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McKay KA, Tremlett H, Fisk JD, Zhang T, Patten SB, Kastrukoff L, Campbell T, Marrie RA. Psychiatric comorbidity is associated with disability progression in multiple sclerosis. Neurology 2018. [PMID: 29523642 DOI: 10.1212/wnl.0000000000005302] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Emerging evidence suggests that comorbidity may influence disability outcomes in multiple sclerosis (MS); we investigated the association between psychiatric comorbidity and MS disability progression in a large multiclinic population. METHODS This retrospective cohort study accessed prospectively collected information from linked clinical and population-based health administrative databases in the Canadian provinces of British Columbia and Nova Scotia. Persons with MS who had depression, anxiety, or bipolar disorder were identified using validated algorithms using physician and hospital visits. Multivariable linear regression models fitted using an identity link with generalized estimating equations were used to determine the association between psychiatric comorbidity and disability using all available Expanded Disability Status Scale (EDSS) scores. RESULTS A total of 2,312 incident cases of adult-onset MS were followed for a mean of 10.5 years, during which time 35.8% met criteria for a mood or anxiety disorder. The presence of a mood or anxiety disorder was associated with a higher EDSS score (β coefficient = 0.28, p = 0.0002, adjusted for disease duration and course, age, sex, socioeconomic status, physical comorbidity count, and disease-modifying therapy exposure). Findings were statistically significant among women (β coefficient = 0.31, p = 0.0004), but not men (β coefficient 0.22, p = 0.17). CONCLUSION Presence of psychiatric comorbidities, which were common in our incident MS cohort, increased the severity of subsequent neurologic disability. Optimizing management of psychiatric comorbidities should be explored as a means of potentially mitigating disability progression in MS.
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Affiliation(s)
- Kyla A McKay
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helen Tremlett
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Tingting Zhang
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lorne Kastrukoff
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Trudy Campbell
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
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Marrie RA, Miller A, Sormani MP, Thompson A, Waubant E, Trojano M, O'Connor P, Fiest K, Reider N, Reingold S, Cohen JA. Recommendations for observational studies of comorbidity in multiple sclerosis. Neurology 2016; 86:1446-1453. [PMID: 26865523 PMCID: PMC4831039 DOI: 10.1212/wnl.0000000000002474] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/07/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To reach consensus about the most relevant comorbidities to study in multiple sclerosis (MS) with respect to incidence, prevalence, and effect on outcomes; review datasets that may support studies of comorbidity in MS; and identify MS outcomes that should be prioritized in such studies. METHODS We held an international workshop to meet these objectives, informed by a systematic review of the incidence and prevalence of comorbidity in MS, and an international survey regarding research priorities for comorbidity. RESULTS We recommend establishing age- and sex-specific incidence and prevalence estimates for 5 comorbidities (depression, anxiety, hypertension, hyperlipidemia, and diabetes); evaluating the effect of 7 comorbidities (depression, anxiety, hypertension, diabetes, hyperlipidemia, chronic lung disease, and autoimmune diseases) on disability, quality of life, brain atrophy and other imaging parameters, health care utilization, employment, and mortality, including age, sex, race/ethnicity, socioeconomic status, and disease duration as potential confounders; harmonizing study designs across jurisdictions; and conducting such studies worldwide. Ultimately, clinical trials of treating comorbidity in MS are needed. CONCLUSION Our recommendations will help address knowledge gaps regarding the incidence, prevalence, and effect of comorbidity on outcomes in MS.
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Affiliation(s)
- Ruth Ann Marrie
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH.
