Multiple sclerosis in Saudi Arabia: Anxiety, depression and suicidality

Social Anxiety and Obsessive-Compulsive Disorder Are Common Among Persons With Multiple Sclerosis at King Abdulaziz Medical City, Riyadh

Background

Multiple sclerosis (MS) is associated with a physical disability and disturbed psychosocial functioning in young people. Many psychological and psychiatric comorbidities have been reported in MS.

Objective

To determine the frequency of social anxiety disorder (SAD) and obsessive-compulsive disorder (OCD) among MS patients and their relation to MS severity.

Methods

A cross-sectional survey was conducted in an adult MS cohort. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Social Phobia Inventory (SPIN) were used to determine the presence and severity of OCD and SAD. The Statistical Package for the Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY) was used for statistical analysis. The Mann-Whitney U test and logistic regression were used to assess the association of the two diseases with the severity of MS.

Results

A total of 145 persons with MS (pwMS) were studied. The mean age was 33.5 (±8.5) years; the mean duration of MS was 7.2 (± 5.1) years. The majority (74.1%) were women; 57.3% were married; 63% had a college education; 50% belonged to the higher middle-class socioeconomic strata. Relapsing-remitting multiple sclerosis was the most common type of MS (92.2%). The mean Expanded Disability Status Scale (EDSS) score was 2.24 (±2.19). SAD was reported by 26.9%, and OCD was reported by 31% of the cohort. PwMS with walking difficulty but not wheelchair-bound had a statistically significant increased risk of SAD (p = 0.036). There was no direct association between MS-related disability and OCD. However, pwMS with SAD were more likely to have concomitant OCD (t=4.68, p-value <0.001, 95% CI: 0.47-1.16). Increasing disability was associated with higher chances of developing social anxiety and, in turn, OCD (t=3.39, p-value <0.001, 95% CI: 0.66-2.52).

Conclusions

Social anxiety and obsessive-compulsive disorders were present in nearly one-third of pwMS. Impaired walking but not wheelchair dependence was associated with social anxiety. PwMS with SAD were more likely to have obsessive-compulsive disorder.

Depression and perceived social support among Saudi patients with multiple sclerosis

PURPOSE

To examine the association between depression level and perceived social support among patients with multiple sclerosis (MS) in Saudi Arabia.

DESIGN AND METHODS

A cross-sectional, descriptive, correlational design was used with 140 patients. A self-reporting questionnaires were used.

FINDINGS

The age range of the participants was 18-59 years (mean 34.3 years, SD 7.69). The mean score for reported depression was 27.5 which is considered as moderate level of depression. The mean score of the Multidimensional Scale of Perceived Social Support (MSPSS) was 45.3 (SD = 16.2). Patients with MS who received higher level of social support exhibits lower level of depression.

PRACTICE IMPLICATIONS

Aside from addressing physiological needs, healthcare providers must ensure that patients with MS receive positive social support to decrease level of depression.

Depression, anxiety and stress severities in multiple sclerosis patients using injectable versus oral treatments

AIM

Studies on multiple sclerosis in Saudi Arabia remain scant, particularly studies on the psychological aspects. This study measures severities of depression, anxiety and stress, and compares them to the used disease-modifying treatment.

MATERIALS & METHODS

Cross-sectional study using a phone questionnaire targeting 452 Saudi patients with relapsing-remitting multiple sclerosis following in King Khalid University Hospital, King Fahad Medical City or Security Forces Hospital.

RESULTS

From 235 patients, 149 used interferons, 58 used fingolimod and 28 used natalizumab. Depression scores were similar among all demographic and drug groups. Interferons versus fingolimod anxiety scores were significantly different (p = 0.035). Stress scores were within normal limits.

CONCLUSION

Mild anxiety was higher among interferon users, which could be due to injection anxiety reasons.

The Relationship between Psychosocial Factors and Cognition in Multiple Sclerosis

INTRODUCTION

Multiple sclerosis (MS) is a common disorder in some regions of the world, with over 2.3 million people diagnosed worldwide. Cognitive impairment is one of the earliest symptoms to present in the course of the disease and can cause significant morbidity. We proposed a study to explore the psychosocial predictors of cognitive impairment in MS patients in Saudi Arabia, a previously unexplored patient population.

METHODS

Demographic data, depression scale (PHQ9), symptom burden (PHQ15), anxiety (GAD7), disease duration, and Montreal Cognitive Assessment (MOCA) scores were collected from 195 patients in a neurology clinic in Ryiadh, Saudi Arabia. Univariate and multiple regression analyses were conducted to identify variables that are significantly associated with cognitive impairment.

RESULTS

Variables that were identified to be significantly associated with cognition, p < 0.05, were education level, disease duration, and family history.

DISCUSSION

Both education level and disease duration were variables identified in previous studies. We showed family history to be a significant variable, and no association was found with depression or anxiety, which is unique to our study population.

CONCLUSIONS

We identified several psychosocial predictors that are associated with cognition in our patient population. It was also noted that a difference exists between patient populations, highlighting the need for further studies in specific geographical regions.