disorder - epidemiology; Bipolar Disorder - therapy; Comorbidity; Cost of Illness; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Depressive Disorder - diagnosis; Depressive Disorder - epidemiology; Depressive Disorder - therapy; Educational Status; Female; Humans; Male; Medical sciences; Mental Disorders - diagnosis; Mental Disorders - epidemiology; Mental Disorders - therapy; Middle Aged; Multiple Sclerosis - epidemiology; Multiple Sclerosis - psychology; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Multivariate Analysis; Neurology; Registries; Schizophrenia - diagnosis; Schizophrenia - epidemiology; Schizophrenia - therapy; Social Class; Surveys and Questionnaires; comorbidity; depression; psychiatry; socioeconomic status; multiple sclerosis; Mood disorder; Concomitant disease; Nervous system diseases; Multiple sclerosis; Socioeconomic status; Polypathology; Central nervous system disease; Depression; Degenerative disease; Psychiatry; Inflammatory disease
• ISSN: 1352-4585; 1477-0970
• DOI: 10.1177/1352458508099477

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.