General psychiatric support warranted in MS patients

Nov 3 2015

By Lucy Piper, Senior medwireNews Reporter

Multiple sclerosis (MS) has a nonspecific effect on psychiatric morbidity, increasing the risk of all psychiatric disorders, shows a large population-based study.

“From a policy perspective, this implies the need for general psychiatric support rather than illness-specific strategies”, say researcher Ruth Ann Marrie (University of Manitoba, Winnipeg, Canada) and colleagues.

The results, published in Neurology, showed that the incidence and prevalence of anxiety, bipolar disorder, depression and schizophrenia, measured from 1995 to 2005, were higher in a group of 44,452 patients with MS than in 220,849 healthy individuals matched for age, gender and geographical area.

The age-standardised incidence of depression was 71% higher in the MS population than in the matched population, while the age-standardised prevalence was 79% higher. For anxiety, the corresponding differences were 42% and 58% and for bipolar disorder and schizophrenia they were 99% and 107% and 74% and 11%, respectively.

The researchers report that the incidence of all psychiatric comorbidities was stable over time, with the exception of a decline in schizophrenia, while prevalence increased slightly.

“Prevalence may increase despite stable incidence because of earlier diagnosis or improving survival”, notes the team.

“We also assumed that our incident cases became prevalent cases for the entire study period, consistent with the current conceptualization of each of these disorders as lifelong, recurrent conditions.”

Women, who comprised 71.3% of the MS patients, had a higher incidence and prevalence of depression, anxiety disorder and bipolar disorder than men, and this was true for the matched population also, whereas the rates for schizophrenia were higher among men than women.

The researchers note, however, that men face a greater risk of depression when they develop MS than do women. The disparity in depression incidence between women and men was smaller in patients with MS than it was in the general population, in that depression incidence was 26% higher for women than men among those with MS but 50% higher among those without the condition.

This corresponded to a 93% higher incidence of depression among men with MS versus those without the condition, compared with a 59% higher incidence among women.

“This finding requires replication in other population-based cohorts,” say the researchers, “but its implications for clinical management of MS are considerable.”

They add: “Examination of the underlying reasons, such as lower perceived levels of social support, lower self-efficacy, or fewer health-seeking behaviors among men with MS, is warranted.”

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