| | - Aaron Miller
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Maria Pia Sormani
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Alan Thompson
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Emmanuelle Waubant
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Maria Trojano
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Paul O'Connor
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Kirsten Fiest
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Nadia Reider
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Stephen Reingold
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
| | - Jeffrey A Cohen
- From the Departments of Internal Medicine (R.A.M., K.F.) and Community Health Sciences (R.A.M., N.R.), University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (A.M.), New York, NY; Biostatistic Unit, Department of Health Sciences (M.P.S.), University of Genova, Italy; Faculty of Brain Sciences (A.T.), University College London, UK; University of California San Francisco (E.W.); Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari, Italy; St. Michael's Hospital (P.O.), Toronto, Canada; Scientific and Clinical Review Associates, LLC (S.R.), Salisbury, CT; and Mellen Center for MS Treatment and Research (J.A.C.), Cleveland Clinic, OH
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Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS, Cutter G, Reider N. The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review. Mult Scler 2015; 21:305-17. [PMID: 25583845 PMCID: PMC4429164 DOI: 10.1177/1352458514564487] [Citation(s) in RCA: 316] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychiatric comorbidity is associated with lower quality of life, more fatigue, and reduced adherence to disease-modifying therapy in multiple sclerosis (MS). OBJECTIVES The objectives of this review are to estimate the incidence and prevalence of selected comorbid psychiatric disorders in MS and evaluate the quality of included studies. METHODS We searched the PubMed, PsychInfo, SCOPUS, and Web of Knowledge databases and reference lists of retrieved articles. Abstracts were screened for relevance by two independent reviewers, followed by full-text review. Data were abstracted by one reviewer, and verified by a second reviewer. Study quality was evaluated using a standardized tool. For population-based studies we assessed heterogeneity quantitatively using the I² statistic, and conducted meta-analyses. RESULTS We included 118 studies in this review. Among population-based studies, the prevalence of anxiety was 21.9% (95% CI: 8.76%-35.0%), while it was 14.8% for alcohol abuse, 5.83% for bipolar disorder, 23.7% (95% CI: 17.4%-30.0%) for depression, 2.5% for substance abuse, and 4.3% (95% CI: 0%-10.3%) for psychosis. CONCLUSION This review confirms that psychiatric comorbidity, particularly depression and anxiety, is common in MS. However, the incidence of psychiatric comorbidity remains understudied. Future comparisons across studies would be enhanced by developing a consistent approach to measuring psychiatric comorbidity, and reporting of age-, sex-, and ethnicity-specific estimates.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Canada/Department of Community Health Sciences, University of Manitoba, Canada
| | | | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, USA
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | | | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Nadia Reider
- Department of Community Health Sciences, University of Manitoba, Canada
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Brenner P, Alexanderson K, Björkenstam C, Hillert J, Jokinen J, Mittendorfer-Rutz E, Tinghög P. Psychiatric diagnoses, medication and risk for disability pension in multiple sclerosis patients; a population-based register study. PLoS One 2014; 9:e104165. [PMID: 25093730 PMCID: PMC4122497 DOI: 10.1371/journal.pone.0104165] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Psychiatric comorbidity is common among multiple sclerosis (MS) patients. The majority of MS patients of working ages are on disability pension. The aims of this study were to chart the prevalences of psychiatric diagnoses and medications among MS patients of working ages, and to investigate their association with the risk for future disability pension. METHODS This nationwide, population-based prospective cohort study includes 10,750 MS patients and 5,553,141 non-MS individuals who in 2005 were aged 17-64 years. Psychiatric diagnoses and medications were identified using nationwide registers. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated adjusting for socio-demographics. Furthermore, a survival analysis with five-year follow-up was performed among the 4,571 MS patients not on disability pension in 2005, with psychiatric diagnoses and medication as risk factors, and disability pension as the outcome. RESULTS Among MS patients, 35% had been prescribed psychiatric medication compared to 10% of non-MS individuals, adjusted OR 3.72 (95% CI 3.57 to 3.88). Ten percent of MS patients had received a psychiatric diagnosis, compared to 5.7% of non-MS individuals, OR 1.82 (95% CI 1.71 to 1.94). Serotonin reuptake inhibitors (SSRIs), were the most commonly prescribed drugs (17%) among MS patients, while depression (4.8%) was the most common psychiatric diagnosis. In the survival analysis, MS patients with any psychiatric diagnosis had a hazard ratio (HR) of 1.83 (95% CI 1.53 to 2.18) for disability pension compared to other MS patients. MS patients with any psychiatric drug prescription had a HR for disability pension of 2.09 (95% CI 1.84 to 2.33). CONCLUSION Psychiatric diagnoses and medications are common among MS patients and adversely affect risk for disability pension. This highlights the importance of correct diagnosis and management of psychiatric comorbidity, in a clinical as well as in a societal perspective.
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Affiliation(s)
- Philip Brenner
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Björkenstam
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hillert
- Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jussi Jokinen
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Petter Tinghög
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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